Accuracy of patient self‐report as a measure of inhaled asthma medication use

Patel, Mitesh; Perrin, Kyle; Pritchard, Alison; Williams, Mathew; Wijesinghe, Meme; Weatherall, Mark; Beasley, Richard

doi:10.1111/resp.12059

Cited by 65 publications

(46 citation statements)

References 30 publications

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“…In accordance with previous studies [22], the present study showed that self-reporting, in general, is not a valid measure of actual adherence to ICS, although we observed that it seems to be more accurate during pregnancy than in non-pregnant women. This could be due to the women feeling responsible for more than their own health, and thus reporting more truthfully, or it could be a coincidence.…”

Section: Discussionsupporting

confidence: 76%

Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy' Program

Baarnes

Hansen²,

Ulrik³

2016

Respiration

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Background: Poor adherence with inhaled corticosteroids (ICS) is a major problem in asthma and according to previous studies not least during pregnancy. Objective: Our aim was to assess if enrolment in an asthma management program, and by that close monitoring, can improve self-reported and documented adherence with ICS in pregnant women with asthma. Methods: Pregnant women with doctor-diagnosed asthma, currently being prescribed ICS, referred during a 12-month period to the outpatient respiratory clinic, were consecutively included in the study. They had follow-up visits every 4 weeks during pregnancy. Asthma control was assessed according to GINA guidelines. Self-reported adherence was compared to documented adherence, defined as medical possession rate (MPR), calculated on the basis of filled prescriptions (data from each individuals' medication profile at www.fmk-online.dk). Results: A total of 130 women fulfilled the inclusion criteria, but at the initial visit, 16 women reported no current use of ICS, and the analyses are therefore based on 114 patients. Self-reported adherence to ICS was significantly higher during pregnancy than before pregnancy (73 and 52%, respectively, reporting good adherence; p < 0.001). The actual adherence, i.e. MPR, was also higher during pregnancy than before (46 vs. 28%, p < 0.0001). In keeping with this, an overall improvement was also observed in asthma control. Of the women with a low pre-pregnancy MPR, 71% had moderate or good adherence (MPR) during pregnancy. Self-reported adherence was significantly correlated with MPR during pregnancy (p = 0.004) but not before pregnancy (p = 0.46). At the 3-month postpartum visit, adherence was close to the pre-pregnancy level. Conclusion: Enrolment in an asthma management program during pregnancy seems to improve adherence with controller medication, but self-reported adherence is not a valid measure for actual adherence in patients with asthma.

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Section: Discussionsupporting

confidence: 76%

Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy' Program

Baarnes

Hansen²,

Ulrik³

2016

Respiration

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“…In Europe, the loss of productivity and work impairment due to asthma is estimated as EURO9.8 billion per year (ERS 2015). Poor adherence to maintenance inhaled corticosteroid therapy is a challenge for those treating patients with asthma, as parental reporting in children and self-reporting in adults have been shown to correlate poorly with actual use (Tashkin 1991;Bender 2000;Burgess 2011;Patel 2013). Prescription checks are also imprecise, merely representing the maximum that could have been taken.…”

Section: B a C K G R O U N D Description Of The Conditionmentioning

confidence: 99%

“…Electronic monitoring devices, initially termed "nebuliser chronologs", were first described in asthma clinical practice in the 1980s (Spector 1986). They were prone to technical problems (Gong 1988;Nides 1993), but since then have been more successfully used to monitor treatment usage (Gibson 1995;Foster 2012;Patel 2013). They make it possible to record medication usage and patterns of treatment.…”

Section: Description Of the Interventionmentioning

confidence: 99%

Electronic monitoring and reminding devices for improving adherence to inhaled therapy in patients with asthma

Craven

Morton

Spencer

et al. 2015

Cochrane Database of Systematic Reviews

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“…Several studies have shown the level of ICS adherence to be dependent on the method of measuring, 52-54 but even when including only studies using CMA/medical possession ratio as a measure of ICS adherence, the average adherence has been shown to range from 22% 22 to 50%. 19 CMA is considered to be reliable way of measuring ICS adherence, as it does not involve patient self-reporting, which leads to overestimated adherence, 52 although clearly communicating a no-blame attitude highly improves the accuracy of self-reporting. 55 One of the major problems with assessing adherence as CMA is that we have no way of knowing if the patients take their medication after filling their prescriptions or if they use the correct inhalation techniques, and thus, actual adherence might be even lower than that calculated.…”

Section: Summary and Perspectivesmentioning

confidence: 99%

Asthma and Adherence to Inhaled Corticosteroids: Current Status and Future Perspectives

2014

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Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means to improve adherence. A total of 19 studies met the inclusion criteria: 9 focusing on the level of adherence, 6 focusing on effects of poor adherence, and 7 focusing on interventions to improve adherence. Three of the studies focused on more than one of these end points. The mean level of adherence to ICS was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, < 12 y of formal education, and poor communication with the health-care provider, whereas improved adherence was associated with being prescribed fixed-combination therapy (ICS and long-acting ␤ 2 agonists). Good adherence was associated with higher FEV 1 , a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthmarelated hospitalizations could be attributed to poor adherence. Most studies have reported an increase in adherence following focused interventions, followed by an improvement in quality of life, symptoms, FEV 1 , and oral corticosteroid use. However, 2 studies found no difference in health-care utilization, one observed no effect on symptoms, and one observed more symptoms in subjects in the intervention group compared with the control group. Good adherence to ICS in asthma improves outcome but remains low. Interventions to improve adherence show varying results, with most studies reporting an increase in adherence but unfortunately not necessarily an improvement in outcome. Even following successful interventions, adherence remains low. Further research is needed to explore barriers to adherence and interventions for improvement.

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Accuracy of patient self‐report as a measure of inhaled asthma medication use

Abstract: Self-report is inaccurate in measuring actual use of inhaled asthma treatment with patients who underuse their maintenance therapy overreporting their use and those who overuse their therapy underreporting their use.

Cited by 65 publications

References 30 publications

Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy' Program

Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy' Program

Electronic monitoring and reminding devices for improving adherence to inhaled therapy in patients with asthma

Asthma and Adherence to Inhaled Corticosteroids: Current Status and Future Perspectives

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