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

Abstract

Adherence to asthma medications is generally poor and undermines clinical outcomes. Poor adherence is characterized by underuse of inhaled corticosteroids (ICS), often accompanied by over-reliance on short-acting β 2-agonists for symptom relief. To identify drivers of poor medication adherence, a targeted literature search was performed in MEDLINE and EMBASE for articles presenting qualitative data evaluating medication adherence in asthma patients (≥12 years old), published from January 1, 2012 to February 26, 2018. A thematic analysis of 21 relevant articles revealed several key themes driving poor medication adherence, including asthma-specific drivers and more general drivers common to chronic diseases. Due to the episodic nature of asthma, many patients felt that their daily life was not substantially impacted; consequently, many harbored doubts about the accuracy of their diagnosis or were in denial about the impact of the disease and, in turn, the need for long-term treatment. This was further compounded by poor patient-physician communication, which contributed to suboptimal knowledge about asthma medications, including lack of understanding of the distinction between maintenance and reliever inhalers, suboptimal inhaler technique, and concerns about ICS side effects. Other drivers of poor medication adherence included the high cost of asthma medication, general forgetfulness, and embarrassment over inhaler use in public. Overall, patients' perceived lack of need for asthma medications and medication concerns, in part due to suboptimal knowledge and poor patient-physician communication, emerged as key drivers of poor medication adherence. Optimal asthma care and management should therefore target these barriers through effective patient-and physician-centered strategies.

Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program

“…Of note, assessment of qualitative research focusing on patient-centered drivers of poor medication adherence suggests that SABA overuse may not always be related to the severity of the disease. It may also be due to factors including ICS underuse driven by suboptimal patient knowledge about the difference between maintenance and reliever medication, the patient's need for immediate symptom relief, concerns about the side-effects of steroids, and poor communication between patients and physicians [37]. Additionally, previous analysis of the same patient cohort revealed that, over an 8-year period, SABA prescriptions at the population-level have remained stable [38].…”

<p>Asthma and COVID-19: In Defense of Evidence-Based SABA</p>

“…In fact, in another recent study, funded by the same sponsor, Amin et al have identified underuse of ICS and overuse of SABA as the manifestation of poor adherence which was shown to be related to patients' low-perceived need for asthma medications, inadequate communication between patients and physicians, perceived medication concerns, and suboptimal patient knowledge, including incorrect inhaler technique. 15 Indeed, having identified the symptom (shortness of breath-causing overuse of SABA) of the "fire" and the ease with which an early warning system ("fire alarm") could nowadays be devised, could not the abuse of the SABA device be the signal that initiates a rapid response from the health-care system? Despite their one-sided attacks on SABA, towards the end of the editorial the authors agree that SABA abuse is "an excellent surrogate marker of poor asthma control" and that submit your manuscript | www.dovepress.com…”

“…In fact, in another recent study, funded by the same sponsor, Amin et al have identified underuse of ICS and overuse of SABA as the manifestation of poor adherence which was shown to be related to patients’ low-perceived need for asthma medications, inadequate communication between patients and physicians, perceived medication concerns, and suboptimal patient knowledge, including incorrect inhaler technique. 15 …”

Nutritional Interventions to Improve Asthma-Related Outcomes through Immunomodulation: A Systematic Review

“…Frequently, asthma patients have prescribed a combination of short-acting β2-agonists for short-term relief and inhaled corticosteroids in order to suppress the airway inflammation, thereby preventing exacerbations. Compliance to inhaled corticosteroids is generally low and was previously estimated to be between 22% and 63%, whereas short-acting β2-agonists are often used too frequently [ 4 , 5 ]. Noncompliance to inhaled corticosteroids could lead to a gradual worsening of the airway and even systemic inflammation in asthma patients over time [ 4 , 6 ].…”

“…Compliance to inhaled corticosteroids is generally low and was previously estimated to be between 22% and 63%, whereas short-acting β2-agonists are often used too frequently [ 4 , 5 ]. Noncompliance to inhaled corticosteroids could lead to a gradual worsening of the airway and even systemic inflammation in asthma patients over time [ 4 , 6 ]. This does not only worsen asthma severity, but long-term continuous low-grade systemic inflammation may also contribute to the simultaneous development of disorders related to low-grade inflammation, such as cardiovascular diseases [ 7 ].…”