Patient-Selected Treatment Goals in Severe Asthma

Semin Respir Crit Care Med

Hale

et al. 2022

Self Cite

In little over a generation, the ingenuity of scientists and clinician researchers has developed inhaled medications and pathway-specific biological agents that control the inflammation and physiology of asthma. Unfortunately, whether it is because of cost or difficulty understanding why or how to use inhaled medications, patients often do not take these medications. The consequences of poor treatment adherence, loss of control and exacerbations, are the same as if the condition remained untreated. Furthermore, poor adherence is difficult to detect without direct measurement. Together this means that poor treatment adherence is easily overlooked and, instead of addressing the cause of poor adherence, additional medicines may be prescribed. In other words, poor treatment adherence is a risk for the patient and adds cost to healthcare systems. In this article, we discuss the rationale for and the delivery of successful interventions to improve medication adherence in asthma. We contextualize these interventions by describing the causes of poor treatment adherence and how adherence is assessed. Finally, future perspectives on the design of new interventions are described.

Section: Causes Of Poor Treatment Adherencementioning

confidence: 99%

Section: Interventions Designed To Address Intentional Nonadherencementioning

confidence: 99%

Improving Medication Adherence in Asthma

Kerr

Semin Respir Crit Care Med

Hale

et al. 2022

Self Cite

“…In another large cohort of patients with severe asthma, it was noted that nearly half of the treatment goals identified by patients did not align with those deemed important by physicians. It was also noted that, once a patient had achieved their own personal goals for treatment (as opposed to a particular score on the ACT), there was a subsequent decline in adherence to ICS/long-acting β-agonist (LABA) therapy [ 10 ]. This is illustrated in figure 1 , which graphs the ACT score and adherence rates (on the y-axis) against time.…”

Section: Is It Just a Question That Some People Do Not Take Their Trementioning

confidence: 99%

“… The relationship between ACT scores and adherence in participants who a) did or b) did not achieve their goals. Reproduced and modified from [ 10 ] with permission. …”

Section: Is It Just a Question That Some People Do Not Take Their Trementioning

confidence: 99%

The clinical impact of adherence to therapy in airways disease

Mulvey

Costello

2021

Breathe

Self Cite

For a physician, the final step of a consultation consists of developing a treatment plan and prescription. For the patient, this is the start of a process. First, their role in the treatment plan must be clarified, then they may have to obtain an alternative prescription from their general practitioner. Next, they must have the prescription filled and dispensed from the pharmacy and, finally, they must take the treatment on time and for the required duration. For people with chronic conditions, this requires repeatedly returning to the pharmacy for the prescription to be renewed and dispensed. Given that many patients are on multiple treatment regimens and may have poor health literacy, this becomes a complex process and it is not surprising that this can, and frequently does, go wrong.Research shows that when a patient does not adhere to standard asthma or COPD treatment, they report poor control and overuse of rescue β-agonists, experience frequent exacerbations and are often prescribed add-on treatments such as biological agents. In short, poor treatment adherence can manifest in the same way as a refractory condition.These clinical features should prompt a clinician to investigate poor adherence as they might investigate a new blood or radiological finding. Examining a patient's prescription refill records or a digitally enabled inhaler can demonstrate a number of patterns of inhaler use. A small minority regularly use their treatment as prescribed but many appear to be “cluster users”: a group of patients who use their treatment correctly when they are unwell, but once some level of personal control is attained, they cease or reduce their use. Others may cease using their treatment because they are not perceiving a benefit or because an alternative condition accounts for their symptoms. In other words, clinicians can consider that treatment adherence is like a clinical sign: something to be investigated so that they may understand the patient's condition better.Educational aimsTo highlight the clinical consequences of poor adherence to standard treatments for airways diseases.To describe how poor treatment adherence manifests as complications of the condition.To highlight that when a patient does not benefit as might be expected from a treatment, poor adherence should be considered and evaluated for, before more treatment is added.

“…These fluctuations in symptoms can make it difficult for patients to see a relationship between treatment adherence and clinical symptoms. Recently, Mulvey et al ( 12 ) have shown that once a patient achieves their personal asthma treatment goal, there is a subsequent decline in adherence ( Figure 1 ). These data indicate how person-specific behaviors can influence treatment adherence.…”

Section: Causes Of Poor Adherence To Inhaled Treatmentmentioning

confidence: 99%

A Clinical Perspective on the Role of Electronic Devices in Monitoring and Promoting Adherence in Airways Disease

Mulvey

Greene

et al. 2021

Front. Med. Technol.

Self Cite

Poor adherence to treatment is a common reason why patients with chronic disease have worse outcomes than might be expected. Poor treatment adherence is of particular concern among people with airways disease because, apart from not taking treatment as prescribed, inhaled medication can also be administered incorrectly. Recently, a number of technological advances that accurately document when an inhaled treatment has been used and, in certain instances, how it was used have been developed. There is good evidence from a number of research groups that these devices, either by patient reminders or physician feedback, promote adherence to inhaled treatments. What is less certain is how, in a real-world setting, these devices change outcomes. In this perspective article, the role of electronic devices in quantifying treatment use and addressing poor treatment adherence and their potential role in clinical practice outside of clinical validation trials are described.