Poor asthma control in those who endorse integrative medicine

Published Online August 13, 2014

Despite the availability of effective prescription treatments, poorly controlled asthma is common, particularly in minority and low-income populations. Integrative medicine, which uses therapies originating outside of mainstream medicine, is widely endorsed in place of (alternative) or in addition to (complementary) prescription therapies. For example, ethnic and racial minority populations commonly employ prayer and culturally-relevant home remedies for asthma. Patient and provider discussions about preferences for asthma self-care that includes complementary and alternative medicine (CAM) and/or prescription therapies do not routinely occur. However, these discussions are needed to help align patient preferences with evidence-based treatment recommendations.

In a recent study published in The Journal of Allergy and Clinical Immunology, M. George and colleagues describe the largest study to date of medication and CAM beliefs in Black adults, demonstrating a relationship between CAM endorsement and uncontrolled asthma.
In this study, the researchers developed a brief self-administered screening instrument with low literacy demands to identify the prevalence of negative prescription medication beliefs and CAM endorsement in 337 urban minority adults with persistent asthma, many with uncontrolled disease (69%). CAM for asthma self-care was widely endorsed (93%) and negative beliefs about prescription therapies for asthma were common (68%). Endorsing CAM significantly increased the odds of having uncontrolled asthma (each one unit increase in the CAM endorsement score increased the odds of having uncontrolled asthma by 45%).
Digital recordings of 33 routine office visits for asthma were made. At half of these visits providers received information about their patients’ negative medication beliefs and CAM endorsement immediately prior to the visit; at the other half, the survey was administered after the visit. When patients’ beliefs were known, providers initiated a conversation about these beliefs with their patients providing preliminary evidence that identifying beliefs may prompt critically important clinical discussions about their role in uncontrolled asthma. Visits at which beliefs were discussed were not longer than the “typical” visits.

Negative medication beliefs and CAM endorsement are associated with uncontrolled asthma. If patients complete a brief survey that identifies beliefs that likely undermine asthma medication adherence, providers may be able to change the content of communication during clinic visits to promote better asthma control. These data support the need for clinical models of care to enhance patient-provider communication of the risks and merits associated with self-care decisions to help reconcile difference in patients’ preferences and evidence-based recommendations. Approaches such as these offer a compelling opportunity to deliver patient-centered care.

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.

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