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Allied Health: Articles of Interest

Steroid phobia and asthma
By Stuart Tousman, PhD; Howard Zeitz, MD, FAAAAI; and Chris Wagner, MSN,CPNP,AE-C

The term “steroid phobia” has been used by healthcare professionals (HCPs) to characterize a patient’s fears of taking daily inhaled corticosteroids. Many HCPs believe that these fears lead to a lack of medication adherence.

Adherence to controller medication is a major issue in the field of asthma. Prior research has indicated that individuals with persistent asthma have no more than 40% adherence with controller medications.

In order to understand how HCPs can assist patients with this fear, we must first understand the differences in knowledge between HCPs and patients. According to cognitive psychology, we organize our knowledge into mental representations called schemas. The schema for HCPs indicates a differentiation between oral corticosteroids and inhaled corticosteroids. The HCP with such a schema will probably recommend an inhaled corticosteroid as the controller medication to patients with persistent asthma.

The schema for the asthma patient frequently is constructed from personal experiences and other sources of potentially unreliable information. Research on steroid phobia suggests that when asthma patients hear the word “steroid” they do not differentiate between oral corticosteroids, inhaled corticosteroids and anabolic steroids. Instead, the word “steroid” leads to anabolic steroid knowledge representations and to the belief that inhaled corticosteroids will cause weight gain, emotional disturbances and other negative side effects. The patient’s lack of knowledge regarding the difference between the medications, as well as other information are strong reasons why patients do not adhere to their controller medication treatment plans.

Overcoming steroid phobia and increasing adherence
The key to overcoming steroid phobia and increasing adherence with asthma treatment plans is to use effective teaching techniques when meeting with patients. Motivational interviewing is one technique that has been found to be useful in increasing medication adherence. The principles for motivational interviewing include:

  1. Ask your patients open-ended questions and use effective non-verbal cues. You will be able to tap the patient’s emotional and cognitive asthma schemas by asking open-ended questions. By establishing eye contact, paying attention and nodding your head, you are validating their statements and developing a more trusting relationship.
  2. Develop discrepancies between the patient’s present behaviors/health and potential advantages of increasing use of an inhaled corticosteroid controller agent. If a patient knows some basics about the guidelines, and they understand that their behavior is inconsistent with those guidelines, they will develop cognitive dissonance, a state where thoughts are in conflict. Research indicates that cognitive dissonance can lead to behavior change.
  3. Roll with resistance/avoid arguments. Once the discrepancy is developed, motivational interviewing teaches us to roll with any resistance and not get into arguments about the best course of management. Arguing can erode trust and the patient-centered approach that is necessary to lead to effective long-term behavior change.

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