Objective confirmation of asthma diagnosis improves medication adherence

Backer, Vibeke; Stensen, Lise; Sverrild, Asger; Wedge, Eileen; Porsbjerg, Celeste

doi:10.1080/02770903.2017.1410830

Cited by 13 publications

(18 citation statements)

References 24 publications

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“…4,12 All patients were from a tertiary pediatric asthma clinic, which limits diagnostic heterogeneity and presumably increases adherence due to objective confirmation of the asthma diagnosis. 22 inequality, which may affect adherence. 13,24,25 However, filling prescriptions might still have a socially unequal distribution due to medication costs and pharmacy travel distances.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Assessment of adherence to asthma controllers in children and adolescents

Marckmann

Hermansen

Hansen

et al. 2020

Pediatric Allergy Immunology

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Section: Strengths and Limitationsmentioning

confidence: 99%

Assessment of adherence to asthma controllers in children and adolescents

Marckmann

Hermansen

Hansen

et al. 2020

Pediatric Allergy Immunology

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“…Information on the duration of asthma, age of asthma onset and diagnostic criteria used were missing from the previous adherence studies, all of which are factors that could influence adherence [23,24,[31][32][33]36]. In the studies using administrative or other register data only, asthma diagnosis has typically been based on International Classification of Diseases codes found from these records [25,36,37], causing unreliability and variation in the correctness of asthma diagnosis. For example, a study in the USA [23] identified that only 8.8% of the patients continued to refill their prescriptions from the index date to year's end, whereas in another study [38], ∼50% of the patients did not renew their initial prescription.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical patients with objectively confirmed diagnoses of new-onset adult asthma had, on average, moderate adherence to long-term ICS treatment. This suggests that when evaluating patients' adherence, it is important to ensure that study population includes only patients with reliable asthma diagnoses and need for regular ICS medication [36]. In addition, when assessing long-term adherence to ICS, major variability in annual rates of adherence should be considered and, therefore, follow-up periods should be set long enough.…”

Section: Discussionmentioning

confidence: 99%

12-year adherence to inhaled corticosteroids in adult-onset asthma

et al. 2020

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Adherence to inhaled corticosteroids (ICS) has been suggested to be poor but long-term follow-ups are lacking. The objective of the present study was to assess adherence to ICS treatment in patients with adult-onset asthma during 12-year follow-up.A total of 181 patients with clinically confirmed, new-onset adult asthma were followed for 12 years as part of the Seinäjoki Adult Asthma Study. Adherence to ICS was assessed individually as the percentage of true dispensed ICS in micrograms per true prescribed daily ICS in micrograms over 12 years.Mean 12-year adherence to ICS was 69% (mean±sd dispensed 2.5±1.8 g and prescribed 3.6±1.5 g budesonide equivalent per patient for 12 years), annual adherence varying between 81% (year 1) and 67% (year 12). Patients with good 12-year adherence (≥80%) used oral corticosteroids more often, and had add-on drugs in use and asthma-related visits to healthcare more often. In addition, they showed less reversibility in forced expiratory volume in 1 s and had higher peripheral blood neutrophil counts. However, lung function decline was steeper in patients with poorer adherence (<80%) and this association remained in multiple linear regression analysis. No difference was found in symptom scores, blood eosinophil counts, exhaled nitric oxide or immunoglobulin E between the patients with different levels of adherence.In patients with adult-onset asthma, adherence to ICS was moderate. Poorer adherence (<80%) to ICS was associated with more rapid decline in lung function but was not associated to symptoms or markers of inflammatory endotypes.

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“…We found evidence supporting the fact that an objective confirmation is important to ensure correct diagnosis, treatment, and follow-up. Furthermore, a recent, yet unpublished, study indicates that asthmatics that did not receive a thorough and objectively demonstrated asthma diagnosis are less likely to use the prescribed anti-asthmatic treatment (93). There are several different tests that can be used in the diagnosis of asthma, and the various diagnostic tests have overlapping diagnostic patterns reflected by differences in the sensitivity, specificity, positive predictive value, and the negative predictive value.…”

Section: Summary and Discussion Of The Main Findingsmentioning

confidence: 99%

“…An incorrect diagnosis implies a risk of over-medication and illness behaviour while under-diagnosis results in increased morbidity. A correct diagnosis not only reduces the risks of over-treatment and under-treatment but also seems to affect patients’ understanding of their disease: patients with ‘objectively’ demonstrated asthma were more likely to adhere to their controller medications compared with patients without objectively demonstrated asthma (93). …”

Section: Introductionmentioning

confidence: 99%

The Danish National Database for Asthma: establishing clinical quality indicators

Hansen

Hoffmann-Petersen

Sverrild

et al. 2016

European Clinical Respiratory Journal

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Asthma is one of the most common chronic diseases worldwide affecting more than 300 million people. Symptoms are often non-specific and include coughing, wheezing, chest tightness, and shortness of breath. Asthma may be highly variable within the same individual over time. Although asthma results in death only in extreme cases, the disease is associated with significant morbidity, reduced quality of life, increased absenteeism, and large costs for society. Asthma can be diagnosed based on report of characteristic symptoms and/or the use of several different diagnostic tests. However, there is currently no gold standard for making a diagnosis, and some degree of misclassification and inter-observer variation can be expected. This may lead to local and regional differences in the treatment, monitoring, and follow-up of the patients. The Danish National Database for Asthma (DNDA) is slated to be established with the overall aim of collecting data on all patients treated for asthma in Denmark and systematically monitoring the treatment quality and disease management in both primary and secondary care facilities across the country. The DNDA links information from population-based disease registers in Denmark, including the National Patient Register, the National Prescription Registry, and the National Health Insurance Services register, and potentially includes all asthma patients in Denmark. The following quality indicators have been selected to monitor trends: first, conduction of annual asthma control visits, appropriate pharmacological treatment, measurement of lung function, and asthma challenge testing; second, tools used for diagnosis in new cases; and third, annual assessment of smoking status, height, and weight measurements, and the proportion of patients with acute hospital treatment. The DNDA will be launched in 2016 and will initially include patients treated in secondary care facilities in Denmark. In the nearby future, the database aims to include asthma diagnosis codes and clinical data registered by general practitioners and specialised practitioners as well.

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Objective confirmation of asthma diagnosis improves medication adherence

Abstract: Objective verification of a diagnosis of asthma using asthma tests was associated with an improved redemption of prescription.

Cited by 13 publications

References 24 publications

Assessment of adherence to asthma controllers in children and adolescents

Assessment of adherence to asthma controllers in children and adolescents

12-year adherence to inhaled corticosteroids in adult-onset asthma

The Danish National Database for Asthma: establishing clinical quality indicators

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