Many asthma attacks due to patients not using their medication
Published Online: October 24, 2011
Inhaled corticosteroids are considered the most effective treatment for controlling asthma symptoms and preventing asthma attacks. Yet, poor adherence to prescribed inhaled corticosteroid (ICS) medication by patients is common. Measuring the contribution of this medication underuse to asthma attacks is difficult since patients with asthma often take their medication episodically based on their waxing and waning symptoms.
In original research featured in The Journal of Allergy & Clinical Immunology (JACI), Williams et al. were able to measure the contribution of ICS non-adherence to severe asthma exacerbations in the well characterized SAPPHIRE cohort. The SAPPHIRE cohort is a large, diverse population of patients with asthma from the Detroit metropolitan area who receive care at Henry Ford Health System.
Medication adherence was estimated using detailed electronic prescription and pharmacy fill data. Investigators assessed asthma severity and control through patient questionnaires, medical records for prior of asthma attacks, measured lung function, and patterns of short-acting rescue medication use. A severe asthma attack was one requiring an emergency room visit, admission to the hospital, or treatment with rescue doses of oral corticosteroids.
Accounting for variations in ICS use and asthma severity over time, the study found that approximately 24% of all severe asthma attacks could be attributed to patient non-adherence. Moreover, the benefit of inhaled corticosteroids was largely confined to individuals whose inhaled corticosteroid use exceeded >75% of the prescribed amount and to those whose asthma was poorly controlled initially. These findings evince the large contribution of medication non-adherence to severe asthma exacerbations, and the need for sustained, high levels of ICS medication use rather than low-level, periodic use to avert severe asthma attacks.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.