Asthma Treatment Preference Study. Part 10

The tests for internal consistency in the ranking conducted by the patients showed very good results with a low number of inconsistent replies. Concerning external validity, the initial questionnaire in the present study showed that patients reported breathlessness and cough as the most troublesome symptoms compared with chest tightness and sleep disturbance. This result is in accordance with the findings of Osman.

In total, 85% of patients expressed preferences for an alternative treatment to their current regimen. The presented preference structure indicates variations in patient preferences that might need to be addressed in clinical practice. Some patients may benefit from treatments recommended in guidelines that allow increased flexibility in application. Furthermore, the conjoint analysis in this study underestimates the value of treatments with relatively higher effectiveness, ie, the addition of a  long-acting bronchodilator for regular use to ICS, or the use of a rapid- and long-acting drug as needed (formot-erol) instead of a rapid- and short-acting bronchodi-lator (eg, terbutaline)13 since, in the conjoint analysis, the effectiveness was considered to be constant with all alternative treatments.

The estimates of the willingness to pay for a preferred treatment were in most cases similar to, or higher than, the actual cost of the treatments. A relevant research approach to investigate this further could be to apply conjoint analysis in conjunction with a clinical and economic study that measures clinical benefits and cost-effectiveness.

The findings of this study based on the aggregated results from almost 300 patients can be summarized as follows. Patients focused primarily on the effectiveness of a treatment, ranking SFDs as the most important attribute of treatment. In terms of available therapies, treatment with a combination inhaler was preferred overall, while reliever therapy that was both rapid and long acting was preferred over short-acting drugs. The most preferred treatment was a combination inhaler for maintenance and as-needed use. Interestingly, 85% of patients preferred an alternative treatment over their current treatment, and they were prepared to pay extra for their preferred treatment.

Background: Gastroesophageal reflux (GER) plays a role in inducing or exacerbating asthma. Methods: We evaluated asthma outcome before and after anti-GER treatment in older children (age range, 5 to 10.5 years) who had persistent moderate asthma and were being treated with short- and long-acting bronchodilators, inhaled corticosteroids, and leukotriene antagonists. Forty-six such consecutive children underwent extended esophageal pH monitoring. Of the 27 patients (59%) who had evidence of GER disease, 18 patients underwent medical treatment (lifestyle changes, proton pump inhibitors, and prokinetics) and 9 patients opted for surgical treatment (Nissen fundoplication) of GER.

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