Patient preferences for symptom-driven or regular preventer treatment in mild to moderate asthma: findings from the PRACTICAL study, a randomised clinical trial

Symptom-driven low-dose inhaled corticosteroid-formoterol is safe and effective in mild asthma and has been recommended as one of the preferred treatment regimens at steps 1 and 2 in the 2019 update of the Global Initiative for Asthma (GINA). However there are no data on patient preferences for this regimen. A subgroup of participants in the PRACTICAL study (ACTRN12616000377437), a randomised control trial comparing symptom-driven budesonide-formoterol with maintenance budesonide plus as-needed terbutaline, completed a survey on treatment preferences, satisfaction, beliefs and experience at their final study visit. 306 of 407 eligible participants (75%) completed the survey. Regimen preference was strongly associated with randomised treatment as were preferences for and beliefs about preventer inhaler use. Combination preventer and reliever as needed therapy was preferred by 135/150 (90%, 95% CI 85.2 to 94.8) who were randomised to as-needed budesonide-formoterol, and by 63/156 (40%, 95% CI 32.7 to 48.1) who were randomised to maintenance budesonide. By contrast, twice daily preventer inhaler with a reliever inhaler as required was preferred by 15/150 (10%) of those randomised to as-needed budesonide-formoterol and 93/156 (60%) of those randomised to maintenance budesonide. Satisfaction with all study inhalers was high. Of patients randomised to as-needed budesonide-formoterol (n=138), 92% were confident using it as a reliever at the end of the study. Although most participants preferred the regimen to which they had been randomised, this association was much stronger for those randomised to budesonide-formoterol as needed, indicating that most patients preferred as-needed corticosteroid-formoterol therapy if they had experienced it.