Repeated Instruction on Inhalation Technique Improves Adherence to the Therapeutic Regimen in Asthma

Takemura, Masashi; Kobayashi, Michiru; Kimura, Kiyomi; Mitsui, Katsumi; Masui, Hiroko; Koyama, Misuzu; Itotani, Ryo; Ishitoko, Manabu; Suzuki, Shinichi; Aihara, Kensaku; Matsumoto, Masataka; Oguma, Tsuyoshi; Ueda, Tetsuya; Kagioka, Hitoshi; Fukui, Motonari

doi:10.3109/02770900903581692

Cited by 81 publications

(95 citation statements)

References 35 publications

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“…Fiftytwo (46%) of 114 patients with asthma were accordingly classified as non-adherent, which is similar to the rate reported in our previous study (24,29). Age is associated with adherence to asthma inhalation treatment, with some studies revealing younger patients to be more non-adherent than older adults (29)(30)(31). Middleaged (50 to 64 years old) asthmatic patients were more than 30% less likely to use daily asthma medication compared to adults aged ≥65 years in the United States (32).…”

Section: Discussionsupporting

confidence: 75%

“…This cut-off score enabled us to identify patients who were non-adherent to inhaled medicine and resulted in a reliable AUC. Fiftytwo (46%) of 114 patients with asthma were accordingly classified as non-adherent, which is similar to the rate reported in our previous study (24,29). Age is associated with adherence to asthma inhalation treatment, with some studies revealing younger patients to be more non-adherent than older adults (29)(30)(31).…”

Section: Discussionsupporting

confidence: 71%

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Optimal cut-off value and clinical usefulness of the Adherence Starts with Knowledge-12 in patients with asthma taking inhaled corticosteroids

Takemura¹,

Nishio²,

Fukumitsu³

et al. 2017

J. Thorac. Dis.

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Background: Non-adherence to inhalation regimens is common in asthmatic patients. The Adherence Starts with Knowledge-12 (ASK-12) survey was developed to detect and address patient-specific barriers to medication adherence. Our objective is to investigate the clinical usefulness of the ASK-12 for assessing and addressing adherence to inhalation therapy in asthma. Methods: The ASK-12 was administered to 138 asthmatic patients. Using pharmacy-refill data, we examined the cut-off value of the ASK-12 to identify patients who were non-adherent to inhalation regimens and identify factors associated with non-adherence. To verify the usefulness of the ASK-12, inhalation regimens were prospectively switched to less-expensive and simpler (once-daily) dosing regimens in eight non-adherent asthmatic patients who reported specific-barriers in "inconvenience of twice-daily inhaler use" and "cost".Results: Valid responses were received from 114 (82.6%) patients. A significant correlation was found between pharmacy-refill rates and the ASK-12 total score (r=−0.55, P<0.0001). The optimal cut-off value of the ASK-12 total score to discriminate non-adherent patients (defined by pharmacy-refill rate <80%) was 23, with 71.4% specificity and 93.3% sensitivity. Using this value, 52 (45.6%) patients were classified as nonadherent. Univariate followed by multivariate analysis identified younger age as a predictor of non-adherence to inhalation regimens (odds ratio, 2.67; 95% CI, −0.95 to −0.06; P=0.027). Switching inhaled medicines in eight patients resulted in significant improvements in both ASK-12 scores and asthma control. Conclusions:The ASK-12 is a brief, practical, and clinically useful measure for assessing and addressing adherence to inhalation regimens in asthma.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 71%

Optimal cut-off value and clinical usefulness of the Adherence Starts with Knowledge-12 in patients with asthma taking inhaled corticosteroids

Takemura¹,

Nishio²,

Fukumitsu³

et al. 2017

J. Thorac. Dis.

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“…Eight studies examined healthcare team and system factors, with education provision relating to adherence in three out of four results [32,45,67]. Several other variables were examined in fewer than three results: lower adherence was linked to inability to get an appointment when needed in one result [61], to patientprovider communication in one out of two results [34,40], and to the time interval being registered with the same prescriber in one result [81], while receiving a prescription from a specialist versus a generalist was unrelated to adherence [59].…”

Section: Methodsmentioning

confidence: 99%

“…Adherence was mostly unrelated to the number of drugs in the treatment regimen (three out of four results; [63,70,78]), the number of daily doses (five out of seven results; [39,47,64,67,78]), and having reliever inhalers prescribed (four out of five results [34,47,48,64]). Using dry-powder inhalers (DPIs) versus metered-dose inhalers (MDIs) was linked to adherence in two out of four results [66,67].…”

Section: Methodsmentioning

confidence: 99%

Asthma inhaler adherence determinants in adults: systematic review of observational data

et al. 2014

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Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults.We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition-and patient-related factors.The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis.A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further. @ERSpublications Major opportunities for strengthening evidence on determinants of nonadherence to asthma inhalers: methods and theory

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“…Repeated educations result in better inhalation technique and play a key role in successful inhalation therapy (8,9,22,23,25,30,31). It is reported that repeated education about MDI inhalation technique resulted in a statistically significant improvement in MDI technique scores when compared to single education (33,34). Getting a second education besides the one at the time of first prescription increased the rate of correct technique to 91% (33).…”

Section: Resultsmentioning

confidence: 91%

Metered dose inhaler-spacer use education effects on achieve asthma control in children

Türkeli¹,

Yılmaz²,

Yüksel

2016

Tuberk Toraks

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Repeated Instruction on Inhalation Technique Improves Adherence to the Therapeutic Regimen in Asthma

Abstract: Repeated instruction on inhalation techniques may contribute to adherence to inhalation therapy through decreasing intentional nonadherence. Furthermore, good adherence to the therapeutic regimen may offer good asthma-related outcomes.

Cited by 81 publications

References 35 publications

Optimal cut-off value and clinical usefulness of the Adherence Starts with Knowledge-12 in patients with asthma taking inhaled corticosteroids

Optimal cut-off value and clinical usefulness of the Adherence Starts with Knowledge-12 in patients with asthma taking inhaled corticosteroids

Asthma inhaler adherence determinants in adults: systematic review of observational data

Metered dose inhaler-spacer use education effects on achieve asthma control in children

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