Adherence in severe asthma

Abstract

Adherence in asthma is an important cause for concern. Although nearly 50% of asthma patients are considered poorly adherent to therapeutic advices, adherence is still difficult to assess, understand and improve despite major medical consequences. In this review, we revisited the literature of the last 10 years related to adherence in severe asthma. The concepts have changed and "compliance" is usually replaced by "adherence". Assessment of adherence is addressing ethical issues, but provides important insight into difficult-to-treat asthma. Different tools have been used but none is routinely recommended. Health-related outcomes (poor control, exacerbations, hospitalizations, lung function decline), which are clearly associated with severe asthma, are often worsened by non-adherence with consequences also on patient related outcomes (quality of life). The potential behaviour associated with non-adherence and all other related factors including easy-to-recognize psychological traits can help for patient's future management. Therapeutic educational interventions have been recognized with a scientifically proven efficiency even though evolution and improvements are needed. A multidisciplinary approach is required in severe asthma. Therapeutic adherence for a given patient is always a prerequisite to any other aspects when addressing severe asthma phenotypes. Severe asthma should be considered only in those who still experienced poor asthma outcomes despite optimal adherence. At a glance, poor adherence and severe asthma should be considered antinomic. Better understanding of the causes and customised management are potential future directions.

Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review

“…The findings of this literature review reveal that multiple perspectives and factors affect adherence and one single factor cannot fully explain the reasons behind non-adherence to asthma treatment [9]. However, before going in-depth into the identified factors, it is noteworthy to mention that among recent literature, the term compliance has been replaced by the term adherence because the term compliance is being associated with patients being subordinated to medical advice.…”

“…On the contrary, well-controlled asthma leads to fewer symptoms and almost normal lung functionality regardless of the severity of the disease [8]. Despite these enhancing effects, adherence to asthma is still a misunderstood problem which results in poor asthma control [9].…”

“…Adolescents reported that their busy, hectic and sometimes chaotic lifestyle makes it difficult to stick to routines [20]. Both behavioral types require different types of intervention [6,9,14]. From both types, those who do not adhere to treatment intentionally are the most difficult to treat, hence, both types require tailored intervention strategies [6,9,14,19] to prescribed medicine [6].…”

“…Both behavioral types require different types of intervention [6,9,14]. From both types, those who do not adhere to treatment intentionally are the most difficult to treat, hence, both types require tailored intervention strategies [6,9,14,19] to prescribed medicine [6]. The personality traits low agreeableness, low conscientiousness and high neuroticism, meaning being reluctant, disorganized and moody, are associated with perceived concerns about asthma medication and adherence behavior [22].…”

Severe asthma in pediatrics: Outcomes of the implementation of a special health care protocol

“…Multiple reasons lie behind the lack of treatment adherence, including costs, complex treatment regimens, risk for side effects, and lack of parental monitoring, among others. 25,26 Although there is no completely reliable method to verify adherence, the recommendation is to monitor and promote compliance with therapeutic indications using any method available at the time of consult. Successful adherence is defined as the administration of at least 80% of prescribed doses.…”