Adherence to Treatment in Severe Asthma

Abstract

BackgroundIn Brazil, like many other low- to middle-income countries, most asthmatic patients cannot afford the medication necessary to prevent exacerbations. The reference clinic of the Programme for Asthma Control in Bahia (ProAR; Salvador-Bahia) offers free medical care, pharmaceutical assistance (inhaled medication) and patient education. The reference clinic is accessible to all the population of Salvador and the Programme is targeted on severe asthma.ObjectiveThe aim of the present study was to evaluate adherence to inhaled medication in severe asthmatics enrolled in ProAR.MethodsA sub-group of 160 consecutive severe asthmatics enrolled in ProAR were followed prospectively for 6 months. All patients were assessed by means the Asthma Control Questionnaire, the Beck Depression Inventory and spirometry. The rate of adherence to inhaled corticosteroid was checked monthly. A cut-off point of 80% of the doses prescribed in the period was used to define patients as adherent.ResultsOf the one hundred-sixty patients with severe asthma included, it was possible to objectively assess adherence to the use of the inhaled corticosteroid in 158. Among these, 112 (70.9%) were considered adherent according to the adopted cut-off point. The rate of adherence in the whole sample of subjects was 83.9% of the prescribed doses. There was a significant association between asthma control and adherence to treatment. Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule.ConclusionIn the present study, adherence to treatment was high. In a sample of patients with severe asthma managed in a public program that provides free medication and multidisciplinary treatment at a referral center, adherence to treatment was found to be associated with favorable clinical outcomes.

Risk factors for death in patients with severe asthma

“…Factors related to a lack of asthma control include non-adherence to treatment, a precipitous reduction in the dose of inhaled corticosteroid, carelessness in maintaining environmental controls, and comorbidities. ( 19 ) In another ProAR study, ( 20 ) correct inhaler technique was found to be associated with asthma symptom control. The authors suggested that the inhaler techniques employed by asthma patients should be evaluated, on a regular basis, by a multidisciplinary team.…”

“…An earlier study identified certain factors as being predictive of poor adherence to treatment among patients enrolled in the ProAR, ( 19 ) including adverse events, great distances between the patient residence/workplace and the health care facility, transportation difficulties, and short dosage intervals for prescriptions involving multiple doses. Factors related to a lack of asthma control include non-adherence to treatment, a precipitous reduction in the dose of inhaled corticosteroid, carelessness in maintaining environmental controls, and comorbidities.…”

“…Alguns fatores preditores para a má adesão ao tratamento foram identificados entre os pacientes acompanhados pelo serviço em um estudo prévio, ( 19 ) tais como a presença de eventos adversos, a distância da residência/local de trabalho da unidade de atendimento, a dificuldade de transporte e o intervalo posológico nas prescrições com doses múltiplas. A falta de adesão ao tratamento regular, a redução precipitada da dose do corticoide inalatório, a falta de cuidado com o controle ambiental e a existência de comorbidades podem estar relacionadas com a falta de controle da asma.…”

“…A falta de adesão ao tratamento regular, a redução precipitada da dose do corticoide inalatório, a falta de cuidado com o controle ambiental e a existência de comorbidades podem estar relacionadas com a falta de controle da asma. ( 19 ) Outro fator identificado no ProAR que está associado ao controle dos sintomas é a utilização da técnica inalatória adequada. A técnica de inalação incorreta é um dos fatores que podem dificultar o controle da asma e deve ser avaliada pela equipe multiprofissional regularmente.…”

Patients’ perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy

“…Most commonly reported barriers to long-term controller medication for asthma include: fear of adverse effects, addiction, or dependence to medication; belief that the medication does not help or is not necessary; concerns about a diminishing effectiveness of medication over time; preference for alternative asthma management; sense of only an intermittent need for medication; inconvenient dosage regimens; inadequate knowledge of the medication and/or the disease; cost of the medication; stigmatization of the affected individual; dislike of the provider; medical comorbidity; and the lack of social support [ 13 - 19 ]. In contrast, previously identified facilitators are: simple dosage regimens (e.g., one-daily dose); patients’ knowledge related to the medication and the disease; access to high-quality personalized health care; coping with the disease; appropriate asthma self-management; and, possessing a written action plan [ 16 , 17 , 19 - 21 ]. A first taxonomy of facilitators of physicians’ prescription behavior in the acute care setting, which included 5 domains (knowledge, attitude, and beliefs; operationalization of guidelines; choice of medication; parent or patient-related factors; and setting-related factors), was developed [ 22 ].…”