Improving patient compliance with asthma therapy

Abstract

Patients fail to comply with asthma medication for a variety of reasons. These range from physical inability to use an inhaler, through simple forgetfulness, to a conscious decision not to use medication as prescribed due to internal or cultural health beliefs or socioeconomic factors. In some patients, poor self-care because of deep-rooted psychological factors (i.e. factors of which patients have only limited awareness) can affect compliance. Poor doctor-patient communication can be the cause in many other individuals. Thus, there is no single solution that will improve compliance in all patients. Simplifying the regimen or providing memory aids will be sufficient for some patients, while education or psychological counselling will be more appropriate for others. Doctors can also use a range of communication skills to improve the way in which they present information, motivate patients and reinforce progress. These approaches, plus respect for patients' health beliefs and involving them in treatment decisions, can help foster an atmosphere of mutual responsibility and concordance over medicine taking.

Choice of add-on therapy in asthma — another inhaler or a tablet/syrup? A survey of 1415 UK asthmatics

“…3,8,9 Certainly preference is influenced by knowledge, and these factors are implicated in the psychological stages involved in improving compliance. 10 Patients already using 3 or more inhalers had a greater preference for tablets than those requiring 2 inhalers or less, although there was no relation between total number of puffs used and preference for oral therapy. This difference may reflect different groups of patients; for example those requiring several inhalers might have severe disease, whilst those using many puffs per day may include poor compliers with regular treatment who use their bronchodilator excessively every day.…”

Evaluation of Patient-Reported Outcomes and Quality of Life with the I-neb AAD System in Patients with Chronic Obstructive Pulmonary Disease

“…This feedback provides patients with greater control over the correct use of their nebulizer and may improve patient adherence by providing a memory aid. (18) Moreover, some evidence suggests that poor adherence to nebulized therapy leads to impairment in quality of life. Results of a study by a group of researchers at Guy's Hospital in London (n ¼ 82) showed that 56% of patients were poorly adherent (took <70% of the prescribed dose for regimens of equal to or less than 4 times daily or <60% of the prescribed dose for regimens of equal to or more than 5 times daily) to home nebulizer therapy.…”

A Review of the Effects of Medication Delivery Systems on Treatment Adherence in Children with Asthma

“…Poor inhaler technique is a major cause of underdosing and nonadherence. 38 As Chapman et al 45 have pointed out, when focusing on adherence, it is important to keep sight of clinical outcome. It is better to achieve asthma control with medication being taken less often than prescribed than to achieve perfect adherence with medication that fails to control the disease.…”