Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh

Abstract

Background Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients. Methods This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. Results A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67–146.08), lived in the rural area (23.28, 95% CI 2.43–222.66), less year of schooling (5.69, 95% CI 1.27–25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11–44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41–117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22–26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10–55.26) were the significant contributor of non-adherence. Conclusion Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.

Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review

“…While cutoffs for illness duration in most studies ranged from 1–5 years, one study used a 10-year cutoff, reporting better foot care but poorer diet and physical activity among those with a longer illness duration [ 48 ]. Another study conducted in rural settings reported poorer adherence to asthma inhalers in those with prolonged illness [ 52 ]. Both studies were of low quality.…”

“…Smoking was associated with poorer self-management in three out of four studies, the only exception being a low-quality study conducted on asthmatic individuals [ 52 ]. Other less commonly observed associations were a lower BMI [ 41 , 45 ] and a positive family history of illness [ 34 ] which were associated with better self-management.…”

Digital inhalers for asthma management

“…However, up to 70% of asthma patients do not use their inhalers correctly [3] and improper technique is associated with poor asthma control. Furthermore, almost 43% of asthma patients worldwide are nonadherent to their inhaler treatment plan, with some studies suggesting that the rate may be as high as 87% among patients with severe asthma [4]. Digital inhaler systems (DIS) have demonstrated the ability to identify and improve poor inhaler technique and nonadherence to asthma medications, and ultimately improve asthma control [5 ▪ ,6 ▪▪ ].…”