Non-adherence in difficult asthma and advances in detection

Lindsay, John T.; Heaney, Liam G.

doi:10.1586/17476348.2013.842129

Cited by 33 publications

(30 citation statements)

References 43 publications

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“…It is associated with 80% of asthma deaths7 and is probably the most influential contributor to poor asthma control in children 22. Satisfactory adherence is defined as the administration of at least 80% of prescribed doses 23…”

Section: Step 4: Assess Complex Modifiable Factorsmentioning

confidence: 99%

Managing the pediatric patient with refractory asthma: a multidisciplinary approach

Cook¹,

Beresford²,

Fainardi³

et al. 2017

JAA

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Children with asthma that is refractory to high levels of prescribed treatment are described as having problematic severe asthma. Those in whom persistent symptoms result from a failure of basic asthma management are described as having “difficult asthma”, while those who remain symptomatic despite these factors having been addressed are described as having “severe therapy-resistant asthma” (STRA). The majority of children have difficult asthma; asthma that is poorly controlled because of a failure to get the basics of asthma management right. Modifiable factors including nonadherence to medication, persistent adverse environmental exposures, and psychosocial factors often contribute to poor control in these patients. As our skill in identifying and addressing modifiable factors has improved, we have found that a progressively smaller proportion of our clinic patients is categorized as having true STRA, resulting in an infrequent resort to escalation of treatment. Many of the modifiable factors associated with the diagnosis of difficult asthma can be identified in a general pediatric clinic. Characterization of more complex factors, however, requires the time, skill, and expertise of multiple health care professionals within the asthma multidisciplinary team. In this review, we will describe the structured approach adopted by The Royal Brompton Hospital in the management of the child with problematic severe asthma. We highlight the roles of members of the multidisciplinary team at various stages of assessment and focus on prominent themes in the identification and treatment of modifiable factors.

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Section: Step 4: Assess Complex Modifiable Factorsmentioning

confidence: 99%

Managing the pediatric patient with refractory asthma: a multidisciplinary approach

Cook¹,

Beresford²,

Fainardi³

et al. 2017

JAA

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8] Prescription filling is an imprecise measurement of adherence because it cannot be used to distinguish between the use of medication versus "stockpiling" medication. 42,43 Despite the risk of overestimating adherence, prescription filling data are a useful, noninvasive method of evaluating nonadherence and have been routinely used in the literature as a proxy for medication adherence. 44 Another limitation of our study was the inability to determine if a prescription was provided by the inpatient physician because an identical prescription from a primary care provider or subspecialist may have been included.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Molina¹,

Magruder²,

Aban

et al. 2019

Hospital Pediatrics

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A B S T R A C TBACKGROUND: Asthma is a common cause of pediatric hospitalization. Nonadherence to asthma medications is associated with worse outcomes; however, there is a paucity of data regarding posthospitalization prescription filling and hospital reuse. Our objective was to identify patients at risk for hospital reuse after being hospitalized for asthma.METHODS: This is a retrospective study of patients with asthma who were discharged from a children's hospital in which we use Medicaid claims data to evaluate prescription fills within 30 days and 12 months. Chart reviews were used for demographics, chronic asthma severity, admission severity, and hospital reuse. t and x 2 tests were performed for continuous and categorical variables. A generalized linear mixed model was fitted to predict the odds of hospital reuse, which was defined as requiring an emergency department visit or rehospitalization. Survival analysis using log-rank testing was used for modeling the time to hospital reuse. RESULTS:Fifty-four percent of patients discharged with asthma had hospital reuse within 1 year of discharge. There was no association between hospital reuse and prescription filling for systemic steroids (odds ratio [OR] 1.30; confidence interval [CI]: 0.85-2.00; P 5 .21) or controller medications (OR 1.5; CI: 0.92-2.52; P 5 .10). There was a higher number of controller and systemic steroid prescription fills over 12 months for patients with hospital reuse. The factors associated with greater odds of hospital reuse were severity of chronic asthma diagnosis (P 5 .03) as well as African American race (OR 1.92; CI: 1.17-3.13; P 5 .01). CONCLUSIONS:For Medicaid-insured patients discharged with asthma, worse chronic asthma severity and African American race were associated with greater odds of hospital reuse. Decreased prescription filling was not associated with greater odds of hospital reuse.

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“…The adherence rates fall 23.1% for regimen adherence and 54.2% for timing adherence when medications are given four times daily compared to daily dosing. Nonadherence to treatment is associated with poor baseline asthma control 48,49. The nonadherence rates among asthmatic patients range between 30% and 70%, and because of this the assessment of medication adherence is a critical part of evaluating the difficult to treat asthma patient 50,51.…”

Section: Medication Adherence With Inhalersmentioning

confidence: 99%

Spotlight on fluticasone furoate/vilanterol trifenatate for the once-daily treatment of asthma: design, development and place in therapy

Albertson

Bullick

Schivo

et al. 2016

DDDT

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The use of inhaled corticosteroids (ICSs) plays a key role in the treatment of asthmatic patients, and international guidelines have designated ICSs as an early maintenance therapy in controlling asthma symptoms. When asthmatic patients remain symptomatic on ICSs, one common option is to add a long-acting beta2 agonist (LABA) to the maintenance treatment. Fixed combination inhalers that contain both an ICS and a LABA have been popular for both chronic obstructive pulmonary disease (COPD) and asthma. Historically, these inhalers have been dosed twice daily. However, currently, there is a once-daily combination therapy with the ICS fluticasone furoate (FF) and the LABA vilanterol trifenatate (VI) with indications for use in both COPD and asthma. This dry powder inhaler (DPI) comes in two doses of FF (100 or 200 μg) both combined with VI (25 μg). This article reviews the clinical trial data for FF, VI and FF/VI combination inhalers and documents the efficacy and safety of once-daily inhaled maintenance therapy by DPI in asthmatic patients.

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Non-adherence in difficult asthma and advances in detection

Cited by 33 publications

References 43 publications

Managing the pediatric patient with refractory asthma: a multidisciplinary approach

Managing the pediatric patient with refractory asthma: a multidisciplinary approach

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Spotlight on fluticasone furoate/vilanterol trifenatate for the once-daily treatment of asthma: design, development and place in therapy

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