Asthma and Adherence to Inhaled Corticosteroids: Current Status and Future Perspectives

Abstract

Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means to improve adherence. A total of 19 studies met the inclusion criteria: 9 focusing on the level of adherence, 6 focusing on effects of poor adherence, and 7 focusing on interventions to improve adherence. Three of the studies focused on more than one of these end points. The mean level of adherence to ICS was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, < 12 y of formal education, and poor communication with the health-care provider, whereas improved adherence was associated with being prescribed fixed-combination therapy (ICS and long-acting ␤ 2 agonists). Good adherence was associated with higher FEV 1 , a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthmarelated hospitalizations could be attributed to poor adherence. Most studies have reported an increase in adherence following focused interventions, followed by an improvement in quality of life, symptoms, FEV 1 , and oral corticosteroid use. However, 2 studies found no difference in health-care utilization, one observed no effect on symptoms, and one observed more symptoms in subjects in the intervention group compared with the control group. Good adherence to ICS in asthma improves outcome but remains low. Interventions to improve adherence show varying results, with most studies reporting an increase in adherence but unfortunately not necessarily an improvement in outcome. Even following successful interventions, adherence remains low. Further research is needed to explore barriers to adherence and interventions for improvement.

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…Poor adherence in asthma is well-documented [29,30], even in difficult asthma: A study of adults referred to a clinic for difficult asthma revealed that 35% of the patients filled their ICS prescriptions less than 50% of the time [31]. Poor adherence with controller medication is associated with poor disease control, and it is estimated that 24% of exacerbations and 60% of asthma-related hospital admissions may be attributed to poor adherence [29,32].…”

“…Poor adherence with controller medication is associated with poor disease control, and it is estimated that 24% of exacerbations and 60% of asthma-related hospital admissions may be attributed to poor adherence [29,32]. …”

Early Prescription of Inhalation Corticosteroid in Bronchial Asthma

“…после выписки из стационара [29]. И хорошо известно, что низкая приверженность приводит к недо-статочно эффективному воздействию на воспаление, лежащее в основе заболевания, к повышенному риску обострений и риску летального исхода [30,[31][32][33][34][35][36]. Кроме того, чрезмерное использование монотерапии короткодействующими бета2-агонистами (КДБА) как единственно возможной симптоматической терапии при легкой астме приводит к тому, что регулярная тера-пия ИКС назначается с запозданием [37] и пациент достаточно долго не принимает никакой противовос-палительной терапии.…”

Airway Obstruction and Inducible NO Synthase (iNOS)

“…The incidence of the disease is increasing at an alarming rate affecting 1 in 10 children and 1 in 12 adults with a total of 300 million worldwide [5]. Worldwide, deaths from asthma have reached over 250,000 annually.…”