Published Online: April 15, 2013
Although drug therapies have greatly improved asthma control, only approximately 50% of individuals with asthma actually follow recommendations to take the medications as prescribed. Poor adherence to treatment is a significant cause of lost work and school, lessened quality of life, and avoidable emergency department visits, hospitalizations, and mortality. Physicians usually must rely on patient history to diagnose their adherence status since objective measures are not generally available, but many patients overestimate medication adherence, especially regarding inhaled corticosteroids.
Recently, in The Journal of Allergy and Clinical Immunology: In Practice, Michael Schatz, MD, MS and colleagues report the results of a study from Kaiser Permanente Medical Center in San Diego in which a practical questionnaire was developed that reflects non-adherence risk and identifies potential adherence barriers. A questionnaire that included 20 potential adherence questions was completed by mail by 420 adult asthma patients who filled a prescription for an inhaled corticosteroid (ICS) and a short-acting beta agonist (SABA) in the prior 6 months. Questions without skewed response patterns that were significantly related to self-reported low adherence or prior ICS canister dispensings were identified. Relationships of these questions to Asthma Control Test (ACT) scores, future percent of days covered (PDC) for ICS dispensings, and future oral corticosteroid (OCS) and SABA dispensings were determined.
Five final questions were identified: following “my medication plan,” forgetting to take the medications, not “needing” the medications, side effects, and cost. The relationships of the questions to each other suggested the items should not be summarized by a single score. The responses to each of the 5 questions correlated with ACT scores. Following the medication plan, forgetting, and not needing medication were significantly related to future PDC. Side effects were related to subsequent SABA and OCS dispensings, and cost was significantly related to OCS dispensings.
The authors suggest that these five questions may provide a practical tool that can be used clinically to identify patients at risk of non-adherence and the specific adherence barriers involved. Further studies will be necessary to provide additional validation data in more diverse populations and to show that interventions in response to adherence problems identified by these questions improve asthma outcomes
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.