Enhancing patient adherence to asthma therapy
- Andrea J Apter, MD, MSc, MA
Andrea J Apter, MD, MSc, MA
- Professor of Medicine
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine
- Perelman School of Medicine, University of Pennsylvania
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 . 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.
Strategies to enhance adherence to asthma therapy will be reviewed here. An approach to asthma management, a discussion of what patients need to know about their asthma, and the role of peak flow monitoring are discussed separately. (See "An overview of asthma management" and "What do patients need to know about their asthma?" and "Peak expiratory flow rate monitoring in asthma".)
REASONS FOR NONADHERENCE
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 . Social barriers such as complicated work schedules, caring for other family members, or even the perceived safety of the neighborhood can all affect adherence . Finally, stress, depression, and comorbidities can all influence adherence [9-11].
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