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. 2013 Apr 19:7:329-36.
doi: 10.2147/PPA.S38208. Print 2013.

Nonadherence in difficult asthma - facts, myths, and a time to act

John T Lindsay  1 , Liam G Heaney
Affiliations

Nonadherence in difficult asthma - facts, myths, and a time to act

John T Lindsay et al. Patient Prefer Adherence. .

Abstract

Nonadherence to prescribed treatment is an important cause of difficult asthma. Rates of nonadherence amongst asthmatic patients have been shown to range between 30% and 70%. This is associated with poor health care outcomes and increased health care costs. There is no such thing as a "typical" nonadherent patient. The reasons driving nonadherence are multifactorial. Furthermore, adherence is a variable behavior and not a trait characteristic. Adherence rates can vary between the same individual across treatments for different conditions. There is no consistent link between socioeconomic status and nonadherence, and although some studies have shown that nonadherence is more common amongst females, this is not a universal finding. The commonly held perception that better adherence is driven by greater disease severity has been demonstrated to not be the case, in both pediatric and adult patients. Identification of nonadherence is the first step. If adherence is not checked, it is likely that poor adherence will be labeled as refractory disease. Failure to identify poor adherence may lead to inappropriate escalation of therapy, including the potential introduction of complex biological therapies. Surrogate measures, such as prescription counting, are not infallible. Nonadherence can be difficult to identify in clinical practice, and a systematic approach using a variety of tools is required. Nonadherence can be successfully addressed. Therefore, assessment of adherence is of paramount importance in difficult asthma management, in order to reduce exacerbations and steroid-related side effects as well as hospital and intensive care admissions, health care cost, and inappropriate treatment escalation. In this paper, we present an overview of the literature surrounding nonadherence in difficult asthma. We explore the facts and myths surrounding the factors driving nonadherence as well as how it can be identified and addressed.

Keywords: compliance; concordance; drug monitoring; inhaled corticosteroids.

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References

    1. Masoli M, Fabian D, Holt S, Beasley R the Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy. 2004;59(5):469–478. - PubMed
    1. Asthma [webpage on the Internet] Geneva: World Health Organization; 2012. [Accessed October 19, 2012]. Available from: http://www.who.int/topics/asthma/en/
    1. Barnes PJ, Woolcock AJ. Difficult asthma. Eur Respir J. 1998;12(5):1209–1218. - PubMed
    1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma; 2010. [Accessed October 20, 2012]. Available from: http://www.ginasthma.org/pdf/GINA_Report_2010.pdf.
    1. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization; 2003. [Accessed October 20, 2012]. Available from: http://whqlibdoc.who.int/publications/2003/9241545992.pdf.

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