<p>New insights to improve treatment adherence in asthma and COPD</p>

Abstract

Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient’s adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with better health outcomes, such as improved disease control and a reduction in severe and potentially costly exacerbations. Adherence is a multifaceted concept that includes medication-related, intentional, and unintentional reasons that patients may or may not take their medication as directed. The purpose of this integrative review is to present the individual patient factors that contribute to suboptimal adherence to inhaled therapies and the associated effects on health outcomes, while also highlighting evidence-based strategies for health care providers to improve adherence to such therapies in patients with asthma or COPD. Working closely with patients to establish a model of shared decision-making, which takes patient beliefs and preferences into account when choosing treatment options, has the potential to improve adherence and overall patient outcomes in the management of asthma and COPD.

<p>Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies</p>

“…Among the general drivers, poor communication between patients and physicians, including a lack of a shared decision-making process; inadequate understanding of the disease; and high medication costs have been previously reported to affect medication adherence in chronic illnesses. [43][44][45] Our study findings highlighted patient-physician communication to be crucial to medication adherence in the management of asthma. Medical visits provide a key opportunity to influence a patient's intention to take daily ICS; 46 however, it was found that many patients described feeling rushed or unheard or that they were "just another number."…”

“…25,29,30,38 Poor adherence to medication is also common in chronic illnesses when a tangible benefit is not immediately evident for a particular treatment. 45,47 Figure 2 Drivers of medication adherence in asthma derived from qualitative literature.…”

“…8,17 Suboptimal health literacy among patients contributes to a lack of understanding of the disease and is a common reason for poor medication adherence. 43,45 This is especially problematic in asthma due to the often complex treatment regimens and is the basis of several asthma-specific barriers to medication adherence. Patients lacked an understanding of the difference between reliever and maintenance medications.…”

<p>Exploring Patient’s Perspectives and Experiences After Start with Inhalation Maintenance Therapy: A Qualitative Theory-Based Study</p>

“…1,2 The behavior of taking medication for a chronic disease is a complex and dynamic process, 3 and inhaled therapy has additional challenges for patients in daily practice. 4 Both the inhaler device technique and patient adherence to ICS are crucial in the effectiveness of the medical treatment. [5][6][7][8] However, patient adherence to ICS is shown to be generally poor, [9][10][11][12] and many patients experience problems in achieving and maintaining the correct inhaler device technique.…”

Estimating the Impact of Self-Management Education, Influenza Vaccines, Nebulizers, and Spacers on Healthcare Utilization and Expenditures for Medicaid-Enrolled Children with Asthma

“…perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 29, 2020. ; https://doi.org/10.1101/2020.09.28.20188466 doi: medRxiv preprint devices can reduce the utilization cost of visits due to fewer ED visits and hospitalizations (9). For patients whose asthma remains uncontrolled despite medical management, AS-ME helps patients manage asthma triggers and symptoms and reduce asthma exacerbation (10).…”