Compliance with prescribed drug therapy in asthma

Abstract

Morbidity and mortality from asthma in the Western world is increasing despite effective prophylactic drugs. Beta agonists are increasingly considered causal; while under-prescribing of inhaled steroids or other anti-inflammatories are accepted as causes for the problems, but the role of non-compliance with inhaled asthma therapy is rarely mentioned. Using a novel electromechanical counter MDI actuations have been recorded in three small (9-11 patients), short (2-3 weeks) studies. When aware compliance with prescribed inhaled steroids was under scrutiny, six patients were fully compliant, two took just 70% of the prescribed regimen, but two did not follow the prescribed regimen at all. When unaware of scrutiny, six out of 11 were compliant but five patients were estimated as taking less than 30-51% of the prescribed dose of inhaled steroid. When asked to monitor rescue bronchodilator usage patients consistently under-recorded. Under-use as well as under prescription of inhaled steroids and under-estimation (8) of beta 2-agonists use may be contributory factors to the present increase in asthma mortality and morbidity. These potential problems of poor compliance need larger scale studies to show how and if behaviour can be altered to improve compliance.

Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance?

“…In both, some patients were noted to have made multiple activations of the inhalers prior to follow-up visits. Awareness of monitoring was also shown to affect behaviour in the study by YEUNG et al [17] using a mechanical counter on MDIs containing a beta-agonist and a steroid.…”

Patient adherence with COPD therapy

“…controller or preventer medications) among adult patients are low. Studies by SPECTOR et al [10], MAWHINNEY and coworkers [11,12], YEUNG et al [13], RAND and coworkers [14][15][16] and others, which used electronic monitoring of pMDI dispensing, suggest that average adherence to asthma and COPD regimens is ,50% of prescribed, and may dip much lower [16]. Studies in both asthma and COPD also suggest that, while patients tend to under-use controller or maintenance therapies, symptom-relieving drugs such as bronchodilators are often overused [17,18].…”

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

“…5,[21][22][23][24][25][26] The rate of adherence in pediatric asthma is similar to that in adults. [27][28][29][30][31][32][33][34][35] Children may not adhere to a therapeutic program because medications make them feel strange or uneasy, taking medication makes them feel unpopular, taking medication is a nuisance (eg, it imposes activity restrictions, disrupts lifestyle, increases perceived vulnerability), they may not want to admit symptoms or the need for therapy, there may be fantasies regarding the power and danger of drugs (risks, side effects), and the cost may be prohibitive. 19,23,36 Full adherence is more likely when the child and the caregiver perceive the child as vulnerable to the disease or its complications, complications of the disease are viewed as serious, and there are anticipated benefits from following the treatment program.…”