Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

Abstract

BackgroundIn short-term studies, poor adherence to inhaled corticosteroids (ICS) has been associated with worse asthma control, but the association of long-term adherence and disease control remains unclear.ObjectiveTo assess the relationship between 12-year adherence to ICS and asthma control in patients with adult-onset asthma.MethodsAs part of the Seinäjoki Adult Asthma Study, 181 patients with clinically confirmed new-onset adult asthma and regular ICS medication were followed-up for 12 years. Adherence (%) to ICS was assessed individually ((µg dispensed/µg prescribed)×100) during the follow-up. Asthma control was evaluated after 12 years of treatment according to the Global Initiative for Asthma 2010 guideline.ResultsAsthma was controlled in 31% and not controlled (partly controlled or uncontrolled) in 69% of the patients. Patients with not-controlled asthma were more often male, older, nonatopic and used higher doses of ICS than those with controlled disease. The mean±sd 12-year adherence to ICS was 63±38% in patients with controlled asthma and 76±40% in patients with not-controlled disease (p=0.042). Among patients with not-controlled asthma, those with lower 12-year adherence (<80%) had more rapid decline in forced expiratory volume in 1 s (−47 mL·year−1) compared to patients with better adherence (≥80%) (−40 mL·year−1) (p=0.024). In contrast, this relationship was not seen in patients with controlled asthma.ConclusionsIn adult-onset asthma, patients with not-controlled disease showed better 12-year adherence to ICS treatment than those with controlled asthma. In not-controlled disease, adherence <80% was associated with more rapid lung function decline, underscoring the importance of early recognition of such patients in routine clinical practice.

Long-Term Use of Short-Acting β2-Agonists in Patients With Adult-Onset Asthma

“…[38][39][40] Poor adherence to ICS may lead to enhanced lung function decline, especially when asthma is not controlled (ie, symptomatic needing SABA). 25,41 However, we did not find any difference in lung function measurements or lung function decline between the patients with high or low SABA use over the 12 years. Moreover, an Australian study reported that SABA overusers were more likely to have depression (11.1% vs 5.7%), and a higher proportion of SABA overusers had uncontrolled asthma.…”

“…The 12-year adherence was calculated by comparing cumulative dispensed doses of ICS (mg) with cumulative prescribed doses of ICS (mg) by using a method combining medication possession ratio and proportion of days covered formulas (Figures E2 and E3, available in this article's Online Repository at www.jaci-inpractice.org) (see this article's Online Repository at www.jaci-inpractice.org). 19,25 High SABA use was defined as !36 SABA canisters in 12 years, corresponding to an average of !3 dispensed canisters per year. 1,5,7,10 SABA over-reliance was classified into 3 categories: (1) high SABA use (!36 canisters in 12 years) and no dispensed ICS canisters during the follow-up; (2) high SABA use and <36 dispensed canisters of ICS (corresponding to <3 dispensed canisters per year on average); and (3) high SABA use and fewer ICS than SABA canisters dispensed.…”

Adherence to inhaled corticosteroids in relation to quality of life and symptoms of anxiety and depression in asthma

“…Additionally, Cluley et al and Bosley et al [ 27 , 28 ] measure adherence over 8–10 weeks, while the present study uses long-term adherence over 12 months based on pharmacy redemption data. Indeed, a recent study finds that short-term and long-term adherence often differ substantially, emphasizing that the period of time over which one measures adherence is key [ 29 ]. In accordance with our study, Toelle et al [ 15 ] found no association between ICS adherence and MMD symptoms; in fact, depression symptoms was even associated with a lower risk of non-adherence.…”

Long-term adherence to inhaled corticosteroids in clinical phenotypes of adult-onset asthma

“…For example, noncontrolled asthma combined with less than 80% adherence to ICS has been associated with faster lung function decline versus noncontrolled asthma with 80% or greater adherence. 9 Of the patients in the obese cluster, 96% were not currently working, 60% were receiving a disability pension, 28% had depression, and the average income was the lowest of any cluster. Socioeconomic status was the lowest in the obese and smoking clusters, and financial issues were often associated with poor adherence in the obese versus other clusters, even in Finland, which has a special asthma medication reimbursement system and relatively low medication expenses for patients.…”