Patient tool helps determine adherence to asthma medication
Research Activities, June 2010, No. 358
An important component of managing persistent asthma is the daily use of inhaled corticosteroids (ICS) to reduce airway inflammation. Low-income, minority patients show lower rates of adherence to these medications. A short questionnaire can help doctors determine if poor asthma control in this group is due to low medication adherence or to intrinsic severe asthma despite medication adherence, finds a new study. Researchers gave a 10-item questionnaire to 318 patients with asthma who were receiving care at 2 inner-city clinics; 53 percent had prior asthma hospitalizations and 70 percent had prior oral steroid use.
Each item was framed as a negative statement about using inhaled asthma medications, such as "I only use it when I feel breathless," or "I stop taking it for a while." Patients could respond with one of five answers, ranging from always to never. Additional information was also gathered on hospitalizations, clinical history, and demographics. Patients were given the questionnaire at baseline and then again at 1 and 3 months. The researchers used an electronic monitor attached to the inhaler to calculate the percentage of days patients used ICS.
The new tool measured adherence rates effectively for the English- and Spanish-speaking, low-income minority patients. It also correlated well with the electronic adherence method, considered the gold standard for measuring adherence to ICS. High self-reported adherence on the questionnaire predicted high electronic adherence. In the electronic group, patients used ICS 52 percent of days. Self-reported adherence was higher in those saying that daily ICS use was important and that ICS were controller medications. The study was supported in part by the Agency for Healthcare Research and Quality (HS13312).
See "Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: The Medication Adherence Report Scale for Asthma," by Jessica L. Cohen, B.A., Devin M. Mann, M.D., Juan P. Wisnivesky, M.D., M.P.H., and others in Annals of Allergy, Asthma & Immunology 103, pp. 325-331, 2009.