Altering the Course of Asthma
Overcoming barriers to nonadherence in asthma treatment,☆☆

https://doi.org/10.1067/mai.2002.124570Get rights and content

Abstract

Inadequate patient adherence to prescribed treatment regimens is a major cause of poor clinical outcomes in the treatment of asthma. Among children with asthma, adherence rates are often below 50%. Multiple treatment-, clinician-, and patient-related barriers prevent the achievement of satisfactory levels of adherence. Treatment-related barriers include prolonged and complex regimens, adverse effects, cost, and delayed onset of action. Clinician-related barriers include difficulty in scheduling, treatment by one different care giver after another, perceived clinician disinterest, and time constraints. Patient-related barriers include mild or severe asthma, poor understanding of the need for treatment, insufficient confidence in the clinician or medication, the presence of psychological problems, and low motivation to change behavior. Although all of these factors must be addressed to maximize adherence, patient motivation may be the most critical. This task falls primarily to clinicians (physicians, nurses, staff), and it requires thorough patient and care giver education, more frequent patient contact, and the development of a patient-clinician partnership dedicated to the effective treatment of asthma. (J Allergy Clin Immunol 2002;109:S554-9.)

Section snippets

Nonadherence in children

Recent studies have demonstrated that poor adherence is a pervasive and endemic clinical problem in children. Adherence rates among 27 children with asthma were examined over a 6-month period in a study that used the Doser (MEDITRACK Products, Hudson, Mass) CT (Doser Clinical Trials version). This is a bottle cap device that attaches to the top of an inhaler and automatically monitors usage over a 45-day period.5 Objective data derived from the Doser CT were compared with other adherence

Treatment-related barriers to adherence

Patient nonadherence stems from a number of perceptions of and attitudes toward treatment.

Clinician-related barriers to adherence

Certain factors involving the physician or the setting of the physician's practice can encourage or discourage adherence.

Patient-related barriers to adherence

Attitudes and emotions the patient brings to the treatment formula may determine whether he or she will be adherent.

Strategies for promoting adherence

It is obviously not enough just to write a prescription, even for an effective and convenient medication. The patient's ability to adhere to a therapeutic regimen improves when clinicians address as many factors as possible.

Conclusions

Without substantial, long-term adherence, no medication, no matter how effective, can make the full therapeutic contribution needed to control a debilitating and increasingly prevalent chronic disease such as asthma. Treatments that are easier to take invite better adherence. Patients are better motivated to adhere to a therapy regimen when they understand their illness, have faith in their physicians and treatment, and are free of psychological disorders. Improving a patient's motivation is

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Dr Bender has been a member of the speakers bureau for Merck, Glaxo Wellcome, and Schering-Plough.

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Reprint requests: Bruce G. Bender, PhD, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206.

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