The golden factor in adherence to inhaled corticosteroid in asthma patients

Abstract

Objectives: Adherence to therapy is very important and many factors could be responsible for this issue. Suboptimal adherence to asthma therapy is a major contributor to poor asthma outcomes. Our aim is to find out the most important factor responsible for adherence to therapy in bronchial asthma patients.Subjects and methods: The study included 143 patients with persistent bronchial asthma. Factors that may affect adherence to therapy were studied. These factors included age, sex, residence, level of education, proper asthma education and whether inhaled corticosteroid (ICS) was taken alone, with long acting b2 agonist (LABA) in separate devices or with LABA in a combined form. Adherence to ICS was determined according to Medication Rating Scale.Results: We found that 55.3% of patients that received asthma education were adherent to ICS while only 21% of patients that did not receive asthma education were adherent to ICS therapy. The difference was statistically highly significant (p = 0.003). Other factors do not significantly affect adherence to ICS. Patients that used combined ICS with LABA in the same device were significantly more adherent to therapy (60.25%) than patients that used the same combination in 2 separate devices (34.5%). All patients with well controlled asthma were adherent to ICS, while 47.5% of uncontrolled patients was adherent. Comparison between level of control and adherence to ICS was highly significant (p = 0.003).Conclusion: This study showed how different factors may modulate adherence to asthma treatment and confirmed the importance of patient education in increasing adherence to asthma therapy.

Factors Affecting Drug Compliance in Paediatric Asthma

“…Drug levels can be monitored giving an accurate result but is prohibitively expensive in a developing country 17 . Three studies dealing with compliance in adult asthmatics done in Egypt, Sweden and USA have used questionnaires to decide the patient compliance 5,18,19 . A scale known as modifi ed Morirsky scale which scored the, 'yes' and 'no' answers to determine compliance was also used 5 .…”

“…Three studies dealing with compliance in adult asthmatics done in Egypt, Sweden and USA have used questionnaires to decide the patient compliance 5,18,19 . A scale known as modifi ed Morirsky scale which scored the, 'yes' and 'no' answers to determine compliance was also used 5 . The present study was in paediatric asthmatics and the children were understandably not able to give details of drug administered.…”

“…In an effort to improve the compliance we have to improve our knowledge of factors leading to poor compliance and address them. This may prove to be cost effective in long term disease control 5 . It has been suggested that the term compliance be replaced by the term adherence which depicts the patient as an equal participant in his treatment rather than assuming a passive role 6 .…”

Avaliação do controle da asma em crianças e adolescentes do Programa Respirar da cidade de Ipatinga, Minas Gerais, Brasil

“…Em seu estudo, Rifaat et al 29 concluíram que, entre os diversos fatores que podem modular a adesão ao tratamento em pacientes asmáticos, a educação em asma é o fator ouro, sendo o mais importante em aumentar a adesão à terapia com corticosteroides inalatórios. Quando a não adesão é identificada, o sucesso pode não ser alcançado.…”

“…Além disso, é importante lembrar que as definições de asma grave e as orientações para o manejo de fenótipos específicos são todas baseadas na suposição de que o paciente está aderindo ao tratamento 30 . Entre os temores mais comuns que impedem o uso normal dos costicosteroides inalatórios, está o risco potencial de dependência (60%) e preocupação com os efeitos colaterais dos esteroides (41%), como retardo do crescimento 29 .…”