Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence

Williams, L. Keoki; Peterson, Edward L.; Wells, Karen; Ahmedani, Brian K.; Kumar, Rajesh; Burchard, Esteban G.; Chowdhry, Vimal K.; Favro, David; Lanfear, David E.; Pladevall, Manel

doi:10.1016/j.jaci.2011.09.011

Cited by 307 publications

(246 citation statements)

References 42 publications

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“…Underuse of controller medications for asthma is common and contributes to severe exacerbations, including hospitalizations and emergency department visits (8). Underuse of controller medications may be due to provider underdiagnosis or undertreatment of asthma, or patient medication nonadherence (9).…”

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confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

104

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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.

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confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

104

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“…9 Non-adherence to asthma treatment leads to increased emergency care and mortality. 10,11 The effect of medications depends on the efficacy and the patient adherence to the intended regimen. Adherence with medication regimens is essential for attaining maximal therapeutic benefits.…”

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confidence: 99%

Evaluation of Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in Tertiary Care Teaching Hospital-A Questionnaire Based Study

Shamkuwar¹,

Kumari²,

Meshram³

et al. 2015

J YOUNG PHARM

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The term adherence means, "sticking to a plan" for perceived benefit. This concept is applied for the patients, who have adopted and integrated a plan given by the physician. 9 Non-adherence to asthma treatment leads to increased emergency care and mortality. 10,11 The effect of medications depends on the efficacy and the patient adherence to the intended regimen. Adherence with medication regimens is essential for attaining maximal therapeutic benefits. 12Assessment of the knowledge, and medication adherence practice is crucial for the patients improvements and wellbeing as well as preventing them from complications. In India, there is scarcity of data regarding knowledge, attitude and medication adherence within the asthmatic patients. Hence, the present study is so designed to evaluate the knowledge, attitude and medication adherence among asthmatic patients of central India. MATERIALS AND METHODSThis is a prospective, observational, questionnaire based study conducted at the Pulmonary Medicine, (OPD) of specialized Asthma Clinic of a tertiary care teaching hospital after the approval of institutional ethics committee. The study was conducted over a period of six -months and total 154 patients were included. The inclusion criteria of the study comprised of diagnosed asthmatic patients both male and females above 18 years of age who were on prior medication for at least two-weeks. All participants were enrolled after obtaining their informed consent. Face-to-face interviews of participants were conducted by using the assessment questionnaire for knowledge, attitude and medication ABSTRACT Background:The burden of asthma in India is estimated at more than 15 million patients. Approximately two to four percent of adult population of India is affected by asthma. In recent decade, there are striking advancement in the clinical treatment of asthma. However, in spite of this, the frequency and morbidity of asthma is increasing in several countries. The Objectives of this study was to assess the knowledge, attitude and to evaluate the medication adherence among the asthmatic patients. Methods: This is a prospective, observational, questionnaire based study conducted in a tertiary care teaching hospital of central India after the approval of institutional ethics committee for a period of six months. Face-to-face interview with the patients of specialized Asthma clinic from Pulmonary Medicine, Outpatients Department (OPD) was conducted. This was administered with questionnaires assessing the knowledge, attitude and medication adherence (Morisky 8-items medication adherence scale) towards their disease and treatment. Results: Data of 154 patients were analysed for this study.Here 80 (51.9%) patients were male and 74(48.1%) were female. The maximum knowledge score is 16 and 66.86% of patients scored a mean score of 10.7. In attitude, the maximum score is 24 and 71.25% of patients scored a mean score of 17.1, while in adherence the maximum score is 8 and 42.50 % of patients scored a mean score of 3.4. Conclusion: The pre...

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“…Poor adherence to asthma medication is associated with a broad range of negative outcomes including poor asthma control, increased exacerbations, increased cost, increased hospitalization rates, decreased quality of life, reduced lung function, and other lifestyle limitations for the patient (13,15,(25)(26)(27). Therefore, implementation of effective strategies to improve treatment adherence will help to reduce the associated negative consequences, thereby minimizing overall disease burden.…”

Section: The Burden Associated With Nonadherence To Asthma Medicationmentioning

confidence: 99%

The burden of nonadherence among adults with asthma: a role for shared decision‐making

Pollard

Bansback

FitzGerld

et al. 2017

Allergy

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To cite this article: Pollard S, Bansback N, FitzGerld JM, Bryan S. The burden of nonadherence among adults with asthma: a role for shared decision-making. AbstractA shared approach to decision-making framework has been suggested for chronic disease management especially where multiple treatment options exist. Shared decision-making (SDM) requires that both physician and patients are actively engaged in the decision-making process, including information exchange; expressing treatment preferences; as well as agreement over the final treatment decision. Although SDM appears well supported by patients, practitioners and policymakers alike, the current challenge is to determine how best to make SDM a reality in everyday clinical practice. Within the context of asthma, adherence rates are poor and are linked to outcomes such as reduced asthma control, increased symptoms, healthcare expenditures, and lower patient quality of life. It has been suggested that SDM can improve treatment adherence and that ignoring patients' personal goals and preferences may result in reduced rates of adherence. Furthermore, understanding predictors of poor treatment adherence is a necessary step toward developing effective strategies to improve the patient-reported and clinically important outcomes. Here, we describe why a shared approach to treatment decision-making for asthma has the potential to be an effective tool for improving adherence, with associated clinical and patient-related outcomes. In addition, we explore insights into the reasons why SDM has not been implemented into routine clinical practice.

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Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence

Cited by 307 publications

References 42 publications

Primary Adherence to Controller Medications for Asthma Is Poor

Primary Adherence to Controller Medications for Asthma Is Poor

Evaluation of Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in Tertiary Care Teaching Hospital-A Questionnaire Based Study

The burden of nonadherence among adults with asthma: a role for shared decision‐making

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