Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review

Alahmadi, Fahad; Peel, Adam; Keevil, Brian; Niven, Rob; Fowler, Stephen J.

doi:10.1111/cea.13787

Cited by 16 publications

(14 citation statements)

References 55 publications

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“…In addition, the comparison with other objective measures of inhaler adherence, such as pharmacy refill data, was not possible. Nevertheless, we need to consider that currently available objective methods require laborious analysis by physicians, are costly to implement in clinical practice and, like inhaled corticosteroid serum level and FeNO suppression test, 53 , 54 are not fully validated. Another important limitation is that patient and physician adherence data was retrieved at a different time point than that of the application, therefore a future improvement would be tracking all measurements at the same time points.…”

Section: Discussionmentioning

confidence: 99%

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Cachim

Pereira

Almeida

et al. 2023

Clinical & Translational All

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Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self‐report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1‐week and 1‐month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self‐report (80 [60–95]) and physician assessment (82 [51–94]) ( p < 0.001). A negligible non‐significant correlation was found between the app and subjective measurements ( ρ 0.118–0.156, p > 0.05). There was a moderate correlation between patient self‐report and physician assessment ( ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

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Section: Discussionmentioning

confidence: 99%

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Cachim

Pereira

Almeida

et al. 2023

Clinical & Translational All

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“…This has obvious clinical utility as it can quickly identify those patients who are unlikely to achieve control of type-2 inflammation using inhaled treatment alone and could progress quickly to biologic therapy, but in parallel it can identify those patients where the clinical focus needs to be on better adherence with inhaled treatment. A recent systematic literature review [ 66 ] examining the assessment of adherence to corticosteroids in asthma by drug monitoring or F ENO supports this use of F ENO SuppT as well as outcome data from small single centre studies [ 67 , 68 ]. Additionally, this was further supported by the largest case series from the RASP-UK programme which demonstrated that a positive F ENO SuppT was associated with significantly fewer patients progressing to biologic therapy and a significantly greater chance of being discharged from hospital [ 69 ].…”

Section: Measuring and Identifying Non-adherencementioning

confidence: 96%

Measuring adherence to therapy in airways disease

Holmes

Heaney

2021

Breathe

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Non-adherence to medication is one of the most significant issues in all airways disease and can have a major impact on disease control as well as on unscheduled healthcare utilisation. It is vital that clinicians can accurately determine a patient's level of adherence in order to ensure they are gaining the maximal benefit from their therapy and also to avoid any potential for unnecessary increases in therapy. It is essential that measurements of adherence are interpreted alongside biomarkers of mechanistic pathways to identify if improvements in medication adherence can influence disease control.In this review, the most common methods of measuring adherence are discussed. These include patient self-report, prescription record checks, canister weighing, dose counting, monitoring drug levels and electronic monitoring. We describe the uses and benefits of each method as well as potential shortcomings. The practical use of adherence measures with measurable markers of disease control is also discussed.Educational aimsTo understand the various methods available to measure adherence in airways disease.To learn how to apply these adherence measures in conjunction with clinical biomarkers in routine clinical care.

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“…151,152 Assessment of nonadherence is difficult and a single gold standard measure does not exist but traditional measures have included FeNO monitoring and prednisolone assays. 153 Emerging tools include remote inhaler monitoring, remote FeNO suppression tests, using simplified dosing regimes where possible and use of interactive digital technologies. [154][155][156][157][158]…”

Section: Smokingmentioning

confidence: 99%

Recent Insights into the Management of Inflammation in Asthma

Rupani¹,

Fong²,

Kyyaly³

et al. 2021

JIR

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The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.

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Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 16 publications

References 55 publications

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Measuring adherence to therapy in airways disease

Recent Insights into the Management of Inflammation in Asthma

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