Medication availability and economic barriers to adherence in asthma and COPD patients in low-resource settings

Abstract

Inhaled medication is essential to control asthma and COPD, but availability and proper adherence are challenges in low-middle income countries (LMIC). Data on medication availability and adherence in Central Asia are lacking. We aimed to investigate the availability of respiratory medication and the extent of financially driven non-adherence in patients with COPD and asthma in Kyrgyzstan. A cross-sectional study was conducted in two regions of Kyrgyzstan. Patients with a physician- and spirometry confirmed diagnosis of asthma and/or COPD were included. The main outcomes were (1) availability of respiratory medication in hospitals and pharmacies, assessed by a survey, and (2) medication adherence, assessed by the Test of Adherence to Inhalers (TAI). Logistic regression analyses were used to identify predictors for adherence. Of the 300 participants (COPD: 264; asthma: 36), 68.9% were buying respiratory medication out-of-pocket. Of all patients visiting the hospital, almost half reported medication not being available. In pharmacies, this was 8%. Poor adherence prevailed over intermediate and good adherence (80.7% vs. 12.0% and 7.3%, respectively). Deliberate and erratic non-adherence behavior patterns were the most frequent (89.7% and 88.0%), followed by an unconscious non-adherent behavioral pattern (31.3%). In total, 68.3% reported a financial reason as a barrier to proper adherence. Low BMI was the only factor significantly associated with good adherence. In this LMIC population, poor medication availability was common and 80% were poorly adherent. Erratic and deliberate non-adherent behaviors were the most common pattern and financial barriers play a role in over two-thirds of the population.

Prevalence of medication adherence among adult asthmatic patients in four African countries: A systematic review and meta-analysis

“…According to this review, only less than one-half of the participants were adherent to medications. Fragmented and fragile health care systems, inaccessibility, unavailability and unaffordability of drugs, 39 , 40 low socio-economic status of the African population, 41 and food insecurity and housing instability may be the reasons for the low prevalence of medication adherence among African adult asthmatic patients. 14 , 42 , 43 Evidence also showed that the prevalence of medication adherence is low in communities with inadequate health literacy.…”

Asthma in developing countries in the Asia‐Pacific Region (APR)

“…Among 300 inhaler users, poor adherence to inhalers was noted among 81% with 68% reporting financial reasons as a barrier to proper inhaler adherence. 61 Illustrative of this finding, in 2007 1 month of maintenance asthma treatment from the private sector cost 1.3, 5.4, 2.5 and 2.3 days' wages for a lowest-paid government worker in Bangladesh, Nepal, Pakistan and Sri Lanka, respectively. 8 Limited budgetary allocations to preventive healthcare compared to the curative sector in many developing countries has led to poor availability of asthma diagnostics, medication, and support care, including spirometry services, allergic testing and asthma care nurses.…”

“…Underdeveloped national health services and limitations in free availability of asthma medications are major factors leading to treatment non‐adherence in many LMICs. Among 300 inhaler users, poor adherence to inhalers was noted among 81% with 68% reporting financial reasons as a barrier to proper inhaler adherence 61 . Illustrative of this finding, in 2007 1 month of maintenance asthma treatment from the private sector cost 1.3, 5.4, 2.5 and 2.3 days' wages for a lowest‐paid government worker in Bangladesh, Nepal, Pakistan and Sri Lanka, respectively 8 …”

“…59,60 National health services in APR LMIC are also often underdeveloped, leading to limited availability of asthma medications. [61][62][63] • Asthma heterogeneity and climatic challenges: Different asthma genotypes and phenotypes have been reported in the APR LMIC, making it challenging for risk stratification and asthma management. [64][65][66] Rapid urbanization and economic growth can lead to increased air pollution exposure, contributing to the worsening of asthma burden in APR LMICs.…”

Whole-course management of chronic obstructive pulmonary disease in primary healthcare: an internet of things-enabled prospective cohort study in China

“…In low-income and middle-income countries, both direct and indirect medical expenses attributable to COPD pose a serious threat to their economy 7–10. Hence, it is essential to motivate policy-makers and funders to provide political and financial support and encourage researchers to carry out relevant research for the prevention and control of COPD, especially in low-resource settings 11 12…”