Trajectory Analyses of Adherence Patterns in a Real-Life Moderate to Severe Asthma Population

Boven, Job F M van; Koponen, Marjaana; Lalic, Samanta; George, Johnson; Bell, John; Hew, Mark; Ilomäki, Jenni

doi:10.1016/j.jaip.2019.12.002

Cited by 36 publications

(38 citation statements)

References 34 publications

(41 reference statements)

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“…The 12-year adherence was calculated by comparing cumulative dispensed doses of ICS (µg) to cumulative prescribed doses of ICS (µg) and annual adherence by comparing yearly dispensed doses of ICS (µg) to yearly prescribed doses of ICS (µg). This adherence calculation combines elements from both MPR and PCD formulas (online supplement) 8,28 and we estimated the time-variance of the adherence according to a recent publication 29 .…”

Section: Assessment Of Adherencementioning

confidence: 99%

Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

et al. 2021

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BackgroundIn short-term studies, poor adherence to inhaled corticosteroids (ICS) has been associated with worse asthma control, but the association of long-term adherence and disease control remains unclear.ObjectiveTo assess the relationship between 12-year adherence to ICS and asthma control in patients with adult-onset asthma.MethodsAs part of the Seinäjoki Adult Asthma Study, 181 patients with clinically confirmed new-onset adult asthma and regular ICS medication were followed-up for 12 years. Adherence (%) to ICS was assessed individually ((µg dispensed/µg prescribed)×100) during the follow-up. Asthma control was evaluated after 12 years of treatment according to the Global Initiative for Asthma 2010 guideline.ResultsAsthma was controlled in 31% and not controlled (partly controlled or uncontrolled) in 69% of the patients. Patients with not-controlled asthma were more often male, older, nonatopic and used higher doses of ICS than those with controlled disease. The mean±sd 12-year adherence to ICS was 63±38% in patients with controlled asthma and 76±40% in patients with not-controlled disease (p=0.042). Among patients with not-controlled asthma, those with lower 12-year adherence (<80%) had more rapid decline in forced expiratory volume in 1 s (−47 mL·year−1) compared to patients with better adherence (≥80%) (−40 mL·year−1) (p=0.024). In contrast, this relationship was not seen in patients with controlled asthma.ConclusionsIn adult-onset asthma, patients with not-controlled disease showed better 12-year adherence to ICS treatment than those with controlled asthma. In not-controlled disease, adherence <80% was associated with more rapid lung function decline, underscoring the importance of early recognition of such patients in routine clinical practice.

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Section: Assessment Of Adherencementioning

confidence: 99%

Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

et al. 2021

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“…12 Prescription refills and canister weighing are other indirect objective methods for measuring medication adherence. 12 These methods can provide population-level estimates and with trajectory modelling one can identify different patterns of use; 13 however, they are coupled with drawbacks, like medication dumping, sharing therapy with other patients with asthma, and the need for access to national databases. As a result, the actual amount of the administered dose cannot be easily determined.…”

Section: Introductionmentioning

confidence: 99%

<p>Assessing Adherence to Inhaled Corticosteroids Among Adults with Asthma in Kuwait Using the Medication Adherence Report Scale for Asthma</p>

Albassam¹,

Alharbi²,

Awaisu³

2020

PPA

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Purpose: Inhaled corticosteroids (ICS) are the mainstay maintenance therapy for asthma management. Non-adherence to ICS, which can lead to exacerbations and poor asthma control, is commonly reported among adult patients with asthma. The level of adherence to ICS among adult patients with asthma in Kuwait has not been previously published. The aim of this study was to assess adherence to ICS among adults with asthma in Kuwait. Patients and Methods: A cross-sectional study was conducted among adult patients with asthma using ICS therapy at ambulatory asthma clinics in Kuwait. Adherence to ICS was assessed using the Medication Adherence Report Scale for Asthma (MARS-A). Descriptive and logistic regression analyses were conducted using SPSS version 23. Results: One hundred and forty-nine patients with a mean age of 41.42 (12.75) years participated in the study. The majority of the participants (82.6%) reported low adherence to ICS. Approximately, three-quarters of the participants reported that they used ICS either when needed or when they felt breathless. Furthermore, about half of them admitted that they tried to avoid using ICS (46.3%), or forgot to take ICS (51%), or only used ICS before performing an exercise that made them breathless (54%). In the multivariate logistic regression analysis, independent predictors (age, education, and smoking status) were not found to significantly influence the overall adherence to ICS therapy. Conclusion: Adherence to ICS among adult patients with asthma was found to be low in ambulatory care settings in Kuwait. Future studies should aim to determine the barriers to ICS adherence among patients with asthma, with a focus on developing effective intervention strategies.

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“…Poor asthma control is usually ascribed to poor adherence with prescribed medications [ 14 , 54 , 55 , 56 , 57 ] and we assumed that many of the persistent symptoms in the WTC EHC patients would be due to failure to use appropriate medications. We therefore presumed that LRS would improve with adherence to a treatment of ICS/LABA and designed a run-in period to confirm adherence before defining study status as Uncontrolled or Controlled.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Reibman

Caplan-Shaw

et al. 2020

IJERPH

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The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.

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Trajectory Analyses of Adherence Patterns in a Real-Life Moderate to Severe Asthma Population

Cited by 36 publications

References 34 publications

Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

<p>Assessing Adherence to Inhaled Corticosteroids Among Adults with Asthma in Kuwait Using the Medication Adherence Report Scale for Asthma</p>

Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

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