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. 2018 Apr 4;51(4):1701836.
doi: 10.1183/13993003.01836-2017. Print 2018 Apr.

Nonadherence in the era of severe asthma biologics and thermoplasty

Joy Lee  1   2 , Tunn Ren Tay  1 , Naghmeh Radhakrishna  1 , Fiona Hore-Lacy  1 , Anna Mackay  1 , Ryan Hoy  1   2 , Eli Dabscheck  1   3 , Robyn O'Hehir  1   3 , Mark Hew  1   2
Affiliations

Nonadherence in the era of severe asthma biologics and thermoplasty

Joy Lee et al. Eur Respir J. .

Abstract

Nonadherence to inhaled preventers impairs asthma control. Electronic monitoring devices (EMDs) can objectively measure adherence. Their use has not been reported in difficult asthma patients potentially suitable for novel therapies, i.e. biologics and bronchial thermoplasty.Consecutive patients with difficult asthma were assessed for eligibility for novel therapies. Medication adherence, defined as taking >75% of prescribed doses, was assessed by EMD and compared with standardised clinician assessment over an 8-week period.Among 69 difficult asthma patients, adherence could not be analysed in 13, due to device incompatibility or malfunction. Nonadherence was confirmed in 20 out of 45 (44.4%) patients. Clinical assessment of nonadherence was insensitive (physician 15%, nurse 28%). Serum eosinophils were higher in nonadherent patients. Including 11 patients with possible nonadherence (device refused or not returned) increased the nonadherence rate to 31 out of 56 (55%) patients. Severe asthma criteria were fulfilled by 59 out of 69 patients. 47 were eligible for novel therapies, with confirmed nonadherence in 16 out of 32 (50%) patients with EMD data; including seven patients with possible nonadherence increased the nonadherence rate to 23 out of 39 (59%).At least half the patients eligible for novel therapies were nonadherent to preventers. Nonadherence was often undetectable by clinical assessments. Preventer adherence must be confirmed objectively before employing novel severe asthma therapies.

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Conflict of interest statement

Conflict of interest: M. Hew received an unrestricted grant from GlaxoSmithKline (GSK) during the conduct of the study to purchase adherence monitoring devices (GSK had no role or input into the design, conduct, analysis or reporting of the study); and has received grants from AstraZeneca (unrestricted grant to develop an electronic clinic template) and Novartis (unrestricted grant to host a severe asthma preceptorship), personal fees for advisory board participation from GSK, Seqirus and AstraZeneca; and has undertaken contracted research on behalf of AstraZeneca, Novartis, GSK and Sanofi, outside the submitted work; all for which his employer Alfred Health has been reimbursed.

Figures

FIGURE 1
FIGURE 1
Patients eligible for novel asthma therapies: biologics and bronchial thermoplasty (47 out of 69). IL: interleukin.
FIGURE 2
FIGURE 2
Patient flow through each stage of the study.
FIGURE 3
FIGURE 3
Patients with unknown adherence, confirmed adherence, possible nonadherence and confirmed nonadherence in a) all 69 difficult asthma patients and b) the 47 patients eligible for novel asthma therapies (biologics or thermoplasty).
FIGURE 4
FIGURE 4
Detection of nonadherence by subjective methods in 45 difficult asthma patients with objective data from the electronic monitoring device (EMD).
See this image and copyright information in PMC

Comment in

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