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Enhancing patient adherence to asthma therapy

William Bailey, MD
Andrea J Apter, MD, MSc, MA
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


Patient adherence to medical regimens is a major problem in chronic disease management. Adherence to asthma medication regimens tends to be very poor, with the reported rates of nonadherence ranging from 30 to 70 percent [1-3]. Up to three-quarters of the total costs associated with asthma may be due to poor asthma control. Improved patient adherence may lead to improvements in asthma control and quality of life [4]. The role of the clinician is to adequately inform the patient about the prescribed regimen, and to discuss the importance of adherence even in the absence of symptoms. In the patient who subsequently manifests nonadherence, the clinician should explore with the patient barriers to adherence and methods to overcome these barriers.


A number of factors are associated with nonadherence to asthma therapy [1,2,5,6]. Medication-related factors include difficulties with inhaler devices, complex regimens, side effects, cost of medication, dislike of medication, and distant pharmacies.

Factors unrelated to medications include misunderstanding or lack of instruction, fears about side effects, dissatisfaction with health care professionals, unexpressed/undiscussed fears or concerns, inappropriate expectations, poor supervision/training or follow-up, anger about one's condition or its treatment, underestimation of severity, cultural issues, stigmatization, forgetfulness or complacency, attitudes toward ill health, and religious issues [7]. Social barriers such as complicated work schedules, caring for other family members, or even the perceived safety of the neighborhood can all affect adherence [8]. Finally, stress, depression, and comorbidities can all influence adherence [9-11].

Several other reasons make adherence to asthma treatment recommendations problematic: medication regimens are of long duration and include multiple medicines; dosing may occur on both a fixed schedule and an as needed basis; and patients go through periods of symptom remission [3].

A number of types of nonadherence can interfere with therapy, including underuse, overuse, or erratic use [1,12]. Underuse of asthma medications appears to be more common than overuse [13,14]. In a study comparing self-reported use of inhaled medications recorded in a diary to actual use determined by an electronic monitor of inhaler activation, it was found that subjects were not as compliant as they reported to be in their diaries [15]. Another study found that inhaled beta agonists are no more likely to be overused than anti-inflammatory agents [16]. This observation tends to dispel the concern that patients will overuse inhaled beta agonists because of their fast symptom relief.


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Literature review current through: Sep 2016. | This topic last updated: Aug 4, 2015.
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