Assessing Adherence to Inhaled Corticosteroids Among Adults with Asthma in Kuwait Using the Medication Adherence Report Scale for Asthma

Asthma medication adherence, control, and psychological symptoms: a cross-sectional study

BACKGROUND

Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control.

METHODS

We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control.

RESULTS

A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: - 0.48 to - 0.24; p < 0.001, respectively).

CONCLUSIONS

The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes.

A Systematic Review of Patient-Reported Adherence Measures in Asthma: Which Questionnaire Is Most Useful in Clinical Practice?

BACKGROUND

Suboptimal adherence to inhaled corticosteroid in asthma is a worryingly prevalent yet modifiable factor in uncontrolled disease. Several objective measures of adherence exist, but they are time-consuming. The use of patient-reported adherence measures (PRAMs) could therefore offer a time-efficient pragmatic approach to assessing adherence in clinical practice and potentially the appropriate interventions to improve it.

OBJECTIVES

To identify the PRAMs available for asthma and assess their psychometric quality, accessibility, and usefulness in clinical practice, as well as to provide recommendations for clinicians based on these findings.

METHODS

We conducted a systematic review of six databases. Articles included in this study were English language, full-text, original, asthma-specific PRAMs or development/validation studies of a generic PRAM that had been administered to adults with asthma, investigated inhaled corticosteroid adherence in adults (aged 18 years and older), and assessed at least one COnsensus-based Standards for the selection of health Measurement INstruments measurement property.

RESULTS

We included 15 PRAM developmental and/or validation studies in this systematic review. Studies evaluated a range of COnsensus-based Standards for the selection of health Measurement INstruments measurement properties, but none evaluated all of them.

CONCLUSIONS

Based on this review, we recommend that when a PRAM is used, it should be the Test of the Adherence to Inhalers. However, the Adherence Starts with Knowledge-20 and Adherence Starts with Knowledge-12 may also be useful. Our results highlight the need for PRAM developers to assess questionnaires robustly and provide guidance for clinicians regarding how to act on PRAM answers by developing materials such as decision support tool kits.

Correlation Analysis of the Therapy Adherence to Long-Acting Inhalers Among Patients with Stable COPD

Purpose

Long-acting inhalers are the mainstay maintenance therapy for stable chronic obstructive pulmonary disease (COPD) management. The aim of this study was to assess adherence to inhalers among adults with COPD in China and to develop strategies to improve adherence for the next step.

Patients and Methods

A cross-sectional study was conducted among 246 adult patients with COPD using long-acting inhalers to explore different demographic characteristics, disease characteristics and medication regimens. Adherence to inhalers was assessed using the Medication Adherence Report Scale (MARS).

Results

Among the 246 patients included in the present study, 93 (37.80%) had good adherence, while 153 (62.20%) had poor adherence. From the comparison of patients with good and poor adherence, we found that the course of disease and education background had a significant effect on adherence (p < 0.05). Among the LAMA therapy group, inhaled tiotropium bromide spray (Ingelheim am Rhein, Germany) with active release technology had better adherence than inhaled tiotropium bromide powder (Ingelheim am Rhein, Germany) (p < 0.05). Moreover, COPD patients with good adherence had better pulmonary function and fewer moderate or severe exacerbations in the past year (p < 0.05).

Conclusion

The factors affecting the use of inhalers in patients with stable COPD are complicated. Medical staff should select appropriate inhalers according to the patient's disease status and duration and provide medication education to improve adherence.

Adherence to Inhaled Corticosteroid Therapy and Its Clinical Impact on Asthma Control in Adults Living with Asthma in Northwestern Ethiopian Hospitals

BACKGROUND

Inhaled corticosteroids (ICS) are the backbone of and primary choice for long-term asthma control therapy; however, the level of adherence to this regimen has not yet been investigated, particularly in the study area of Northwest Ethiopia. Therefore, this study aimed to examine the level of adherence to ICS treatment and its impact on adults living with asthma in Northwestern Ethiopian hospitals.

MATERIALS AND METHODS

A multicenter institution-based survey was conducted in asthma patients treated with ICS-based regimens in public hospitals in Northwest Ethiopia. Adherence to ICS was measured with the Medication Adherence Report Scale for Asthma. Descriptive statistics were used to present respondents' characteristics, and logistic regression was used to test associations between predictors and outcome variables. A level of p<0.05 was used as a cut-off point for a significant association.

RESULTS

Of a total of 422 approached subjects, 96.7% completed the survey. The mean (±SD) age of the participants was 49.82 (±16.1) years. The majority of participants (86.1%) had a low level of adherence to ICS treatment. A significant proportion (42%) of the respondents reported that they utilized ICS only before performing exercises that made them breathless. Around two-fifths of the participants used ICS either when they needed it or when they felt breathless. Furthermore, one-third of the study subjects reported that they either avoided or forgot to take ICS. Participants who had access to free healthcare services had better adherence to ICS (p=0.01), and non-adherence to ICS therapy was significantly associated with poor levels of asthma control (p≤0.001).

CONCLUSION

This study found that adult patients with asthma had low levels of adherence to ICS therapy. Future prospective research in a larger population, focusing on identifying the obstacles to ICS adherence in patients living with asthma and creating successful intervention options, is recommended.

Relationships between symptom control, medication management, and health literacy of patients with asthma in Vietnam

Background

Asthma is a significant health issue among Vietnamese adults in both urban and rural areas. The disease needs serious concern to minimize impact and improve the situation.

Objective

This study aimed to describe the level of health literacy, symptom control, and medication management and determine the relationships among them in patients with asthma in Da Nang, Vietnam.

Methods

A cross-sectional descriptive study was conducted among 84 patients with asthma. The questionnaires were used in this study, including demographic form, the Short-Form Health Literacy questionnaire (HL-SF12), Asthma Control Test (ACT), and Medication Adherence Reporting Scale for Asthma (MARS-A). Pearson product-moment correlation was applied to determine the relationship between health literacy, symptom control, and medication management.

Results

The score revealed for general-health literacy, symptom control, and medication management were 28.70 (SD = 9.66), 17.72 (SD = 4.67), and 3.63 (SD = 0.75), respectively. Health literacy level had moderate positive relationships with symptom control (r = 0.41) and medication management (r = 0.44).

Conclusion

The patients had limited health literacy, partially controlled symptom, and poor adherence to the medication. Health literacy level had moderate positive relationships with symptom control and medication management. These findings are crucial for effective treatment and management of the disease in Vietnam. To improve medication management and symptom control among patients with asthma, nurses should concern patients' health literacy level.

Non-adherence to inhaled medications among adult asthmatic patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Medication non-adherence is one of a common problem in asthma management and it is the main factor for uncontrolled asthma. It can result in poor asthma control, which leads to decreased quality of life, increase hospital admission, increased health care utilization, lost productivity, and mortality. To date, there have been no studies and protocols that estimated the pooled national prevalence of non-adherence to inhaled anti-asthmatic medications in Ethiopia. Therefore, the primary purpose of this systematic review and meta-analysis is to determine the pooled national prevalence of non-adherence to inhaled medications among asthmatic patients in Ethiopia.

METHODS

Different database searching engines including PubMed, Scopus, Google Scholar, Africa journal online, World Health Organization afro library, and Cochrane review were systematically searched by using keywords such as "prevalence, non-adherence to inhaled medications, inhaled corticosteroids, and asthmatic patients" and their combinations. Six published observational studies that report the prevalence of non-adherence to inhaled medications were finally selected. The Preferred Reporting Items for Systematic Review and Meta-Analysis guideline was followed. Heterogeneity across the included studies was evaluated by the inconsistency index (I2). The random-effect model was fitted to estimate the pooled prevalence of non-adherence to inhale anti-asthmatic medications. All statistical analysis was done using R version 3.5.3 and R Studio version 1.2.5033 software for windows.

RESULTS

The pooled national prevalence of non-adherence to inhaled medications among asthmatic patients was 29.95% (95% CI, 19.1, 40.8%). The result of this meta-analysis using the random-effects model revealed that there is high heterogeneity across the included studies. The result of subgroup analysis indicates that one out of three in the Oromia region and one out of five in the Amhara region asthmatic patients was non-adherent to their inhaled anti-asthmatic medications.

CONCLUSION

the prevalence of non-adherence to inhaled anti-asthmatic medications was high. Thus, our finding suggests that one out of four asthmatic patients were non-adherent to inhaled medications. The ministry of health, health policymakers, clinicians, and other health care providers should pay attention to strengthening the adherence levels to inhaled anti-asthmatic medications, and country-based interventions should be developed to reduce the burden of non-adherence to inhaled anti-asthmatic medications.