Published Online: July 22, 2014
Controller inhalers are highly effective in reducing the burden and risk of asthma, but many patients do not use them regularly. This poor adherence contributes to uncontrolled symptoms, impaired quality of life, flare-ups, urgent doctor visits and loss of life. General practitioners (GPs) identify poor adherence with controller inhalers as a major barrier to the delivery of effective asthma care, yet practical adherence interventions are lacking.
In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Foster and colleagues conducted a 6-month cluster randomized controlled trial which tested the effectiveness of two GP-delivered interventions designed to tackle poor medication-taking routines and/or patients’ concerns about inhaler use. The participants were split into four groups. One group received automated twice-daily inhaler reminders for missed doses plus adherence feedback via a monitoring device clipped to the inhaler, and a secure website accessible by patients and their GP; the reminders could be customized or stopped by patients. A second group engaged in personalized adherence discussions with their doctors about key barriers to medication-taking; a third group received both interventions. A fourth group received active usual care alone; all GPs received brief action plan and inhaler technique training. For all patients, electronic inhaler monitors remotely uploaded adherence data for analysis.
In this first ever study in primary care, patients receiving reminders took on average 73% of their prescribed daily doses over 6 months compared to only 46% in patients who did not have reminders. Further, although there was no difference in symptom control between groups, severe flare-ups were experienced significantly less by patients receiving reminders than those not receiving them (11% versus 28%). There were no differences between groups receiving or not receiving personalized adherence discussions. Half of participating patients and GPs lived or practiced in a socially disadvantaged location.
The authors’ findings demonstrate that reminders and feedback for controller inhaler use significantly improve treatment adherence for at least six months, and are considered acceptable and feasible by asthma patients and GPs in real-world primary care settings.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.