Influence of Patients' Adherence to Medication, Patient Background and Physicians' Compliance to the Guidelines on Asthma Control

Abstract

This study conducted a thorough examination on the associations among several factors of asthma therapy, i.e., physicians' compliance with the guidelines, patients' adherence to medication, asthma symptom severity, asthma episodes, and patient background. Fifty outpatients treated continuously for asthma from October 2002 to October 2004 at Showa University Hospital were selected and their medical charts were surveyed. Physicians were recognized as noncompliant when their treatments included divergence from the Asthma Prevention and Management Guidelines. Patient adherence was evaluated as the ratio of the``measured (dispensed)'' doses divided by the``expected (prescribed)'' doses. The inhaled corticosteroids adherence and the ratio of the asthma-related emergency department visits of the patients with a family asthma medical history were signiˆcantly higher ( p＝0.034) and lower (p＝0.043), respectively, than those without this medical history. This may indicate the necessity of education for patients with no family history of asthma. A signiˆcant correlation between the mean patients' adherence and the asthma symptom severity at the end of surveillance was found ( p＝0.010), suggesting the importance of patient adherence in asthma control. The asthma symptom severity in the noncompliant group at the beginning of surveillance was signiˆcantly worse ( p＝0.016), suggesting that physician compliance was low when the asthma symptom severity was poor. Based on the aboveˆndings, we proposed a ‰ow-chart, which includes the conˆrmation processes of patients' adherence to medication and physicians' compliance to guidelines, in order to better control asthma, while also taking their family medical history into account.

Asthma inhaler adherence determinants in adults: systematic review of observational data

“…Smoking status was consistently unrelated to adherence [40,48,52,57,58,63,64,71], as was depression [40,45,57,58].…”

“…Numerous other patient-level variables were examined in fewer than three analyses, most with nonsignificant results: general health status and body mass index [57]; marital status [48]; number of causal attributions for asthma [38]; extent of attributing asthma to internal causes [41]; general health self-efficacy [65]; self-control [45]; and various personality and medical history characteristics [34,39,45,52,58,62,68,69,71,73,74]. Several exceptions referred to better adherence in people who consider medication as less harmful (two results [60]), display lower neuroticism, higher agreeableness and conscientiousness (one out of two results [69,74]), and believe more strongly that their asthma can be controlled [38,41].…”

“…Several exceptions referred to better adherence in people who consider medication as less harmful (two results [60]), display lower neuroticism, higher agreeableness and conscientiousness (one out of two results [69,74]), and believe more strongly that their asthma can be controlled [38,41]. Several single results showed better adherence in people with a family history of asthma [71], asthma onset at younger age [58], lower impulsivity [62] and high literacy [80]. Other single findings suggested that more adherent people attribute their asthma more to external factors [41], believe that God is less in control of their health and attribute more control to physicians [73], perceive themselves less vulnerable to side-effects, report higher intention to use inhalers [72], have better inhaler use skills [79], are more satisfied with the device [70], prefer to use inhalers rather than pills [32], have no preferences regarding daily inhaler dosage [75], believe more strongly in participating actively in care [36], and report no symptom improvement due to herbal drugs [52].…”

Relationship between medication beliefs, self-reported and refill adherence, and symptoms in patients with asthma using inhaled corticosteroids

“…Given the subjectivity of self-report instruments, it is important to use objective methods as well to determine the relationship between adherence and asthma symptoms. Currently, this relationship has not been fully elucidated 24,25…”

Can montelukast correct immune dysregulation in preschool children with mild persistent asthma?

“…57 Montelukast can suppress the proliferation of inflammatory cells and decrease cytokines and inflammatory mediators while inhibiting airway remodeling or fibrosis. 58 The existing study investigates the role of Treg cells in the pathogenesis of mild asthma in children by detecting the levels of Tregs and cytokines in the peripheral blood. The serum levels of IL10, and Treg cells count decreased in asthmatic children as compared to the control group.…”