Adherence rate to inhaled corticosteroids and their impact on asthma control

Lasmar, Laura Maria de Lima Belizário Facury; Camargos, Paulo Augusto Moreira; Champs, Natália Silva; Fonseca, Maria Teresa Mohallem; Fontes, Maria Jussara Fernandes; Ibiapina, Cássio da Cunha; Alvim, Cristina Gonçalves; Moura, José Augusto Rubim de

doi:10.1111/j.1398-9995.2008.01877.x

Cited by 151 publications

(121 citation statements)

References 23 publications

(29 reference statements)

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“…Only four (5%) children had uncontrolled asthma, one of which had poor adherence to ICS. In comparison to earlier studies of long-term adherence in childhood asthma [6,22], median adherence was remarkably high (87%) in our study cohort. Despite the overall high levels and associated limited variability of both adherence and asthma control, a significant and consistent association was found between the two variables.…”

Section: Discussioncontrasting

confidence: 90%

“…In previous studies, substantially different levels of adherence needed to achieve asthma control were reported, ranging from 40-60% to .80% [6,22]. However, in these studies, a high prevalence of children with short-term asthma control despite low adherence to ICS was observed, suggesting ICS overtreatment of mild intermittent symptoms or asthma in clinical remission.…”

Section: Discussionmentioning

confidence: 90%

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It's the adherence, stupid (that determines asthma control in preschool children)!

Klok

Kaptein

Duiverman

et al. 2013

European Respiratory Journal

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Although guideline-based asthma care and adherence to inhaled corticosteroids are predictors of asthma control, the role of adherence in maintaining long-term asthma control is largely unknown. This study was designed to explore the relationship between adherence to inhaled corticosteroids and long-term asthma control in young children with asthma.In this observational study, 81 2-6-year-old asthmatic children, using inhaled corticosteroids, closely followed-up in a programme with extensive self-management training, were enrolled. Adherence was measured daily for 12 months using Smartinhaler (Nexus6 Ltd, Auckland, New Zealand) devices. Longterm asthma control was assessed by parents and physicians and included clinical assessment, an asthma control questionnaire and lung function measurement. We examined the association of adherence to asthma control, adjusting for seasonal influences and clinical characteristics.Median (interquartile range) adherence was 87% (70-94%), and 64 (79%) children had well-controlled asthma throughout follow-up. Adherence .80% was associated with better asthma control, and we found no important confounders of this association. Children with persistent mild symptoms had lower adherence rates (p50.028).Guideline-based asthma care was associated with good asthma control in most children. Adherence to inhaled corticosteroids was an independent strong predictor of long-term asthma control, with highest levels of asthma control found in children with adherence .80% of doses prescribed. @ERSpublications Adherence to inhaled corticosteroids strongly predicts long-term asthma control in young children

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 90%

It's the adherence, stupid (that determines asthma control in preschool children)!

Klok

Kaptein

Duiverman

et al. 2013

European Respiratory Journal

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“…The most commonly used value is 80%. 20,56 Lasmar et al 57 showed 80% to be the threshold between controlled and uncontrolled asthma, whereas Schroeder et al 58 argued that an arbitrary cutoff value is meaningless and should be replaced with a continuous measure of adherence. In the articles included in this review, the cutoff value varied between 50 and 80%.…”

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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“…Poor adherence to ICSs has been estimated to account for up to 60% of asthma-related hospitalizations (10)(11)(12)(13)(14). Furthermore, it has been suggested that optimal asthma control entails adherence rates to medication treatment more than 75% of the time (15). To date, studies of adherence to asthma controller medications in realworld populations have focused on dispensing data.…”

mentioning

confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

104

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Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.Objective: To compare adherence to the major controller medication regimens for asthma.Methods: This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).Measurements and Main Results: Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.Conclusions: Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.

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Adherence rate to inhaled corticosteroids and their impact on asthma control

Cited by 151 publications

References 23 publications

It's the adherence, stupid (that determines asthma control in preschool children)!

It's the adherence, stupid (that determines asthma control in preschool children)!

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

Primary Adherence to Controller Medications for Asthma Is Poor

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