Compliance with oral corticosteroids during steroid trials in chronic airways obstruction.

Hatton, M. Q. F.; Allen, Matthew B.; Vathenen, S. V.; Feely, M.; Cooke, N. J.

doi:10.1136/thx.51.3.323

Cited by 17 publications

(9 citation statements)

References 7 publications

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“…One study using phenobarbitone as a marker of compliance showed that 26% of patients in a corticosteroid trial failed to take the tablets and could have been classified as nonresponsive [3]. In children, several diseases may present with wheezing, including cystic fibrosis and acute viral bronchiolitis.…”

Section: Difficult Asthma Pj Barnes Aj Woolcock Ers Journals Ltmentioning

confidence: 99%

Difficult asthma

Barnes¹,

Woolcock²

1998

Eur Respir J

250

165

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Asthma is usually easy to manage, but approximately 5% of patients are not controlled even on high doses of inhaled corticosteroids. It is important to assess these patients carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases, particularly chronic obstructive pulmonary disease (COPD), and vocal cord dysfunction ("pseudo-asthma"). Poor adherence to therapy, particularly inhaled corticosteroids, is a common reason for a poor response. There may be unidentified exacerbating factors, including unrecognized allergens, occupational sensitizers, dietary additives, drugs, gastro-oesophageal reflux, upper airway disease, or other systemic diseases, that need to be identified and avoided or treated. Psychological factors may be important in some patients, but it is difficult to know whether these are causal or secondary to troublesome disease. Some patients have instability of their asthma, with resistant nocturnal asthma, premenstrual exacerbations or chaotic and unpredictable instability (brittle asthma). A few patients are completely resistant to corticosteroids, but more patients are relatively resistant and require relatively high doses of corticosteroids to control their symptoms (steroid-dependent). Some patients develop progressive loss of lung function, as in patients with COPD. Management of patients with difficult asthma should be supervised by a respiratory specialist and should involve careful assessment to confirm a diagnosis of asthma, identification and treatment of exacerbating factors, particularly allergens, and recording of peak expiratory flow patterns. A period of hospital admission may be the best way to assess and manage these patients. Treatment involves optimizing corticosteroids therapy, assessing additional controllers such as long-acting inhaled or subcutaneous beta2-agonists or subcutaneous, theophylline and antileukotrienes. In some patients, the use of immunosuppressive treatments may reduce steroid requirements, although these treatments are rarely effective and have side-effects. In the future, the nonsteroid anti-inflammatory treatments now in development may be useful in these patients.

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Section: Difficult Asthma Pj Barnes Aj Woolcock Ers Journals Ltmentioning

confidence: 99%

Difficult asthma

Barnes¹,

Woolcock²

1998

Eur Respir J

250

165

View full text Add to dashboard Cite

show abstract

“…The consequences may be less severe for some drugs than for others but generally act to reduce the benefits that might be expected from clinical trials 9 10. Patient diaries and tablet counts overestimate the degree of adherence to the prescribed schedule when they are compared with more sophisticated methods of assessment 11 12. We should hardly be surprised that our patients wish to hide their failings from us, and concordance, where the patient and prescriber have discussed in detail the value of adherence, and by implication the price of failure to adhere, may encourage this all too human deceit.…”

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confidence: 99%

Is concordance the primrose path to health?

Ferner

2003

BMJ

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“…Drug efficacy depends not only on biological activity but also on adherence. Studies have shown that, whether administered orally 27 or by inhalation, 28 adherence in subjects with airways disease is less than ideal. Measures to improve adherence, such as educating prescribers, counselling patients and simplifying dosing regimens, result in improved efficacy 29 .…”

Section: Discussionmentioning

confidence: 99%