Primary Adherence to Controller Medications for Asthma Is Poor

Abstract

Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.Objective: To compare adherence to the major controller medication regimens for asthma.Methods: This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).Measurements and Main Results: Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.Conclusions: Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.

Randomized controlled trial of primary prevention of atopy using house dust mite allergen oral immunotherapy in early childhood

“…This level of adherence is similar to that reported for other long-term therapies that seem to be effective. 37 In summary, this is the first proof-of-concept study providing early evidence of the safety and possibly efficacy of this approach. Because the sample size is relatively small, further proof of efficacy of early intervention requires replication in larger multicenter studies.…”

Why and how to step down chronic asthma drugs

“…and 30% for LTRA. 75 Data indicate that for drugs generally, the frequency of administration is a predictor of adherence. 76 This pattern seems to hold for asthma drugs as well.…”

Special considerations—asthma in children

“…[60][61][62][63] Poor asthma control should prompt a thorough examination of medication adherence because this is among the most common causes of poor response to therapies. 8,64 Although beyond the scope of this review, adherence can be maximized with targeted and engaging asthma education strategies focused on both children and their caregivers.…”