Compliance during long-term treatment with fluticasone propionate in subjects with early signs of asthma or chronic obstructive pulmonary disease (COPD): Results of the detection, intervention, and monitoring program of COPDand asthma (DIMCA) study

In a prospective study, we investigated the long-term compliance to flutica sone propionate (FP) by dry powder inhalation (Rotadisk(R)) in subjects wit h early signs of asthma and chronic obstructive pulmonary disease (COPD) wi thout an established diagnosis. Subjects were selected from a large screeni ng program on early stages of asthma and COPD (Detection, Intervention, and Monitoring Program of COPD and Asthma [DIMCA] program) in the general prac tice. Forty-eight adult subjects with "early signs of COPD" (slightly incre ased forced expiratory volume in 1 sec [FEV1] decline of >0.04 L/year) and 29 adult subjects with "early signs of asthma" (signs of bronchial hyperres ponsiveness or reversibility) participated in a randomized placebo-controll ed trial with FP (Flixotide(R) 500 mu g daily) versus placebo with a durati on of 2 years or 1 year, respectively. Compliance was measured by counting Rotadisks returned. By means of a questionnaire, participants were asked ab out perceived effects and/ or side effects of the trial drug. The mean over all individual compliance rates of 72% (range 7%-102%) in the early COPD tr ial and 71% (range 8%-99%) in the early asthma trial were maintained throug hout the study. Perceived effectiveness (12% of the participants) or side e ffects (30% of the participants) of the trial drug were not related to comp liance. The willingness of patients to use the trial drug in daily practice if efficacy would be proved was statistically significantly related to com pliance during the trial (p = 0.017). It was concluded that the compliance rates found were relatively high in patients with symptoms of mild asthma o r COPD without an established diagnosis. Conviction of the importance of tr eatment influenced compliance more positively than perceived (side) effects . These results again emphasize the importance of patient education in esta blishing early treatment with inhaled corticosteroids.