Adherence to asthma management guidelines by middle-aged adults with current asthma

Kandane‐Rathnayake, Rangi; Matheson, Melanie C.; Simpson, Julie A; Tang, Mimi L.K.; Johns, DP; Mészáros, D; Wood‐Baker, Richard; Feather, Iain; Morrison, Stephen; Jenkins, Mark A.; Giles, Graham G.; Hopper, John L.; Abramson, Michael J.; Dharmage, Shyamali C.; Walters, E. Haydn

doi:10.1136/thx.2009.118430

Cited by 59 publications

(42 citation statements)

References 33 publications

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“…Asthmatic patients characteristically rely on SABA use to relieve their symptoms rather than controller medications to control their disease. Reports from the United States 36 and around the world 37 have consistently described poor adherence with controller medication use by patients with persistent asthma, surprisingly so in patients with difficult-to-treat asthma. 38 Nonadherence to controller medication use in asthmatic patients has been directly related to poor outcomes, such as ED visits and hospitalizations.…”

Section: Discussionmentioning

confidence: 97%

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma

Ivanova

Bergman

Birnbaum

et al. 2012

Journal of Allergy and Clinical Immunology

257

168

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Section: Discussionmentioning

confidence: 97%

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma

Ivanova

Bergman

Birnbaum

et al. 2012

Journal of Allergy and Clinical Immunology

257

168

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“…Although an 80% adherence rate with ICS has been suggested as the minimum acceptable level of adherence for achieving good asthma control [9], reported ICS adherence rates range from 30 to 70% in the literature [10]. A recent longitudinal study of middle-aged adults with asthma found that 74% (n = 351) used inadequate preventer medication [11]. Similarly, in children, inhalers are largely underused; one study in 8-16 year olds found that inhalers were underused on 33% of days in a month [8].…”

Section: Introductionmentioning

confidence: 99%

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

Lycett¹,

Wildman²,

Raebel³

et al. 2018

Respiratory Medicine

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Background: Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma. Aim: The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data. Methods: Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence. Results: Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment -all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment -immediate and longterm side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma -22% of studies reported that embarrassment contributed to poor adherence. Conclusions: Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.

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“…9 One of the plausible reasons for poorly controlled asthma may be that patients with asthma tend to exhibit poor adherence. 10 Poor adherence to controller medication may lead to a decline in lung function, 11 poor symptom control, 12 and increased risk of asthma-related hospitalizations. 13 Furthermore, poorly controlled asthma also places a much larger burden on the national economics compared with guideline-defined well-controlled asthma.…”

Section: Introductionmentioning

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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Adherence to asthma management guidelines by middle-aged adults with current asthma

Cited by 59 publications

References 33 publications

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

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

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