Modelling the effect of beliefs about asthma medication and treatment intrusiveness on adherence and preference for once-daily vs. twice-daily medication

Abstract

People with asthma who do not adhere to their maintenance medication may experience poorer asthma control and need more healthcare support than those who adhere. People (N = 1010) aged 18–55 years with self-reported asthma, taking one or more asthma maintenance medication(s), from five European countries, participated in a survey using validated scales (Medication Adherence Report Scale [MARS], Asthma Control Test™ [ACT], Beliefs about Medicine Questionnaire [BMQ] and the Asthma Treatment Intrusiveness Questionnaire [ATIQ]). We performed a post hoc evaluation of adherence to maintenance medication, asthma control, beliefs about medication, preferences for once-daily vs. twice-daily asthma maintenance medication and treatment intrusiveness, using structural equation modelling to investigate the relationships between these factors. Most participants reported potential problems with asthma control (ACT < 19: 76.8% [n = 776]), low adherence (median MARS = 3.40) and preferred once-daily medication (73.5% [n = 742/1010]). Non-adherence was associated with worse asthma control (r = 0.262 [P < 0.001]) and a expressed preference for once-daily medication over a "twice daily medication that works slightly better" (test statistic [T] = 2.970 [P = 0.003]). Participants reporting non-adherence/preferring once-daily medication had negative beliefs about their treatment (BMQ necessity-concerns differential: r = 0.437 [P < 0.001]/T = 6.886 [P < 0.001]) and found medication intrusive (ATIQ: r = −0.422 [P < 0.001]/T = 2.689[P = 0.007]). Structural equation modelling showed complex relationships between variables, including: (1) high concerns about treatment associated with increased perceived treatment intrusiveness and reduced adherence, which influenced asthma control; (2) high concerns about treatment and healthcare seeking behaviour, which were predictive of preferring twice-daily asthma medication. Concerns about medication and perceived treatment intrusiveness were predictive of poor adherence, and were associated with preference for once-daily asthma medication. Confirm the utility of the PAPA model and NCF in explaining nonadherence linked to poor asthma control.

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

“…Self-report measures are considered not su ciently precise and unreliable compared to other methods. Pill or dosage counts possibly overestimate the exact doses taken, as patients may in uence the amount of those left in the package (21)(22)(23). However, to properly assess the primary adherence in community setting, no other method than database search provides the most accurate data (24).…”

Influence of high-intensity interval training in adolescents with asthma

“…This is a significant problem, especially in youth with asthma who cite barriers to physical activity such as administering medication in front of their peers and embarrassment of their condition (Cohen et al, 2003). When reporting their medication and adherence, participants often described taking their prescribed preventer sporadically and not as directed (Chapman et al, 2017). This poor control is likely to exacerbate their symptoms during exercise, further reinforcing their perception of an inability to, and fear of, exercise.…”

“…According to the healthcare utilisation questionnaire (Appendix C), it was clear that participants with asthma were unaware of the type of medication that they were taking and whilst they knew how often their inhalers were prescribed to be taken, few adhered to this. Failing to take their medication as prescribed may have resulted in less controlled asthma than reported (Chapman et al, 2017), as evidenced by the high levels of FeNO in studies 2 & 3 (Chapter 5 & 6). Additionally, participants who reported more severe asthma by medication step and adhered to their medication may have better controlled their asthma, essentially cancelling out effects which would have been expected.…”

“…The questionnaire revealed that adherence to medication was indeed an issue, with some participants reporting "taken when needed" with regards to their preventer inhaler that should be taken daily. Therefore, these participants would not have experienced the full benefit of their treatment (Chapman et al, 2017), resulting in poorer control.…”

“…If, however, exercise provokes their asthma symptoms, then their asthma management needs amendment, as well-controlled asthma should not affect a person's ability to participate in exercise (Berntsen, 2011). Furthermore, adolescents may not be adhering to their prescribed medication, as evidenced by the healthcare utilisation questionnaire, potentially assuming that their asthma has been cured due a lack of symptoms in recent months, which may put them at a higher risk of an attack (Chapman et al, 2017).…”