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The Lived Experience of Adherence to Asthma Medication in Young Adults (18-34 years)
Abstract
Background
Adherence to asthma medications is commonly poor and is the primary cause for anticipated worsening health outcomes for patients with asthma. Worldwide, qualitative investigations that examine the adherence of young adults (18-34 years) to their asthma medication are limited.
Method
This study used a phenomenological research approach to explicate the experience of asthma medication adherence as described by young adults. Data were collected using semi-structured in-depth video interviews conducted with participants aged between 18-34 years to elicit their lived experience with adherence to asthma medication. Data from the interviews were transcribed and analyzed using the Edward and Welch (1 Edward K-L, Welch T. The extension of Colaizzi’s method of phenomenological enquiry. Contemporary Nurse. 2011;39(2):163-71. [Google Scholar]) extension of Colaizzi’s approach to phenomenology.
Results
Results yielded four main themes related to the phenomenon of adherence that emerged from the analysis. The themes were: Having a plan; Having knowledge about your medication and asthma triggers; Being responsible with asthma medication; and Health belief.
Conclusion
According to the findings, for young people adhering to asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief. If young adults with asthma received individualized written asthma plans and have adequate knowledge about this plan, developing the correct health belief is likely to result. Hence, this can lead to a greater responsibility to manage their asthma to the recommended adherence level.
... (Physician) 27 On the other hand, trusting the benefit of medications made patients adhere more to asthma treatment. This was presented in another study: 31 These extracts show that a correct perception and belief of medicine is another key component for medicine adherence. ...
... 33,34 Patients lack of trust in health professionals and self-motivation were also identified as barriers to treatment adherence. 31 One study indicated that detecting patients' non-adherence behaviours and appreciating their self-management may help to change their behaviour and increase adherence. 35 On the other hand, patients think that their physicians did not have enough time or provide enough information to them, which contributed to patients lack of sufficient knowledge of the importance of treatment adherence to controlling their asthma. ...
... Norful et al, 2020 28 To explore how Black adults with uncontrolled asthma and their primary care providers communicated about Inhaled corticosteroids (ICS) non-adherence and used shared decision-making to identify strategies to increase ICS use. USA Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence.Wadhahi et al, 202231 To provide a description of the adherent behavior to asthma medication among young adults between the age of ...
Background
Increased medication adherence leads to better asthma control and health outcomes. However, many studies have found that patient adherence to maintenance medication is poor.
Aim
We undertook a meta-synthesis of qualitative studies, to investigate asthma patient and healthcare professionals’ perspectives of medication adherence.
Methods
This systematic review was reported by following the PRISMA guidelines. The Joanna Briggs Institute (JBI) meta-aggregative approach was used for the qualitative synthesis. The protocol was registered in PROSPERO (CRD42022346831).
Results
In total, 12 articles were included in the review. These articles reported findings from 433 participants in total, which included 315 patients and 118 healthcare professionals. Four synthesised findings with sub-themes were identified from the reviewed studies. These synthesised findings were described as: 1) The role of relationship and communication with/between Healthcare Professionals in medication adherence; 2) Insufficient information from Healthcare Professionals acting as a barrier for adherence; 3) How patient’s attitude/beliefs effect their adherence to medication; and 4) Patients’ personal behaviour and other relevant barriers.
Conclusion
The synthesized findings provide a strong evidence-base of patient and health professionals’ perspectives and behaviours toward medication adherence, which helps to identify and address non-adherence. Healthcare providers can use these findings to support patients’ adherence to asthma medications. The findings suggest that empowering people to make informed decisions around medication adherence rather than “adherence controlling” by health professionals is very important. Effective dialogue and appropriate education are critical approaches to increase medication adherence.
Background:
Inhaler corticosteroids (ICS) are the most commonly used antiinflammatory drugs in the treatment of asthma. Although systemic adverse effects are minimal, patients hesitate to use ICS for a long time because of corticophobia. There is no study evaluating corticophobia via Likert-type appendix among the asthmatic patients.
Aim:
In this study, it was aimed to evaluate the fears and beliefs about ICS in asthmatic patients.
Subjects and methods:
Between December 2017 and January 2018, 150 stable asthmatic patients were included in the study. Demographic data (age, education, smoking history, etc.) and asthma-related data (pulmonary function test, drug use) were recorded. The appendix of TOPICOP study applied to the patients with asthma which was composed of 10 questions (five questions about fear of ICS and five questions about beliefs of ICS).
Results:
The rate of ICS maintain in stable asthmatic patients was found to be 66.6%. According to the survey results, 68% of the patients believed that ICS may lead to weight gain, 52% believed that ICS may lead to infection, 73% believed that ICS may pass into bloodstream, and 67.3% believed that ICS may damage the lungs. It was also found that 90.7% needed to be informed about ICS and 67.3% wanted to cut the ICS drug as soon as possible.
Conclusion:
We found that treatment adherence may increase, if physicians allocate more time to asthma patients to inform about ICS beneficial effects at the initiating of ICS treatment and control visits.
The SARS-CoV-2 virus causing COVID-19 pandemic across the world has highlighted the risk of human-to-human transmission, the speed of spread in a globally mobile population and the need for health services to be flexible in their responses to hitherto unknown challenges. One of the hallmarks of COVID-19 is severe acute respiratory syndrome presenting with widespread viral pneumonitis and respiratory failure. It is therefore not unusual for patients with chronic lung diseases such as asthma, COPD, and bronchiectasis to be concerned regarding their particular vulnerability. As healthcare professionals responsible for the care of such patients, it is important to understand how the SARS-CoV-2 virus impacts the respiratory system and the outcomes for patients with chronic lung disease. This review examines the evidence and offers sensible guidance until more is known.
Introduction: Asthma is a chronic inflammatory condition that affect physically, emotionally and psychologically. In adolescent, various factors contributed to poor asthma control. This study aims to identify treatment adherence, quality of life, knowledge and attitude in adolescents with asthma. Method: This cross-sectional study randomly selected 14 schools in two districts of a state in North-eastern of Malaysia. Complete information was obtained from 262 adolescents aged 13 to 18 years old, who were diagnosed with bronchial asthma in the last six months or having recurrent wheeze for the past 12 months. The tools used include Asthma control test; Asthma treatment adherence; Knowledge on asthma; Attitude on asthma; Paediatric asthma quality of life questionnaires have undergone various process of translation, face validation and assessment of the reliability and validity to achieve a standardized Malay language version. Results: There were about 30% of the adolescent who have not taking their medicine regularly with 50% non-compliant once symptom control was achieved. 22.5% of the participants felt embarrass when using inhaler in front of their friends. Our study showed a higher adherenceto medication of more than 70% compared to other studies. However, more than 50% of of the participants have minimal understanding on the disease natural history. Approximately 20-30% of them admitted of experiencing overall poor quality of life at the time of the study. Conclusion: Most participants reported having good asthma treatment adherence; but in our study, half of the adolescent have poor knowledge of asthma and negative attitude towards medication which influenced the quality of life. Bangladesh Journal of Medical Science Vol.19(1) 2020 p.73-82
Purpose:
Asthma is a common disease that is expensive and burdensome for patients. Inhaled corticosteroids (ICS) are the most important drugs for asthma treatment and are often prescribed long-term. However, the use of ICS has been reported to increase pneumonia, though this remains controversial. We evaluated whether the use of ICS increases the risk of pneumonia in asthmatic patients using the Health Insurance Review and Assessment Service (HIRA) database in Korea.
Methods:
The Asthma Management Adequacy Assessment was performed by the HIRA in Korea. Patients with claimed insurance benefits for asthma disease codes and who were prescribed asthma medications more than 2 times were enrolled. Patient demographics, asthma medications, healthcare use, and complications were analyzed.
Results:
The total number of asthma patients was 831,613. Patients using ICS were older and had more comorbidities than those not using ICS; they also visited outpatient clinics and emergency departments, and were more often hospitalized. Pneumonia and other complications occurred more often in patients using ICS, and they used more respiratory medications, except for theophylline. Multiple logistic regression analysis showed that ICS prescription was associated with pneumonia (odds ratio, 1.38; 95% confidence interval, 1.36-1.41). Age, sex, medical care, use of secondary and tertiary hospitals, and hospitalization due to asthma in the previous year were also associated with pneumonia.
Conclusions:
ICS use was associated with increasing pneumonia in asthmatic patients in Korea. Therefore, it is critical to acknowledge that the use of ICS may increase the risk of pneumonia and should be meticulously monitored in asthmatics.
Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient’s adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with better health outcomes, such as improved disease control and a reduction in severe and potentially costly exacerbations. Adherence is a multifaceted concept that includes medication-related, intentional, and unintentional reasons that patients may or may not take their medication as directed. The purpose of this integrative review is to present the individual patient factors that contribute to suboptimal adherence to inhaled therapies and the associated effects on health outcomes, while also highlighting evidence-based strategies for health care providers to improve adherence to such therapies in patients with asthma or COPD. Working closely with patients to establish a model of shared decision-making, which takes patient beliefs and preferences into account when choosing treatment options, has the potential to improve adherence and overall patient outcomes in the management of asthma and COPD.
Background
Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma.
Aim
The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data.
Methods
Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence.
Results
Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment - all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment - immediate and long-term side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma - 22% of studies reported that embarrassment contributed to poor adherence.
Conclusions
Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.
Objective:
To investigate the burden of asthma in a young adult population in urban areas of Argentina.
Design:
A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications.
Results:
In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5).
Conclusion:
Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.
Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
Methods: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Findings: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228).
Interpretation: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
Objective
To explore the barriers and facilitators to inhaled asthma treatment in adolescents with asthma.
Design
Qualitative analysis of posts about inhaler treatment in adolescents from an online forum for people with asthma. Analysis informed by the Perceptions and Practicalities Approach.
Participants
Fifty-four forum participants (39 adolescents ≥16 years, 5 parents of adolescents, 10 adults with asthma) identified using search terms ‘teenager inhaler’ and ‘adolescent inhaler’.
Setting
Posts from adolescents, parents and adults with asthma taking part in the Asthma UK online forum between 2006 and 2016, UK.
Results
Practical barriers reducing the ability to adhere included forgetfulness and poor routines, inadequate inhaler technique, organisational difficulties (such as repeat prescriptions), and families not understanding or accepting their child had asthma. Prompting and monitoring inhaler treatment by parents were described as helpful, with adolescents benefiting from self-monitoring, for example, by using charts logging adherence. Perceptions reducing the motivation to adhere included asthma representation as episodic rather than chronic condition with intermittent need of inhaler treatment. Adolescents and adults with asthma (but not parents) described concerns related to attributed side effects (eg, weight gain) and social stigma, resulting in ‘embarrassment of taking inhalers’. Facilitators to adherence included actively seeking general practitioners’/consultants’ adjustments if problems arose and learning to deal with the side effects and stigma. Parents were instrumental in creating a sense of responsibility for adherence.
Conclusions
This online forum reveals a rich and novel insight into adherence to asthma inhalers by adolescents. Interventions that prompt and monitor preventer inhaler use would be welcomed and hold potential. In clinical consultations, exploring parents’ beliefs about asthma diagnosis and their role in dealing with barriers to treatment might be beneficial. The social stigma of asthma and its role in adherence were prominent and continue to be underestimated, warranting further research and action to improve public awareness of asthma.
In recent decades, both asthma prevalence and incidence have been increasing worldwide, not only due to the genetic background, but mainly because of the effect of a wide number of environmental and lifestyle risk factors.
In many countries noncommunicable diseases, like asthma, are not yet considered a healthcare priority. This review will analyze and discuss disparities in asthma management in several countries and regions, such as access to healthcare human resources and medications, due to limited financial capacity to develop strategies to control and prevent this chronic disease.
This review tries to explore the social and economic burden of asthma impact on society. Although asthma is generally accepted as a costly illness, the total costs to society (direct, indirect and intangible asthma costs) are difficult to estimate, mainly due to different disease definitions and characterizations but also to the use of different methodologies to assess the asthma socio-economic impact in different societies.
The asthma costs are very variables from country to country, however we can estimate that a mean cost per patient per year, including all asthmatics (intermittent, mild, moderate and severe asthma) in Europe is $USD 1,900, which seems lower than USA, estimated mean $USD 3,100.
There are over 10 million people in the United Kingdom aged over 65, a figure predicted to double by 2050. Despite calls for the outdoors to be a focus for health-related physical activity younger adults still tend to be the predominant users of this resource. In an attempt to understand how older adults aged 65+ relate to outdoor adventure sports, data from purposive samples of rock climbers from the north of England (n = 8) and sea kayakers from the Highlands and Islands of Scotland (n = 5) were gathered using focus groups and targeted semi-structured interviews. Analysis using Interpretative Phenomenological Analysis and critical friends showed clear links to theory and highlights the notion that older adults with life course commitments to adventurous ‘serious leisure’ savor the opportunities afforded by growing older. Furthermore, they reject the constant ‘pathologization’ of the ageing process, emphasising instead its positive and meaningful aspects.
Purpose:
To conduct a randomized controlled pilot of a multicomponent, technology-based intervention promoting adherence to controller medication in African-American emerging adults with asthma. The intervention consisted of two computer-delivered sessions based on motivational interviewing combined with text messaged reminders between sessions.
Methods:
Participants (N = 48) were 18-29 years old, African-American, with persistent asthma requiring controller medication. Participants had to report poor medication adherence and asthma control. Youth were randomized to receive the intervention or an attention control. Data were collected through computer-delivered self-report questionnaires at baseline, 1, and 3 months. Ecological Momentary Assessment via two-way text messaging was also used to collect "real-time" data on medication use and asthma control.
Results:
The intervention was feasible and acceptable to the target population, as evidenced by high retention rates and satisfaction scores. Changes in study outcomes from pre- to postintervention favored the intervention, particularly for decrease in asthma symptoms, t (42) = 2.22, p < .05 (Cohen's d = .071).
Conclusions:
Results suggest that the intervention is feasible and effective. However, findings are preliminary and should be replicated with a larger sample and more sophisticated data analyses.
Objectives: To systematically review all available studies on inhaled corticosteroid use and incident pneumonia in asthma patients.
Methods: We performed a literature search from January 1, 1993, through August 15, 2015, using PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers’ web clinical trial registries with multiple search terms. We included studies that compared the risk of incident pneumonia among patients utilizing and not utilizing inhaled corticosteroids. We then summarized risk estimates into two random-effect meta-analyses; one including randomized controlled trials and another one including observational studies.
Results: Fourteen studies were estimable; ten randomized controlled trials included 19,098 participants and four observational studies included 44,016 participants. There was no heterogeneity in randomized trials and summed risk ratio demonstrated the use of inhaled corticosteroids was protective of pneumonia; risk ratio 0.74, 95% CI 0.57to 0.95, p=0.02. On the contrary, observational studies showed summed odds ratio of 1.97; 95% CI 1.87to 2.07, p<0.0001, I²=0%, suggesting increased risk of pneumonia with use of inhaled corticosteroids in asthma patients.
Conclusions: Inhaled corticosteroids are associated with decreased risk of incident pneumonia in patients with asthma based on meta-analysis of available randomized trials. Although observational studies in similar patients suggested higher risk of pneumonia, the inherent methodological limitations confer lower grade of confidence in these studies.
Non-adherence to corticosteroid treatment has been shown to reduce treatment efficacy, thus compromising asthma control.
To examine the experiences of treatment side effects, treatment concerns and adherence to inhaled (ICS) and oral corticosteroids (OCS) among people with asthma and to identify the degree of concordance between clinician estimates of side effects and the prevalence reported by patients.
Asthma UK members were sent validated questionnaires assessing treatment concerns, experiences of side effects and adherence. Questionnaires measuring clinicians' estimates of the prevalence of corticosteroid side effects were completed online.
Completed questionnaires were returned by 1,524 people taking ICS, 233 taking OCS and 244 clinicians (67% of clinicians were primary care nurses). Among people with asthma, 64% of those taking ICS and 88% of those taking OCS reported ⩾1 side effect. People reporting high adherence to ICS (t=-3.09, P<0.005) and those reporting low adherence to OCS (t=1.86, P<0.05; one-tailed test) reported more side effects. There was a disparity between clinicians' estimates of the frequency of side effects and the frequency reported by people with asthma: e.g., although 46% of people taking ICS reported sore throat, clinicians estimated that this figure would be 10%. Patients who reported side effects had stronger concerns about both ICS (r=0.46, P<0.0001) and OCS (r=0.50, P<0.0001). Concerns about corticosteroids were associated with low adherence to ICS (t=6.90, P<0.0001) and OCS (t=1.71; P<0.05; one-tailed test).
An unexpectedly large proportion of people with asthma experienced side effects and had strong concerns about their treatment, which compromised adherence. These findings have implications for the design of interventions to optimise asthma control through improved adherence.
Evaluating the quality of research is essential if findings are to be utilised in practice and incorporated into care delivery. In a previous article we explored ‘bias’ across research designs and outlined strategies to minimise bias.1 The aim of this article is to further outline rigour, or the integrity in which a study is conducted, and ensure the credibility of findings in relation to qualitative research. Concepts such as reliability, validity and generalisability typically associated with quantitative research and alternative terminology will be compared in relation to their application to qualitative research. In addition, some of the strategies adopted by qualitative researchers to enhance the credibility of their research are outlined.
Considering the prevalence and associated burden of disease due to bronchial asthma, it is mandatory to obtain an optimal control of the disease and to improve outcomes for these patients. But it has been observed that there is very poor adherence to the inhalational therapy which leads to the suboptimal control of the disease.
To study the adherence for aerosol therapy in bronchial asthma patients and to assess the impact of health education and self-action plan in improving the compliance to the therapy.
A prospective study was done in a total of 500 bronchial asthma patients over a period of 2 years. Once included in the study, the patients were followed-up for a total of 12 weeks for calculation of nonadherence to the aerosol therapy. In nonadherent patients, we employed various health education strategies to improve the compliance in these cases.
A total of 500 patients of bronchial asthma who were started on aerosol therapy over duration of 2 years were included in the study. At the end of 12 weeks, it was observed that, only 193 patients (38.6%) had regular compliance and 307 patients (61.4%) were noncompliant to aerosol therapy as prescribed for bronchial asthma. Factors that were associated with poor compliance were: Lower educational level status, poor socioeconomic status, cumbersome regimens, dislike of medication, and distant pharmacies. Nondrug factors that reduced the compliance were: Fears about side effects, anger about condition or its treatment, forgetfulness or complacency, and patient's ill attitudes toward health. After employing the various strategies for improving the compliance in these patients, the compliance increased in 176 patients (57.3%) among the earlier defaulted patients, while the remaining 131 patients (42.7%) were found to be noncompliant even after various educational techniques.
Noncompliance in asthma management is a fact of life and no single compliance improving strategy probably will be as effective as a good physician-patient relationship. Optimal self-management allowing for optimization of asthma control by adjustment of medications may be conducted by either self-adjustment with the aid of a written action plan or by regular medical review. Individualized written action plans based on peak expiratory flow are equivalent to action plans based on symptoms.
Background
Beliefs play a crucial role in medication adherence. Interestingly, the relationship between beliefs and adherence varies when different adherence measures are used. How adherence, in turn, is related to asthma symptoms is still unclear. Our aim was to investigate the relationship between beliefs (ie, necessities and concerns) about inhaled corticosteroids (ICS) and subjectively as well as objectively measure adherence and the agreement between these measures. Further, the relationship between adherence and asthma symptoms was examined.
Methods
A total of 280 patients aged 18–80 years who filled at least two ICS prescriptions in the preceding year were recruited to complete a questionnaire. The questionnaire included the Beliefs about Medicines Questionnaire to assess necessity beliefs and concerns about ICS, four questions about ICS use to measure self-reported adherence, and the Asthma Control Questionnaire to assess asthma symptoms. Proportion of days covered was used to determine pharmacy refill adherence.
Results
Data from 93 patients with asthma were analyzed. Necessities were positively related to self-reported adherence (P = 0.01). No other associations were found between beliefs and subjective or objective adherence. There was no correlation between self-reported and refill adherence. Participants were significantly (P < 0.001) less adherent according to self-report data (24.4%) than according to pharmacy data (57.8%). No relationship was found between adherence and asthma symptoms.
Conclusion
Higher necessities are associated with higher self-reported adherence, suggesting that it could be more important to focus on necessities than on concerns in an attempt to improve adherence. Self-reported and refill adherence measurements cannot be used interchangeably. No relationship between adherence and asthma symptoms was found.
Background:
The provision of written asthma action plans (WAAPs) is regarded by regional and international guidelines as an essential component of patient education and self-management. However, the evidence for this practice in children is deficient.
Aim:
To evaluate the effectiveness of adding a personalized WAAP in the treatment of children with partly controlled asthma.
Methods:
Children with partly controlled asthma were randomized to receive a personalized WAAP or no plan, in addition to standard care including education. They were followed up with serial measurement of outcome variables. The primary outcome measured was the number of emergency room (ER) revisits.
Results:
Ninety-one children participated, 45 in the intervention group and 46 in the control group. Comparison with pretrial data revealed significantly improved outcomes with respect to the numbers of ER visits ( p = 0.005 and 0.0002) and acute asthmatic attacks ( p = 0.0064 and 0.0006) in both arms of the study. Children in receipt of a personalized WAAP had fewer ER visits ( p = 0.78), asthma attacks ( p = 0.84), missed school days ( p = 0.28), night-time awakenings ( p = 0.48) and unscheduled doctor visits ( p = 0.69) than those who did not receive a plan.
Conclusion:
The results of this study suggest that the provision of personalized WAAPs may play a useful role in the management of children with partly controlled asthma but is no better than standard care. Asthma education is a critical component in the prevention of exacerbations in children with partly controlled asthma.
Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.
Overuse of short-acting bronchodilators is internationally recognised as a marker of poor asthma control, high healthcare use and increased risk of asthma death. Young adults with asthma commonly overuse short-acting bronchodilators. We sought to determine the reasons for overuse of bronchodilator inhalers in a sample of young adults with asthma.
Qualitative study using a purposive extreme case sample.
A large urban UK general practice.
Twenty-one adults with moderate asthma, aged 20-32 years. Twelve were high users of short-acting bronchodilators, nine were low users.
Asthma had a major impact on respondents' lives, disrupting their childhood, family life and career opportunities. High users of short-acting bronchodilators had adapted poorly to having asthma and expressed anger at the restrictions they experienced. Overuse made sense to them: short-acting bronchodilators were a rapid, effective, cheap 'quick-fix' for asthma symptoms. High users had poorer control of asthma and held explanatory models of asthma which emphasised short-term relief via bronchodilation over prevention. Both high and low users held strong views about having to pay for asthma medication, with costs cited as a reason for not purchasing anti-inflammatory inhalers.
Young adults who were high users of short-acting bronchodilators had adapted poorly to having asthma and had poor asthma control. They gave coherent reasons for overuse. Strategies that might address high bronchodilator use in young adults include improving education to help young people accept and adapt to their illness, reducing stigmatisation and providing free asthma medication to encourage the use of anti-inflammatory inhalers.
The essay delineates main trends in the development of adventure sports and looks into possible future scenarios. Since the 1970s there has been an increase in adventure sports of various kinds. The concept ‘adventure sport’ is used in a wide sense, covering sports that are labelled ‘alternative’, ‘extreme’, ‘X’, ‘gravity’, ‘lifestyle’ and ‘action sports’. The rise of adventure sport must be seen both on the background of developments inside sports itself and the environing society. Adventure sports have things to offer that are difficult to find in other sports, like strong sensations and risk. They represent an opposition and protest against certain aspects of modern societies, but can also be said to express key ideas in modern and post-modern society such as individualism, technology, self-realization and transcendence. The essay discusses various theories and recent empirical findings that may explain and predict developments of adventure sports in the future.
Asthma management requires adequate adherence to many recommendations, including therapy, monitoring of asthma control, avoidance of environmental triggers, and attending follow-up appointments. Poor adherence is common in patients with asthma and is often associated with increased health care use, morbidity, and mortality. Many determinants of poor adherence have been identified and should be addressed, but there is no clear profile of the nonadherent patient. Interventions to improve adherence therefore demand tailoring to the individual by including patient-specific education, addressing patient fears and misconceptions, monitoring adherence, and developing a shared decision process.
Background
In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse (“nonadherence”), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown.
Objective
To estimate the extent of cost-related underuse behaviors and associated factors.
Methods
Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5 to 17 years with asthma in Australia (a high-income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors.
Results
The survey was completed by n = 792 adults (mean age, 47 [standard deviation, 17] years, male 47%, concession 60%) and n = 609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with younger adults (adults: odds ratio [OR]: 1.19; 95% confidence interval [CI]: 1.12, 1.27), males (adults: OR: 1.49; 95% CI: 1.06, 2.08), having concerns about medicines (adults: OR: 3.12; 95% CI: 2.17, 4.35; parents: OR: 2.63; 95% CI: 1.56, 4.55), less comfortable talking to prescribers about cost (parents: OR: 1.22; 95% CI: 1.12, 1.33) or changing medicines (adults: OR: 1.12; 95% CI: 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR: 1.11; 95% CI: 1.01, 1.23), and with poorer asthma control (adults, poor control: OR: 1.87; 95% CI: 1.13, 3.09; parents, poor control: OR: 3.87; 95% CI: 1.99, 7.54), and requiring specialist (parents: OR: 1.83; 95% CI: 1.16, 2.87) or urgent health care visits (adults: OR: 1.54; 95% CI: 1.06, 2.23). Income and concession card status were not associated with cost-related underuse.
Conclusions
Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.
Adherence broadly encompasses the decisions patients make as to whether health care advice should be initiated, as well as the degree to which the recommended health behaviors, once started, are maintained. Disease-related conditions such as severity and duration of illness, as well as treatment-related features such as frequency of dosing and side effects, are 2 of several factors that influence adherence. Other factors affecting adherence include socioeconomic status, patient-related causes, and health system-related reasons. Adherence is rarely, if ever, an all-or-none phenomenon. Typically, patients follow some recommendations closely while deciding others are optional; these decisions are often made without consulting with or notifying health care professionals. Non-adherence can be categorized as either unintentional or intentional. Unintentional non-adherence is easier to remedy because it responds to patient education, simplification of treatment regimens, or the use of a reminder system. Intentional non-adherence is more complex and challenging to address because patients exhibiting these behaviors often do not find evidence-based recommendations compelling, lack the motivation to follow advice, or have deeply entrenched personal beliefs that conflict with health guidance. Novel psychotherapeutic behavioral interventions, such as shared decision-making, motivational interviewing, and coaching are some approaches being tested to determine their effectiveness in mitigating the resistance to treatment that characterizes intentional non-adherence in asthma and COPD populations. In this narrative review, the extent of non-adherence to asthma and COPD management recommendations is explored, the factors affecting adherence are explicated, the methods used to measure adherence are compared and contrasted, and the effectiveness of strategies targeting unintentional and intentional non-adherence is detailed.
Objective:
Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.
Data sources:
Data were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials.
Study selection:
Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.
Results:
There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.
Conclusion:
Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
Objective:
This study examined prescription drug misuse (PDM), sources of PDM, and substance use disorder (SUD) symptoms as a function of educational status among US young adults based on a large nationally representative sample.
Methods:
Data from the 2009-2014 National Survey on Drug Use and Health came from a sample of 106,845 young adults aged 18-25 years. Respondents were categorized by educational status and PDM, sources of PDM, other substance use, and SUD symptoms, with analyses performed separately for prescription opioids, stimulants, and sedatives/tranquilizers.
Results:
Prescription opioid (past-year: 11.9%) and sedative/tranquilizer (past-year: 5.8%) misuse were most prevalent among young adults not attending college, especially among high school dropouts. In contrast, full-time college students and college graduates had the highest rates of prescription stimulant misuse (past-year: 4.3% and 3.9%, respectively). Obtaining prescription medications from friends/relatives for free was the most common source of PDM, especially among college students/graduates. Prescription drug misusers who obtained medications from theft/fake prescriptions, purchases, or multiple sources were more likely to report past-year SUDs and had the most severe overall risk profile of concurrent substance use and SUD. More than 70% of past-month prescription drug misusers who reported multiple sources for PDM had at least 1 past-year SUD.
Conclusions:
Sources of PDM vary by educational status among US young adults, and the college environment is associated with sharing prescription medications. Clinicians can help assess an individual's risk for SUD by determining whether the individual engaged in PDM and the source of prescription medication the individual is misusing.
Background and Objective
Despite literature that spans twenty years describing the barriers to asthma self‐management in adolescents, successful, clinically‐based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self‐management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals.
Methods
Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12‐18 years, 14 healthcare professionals, and 12 parents. Focus groups and interviews were audio‐recorded and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis.
Results
Adolescents’, parents’, and healthcare professionals’ views were summarised into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy, and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self‐management and our results provide further validation for previous studies.
Conclusion and Clinical Relevance
Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents’ ability to effectively self‐manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two‐way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilise to empower adolescents to improve their asthma self‐management.
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Objective
To investigate the burden of asthma in a young adult population in urban areas of Argentina.
Design
A nationwide telephone survey in subjects aged 20–44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications.
Results
In total, 1521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7–7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1–7.7). Wheezing was reported by 13.9% (95% CI 15.6–12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0–11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2–19.9) and family history (OR 3.6, 95% CI 2.3–5.5).
Conclusion
Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.
Objectives:
The first aim of the study (i) assess the current asthma status of general-practitioner-managed patients receiving regular fixed-dose combination inhaled corticosteroid and long-acting beta2 agonist (FDC ICS/LABA) therapy and (ii) explore patients' perceptions of asthma control and attitudes/behaviors regarding preventer inhaler use.
Methods:
A cross-sectional observational study of Australian adults with a current physician diagnosis of asthma receiving ≥2 prescriptions of FDC ICS/LABA therapy in the previous year, who were recruited through general practice to receive a structured in-depth asthma review between May 2012 and January 2014. Descriptive statistics and Chi-Square tests for independence were used for associations across asthma control levels.
Results:
Only 11.5% of the patients had controlled asthma based on guideline-defined criteria. Contrarily, 66.5% of the patients considered their asthma to be well controlled. Incidence of acute asthma exacerbations in the previous year was 26.5% and 45.6% of the patients were without a diagnosis of rhinitis. Asthma medication use and inhaler technique were sub-optimal; only 41.0% of the preventer users reported everyday use. The side effects of medication were common and more frequently reported among uncontrolled and partially controlled patients.
Conclusions:
The study revealed the extent to which asthma management needs to be improved in this patient cohort and the numerous unmet needs regarding the current state of asthma care. Not only there is a need for continuous education of patients, but also education of health care practitioners to better understand the way in which patient's perceptions impact on asthma management practices, incorporating these findings into clinical decision making.
Asthma is a chronic inflammatory disease characterized by symptoms of cough, dyspnea, chest tightness, and wheeze. Inhaled corticosteroids (ICS) have been recommended as initial therapy in the treatment of persistent asthma in all guidelines, as they have been shown to reduce morbidity and mortality. However, high-dose regimens and long-term use of ICS may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. These side effects include impaired growth in children, osteoporosis, fractures, glaucoma, cataracts, and skin thinning. The current recommendations on ICS use in asthma management will be reviewed in this article with a view to highlight treatment strategies that strike an optimal balance between safety and efficacy.
Aim:
Studies have linked the use of inhaled corticosteroids (ICS) to excess pneumonia risk in COPD patients. The risk in asthma patients remains unclear. The objective was to examine the risk of pneumonia with ICS in patients 12 to 35 years old with asthma.
Methods:
We formed a cohort of asthma patients treated from 1990-2007 using Quebec health insurance databases. Subjects were considered currently exposed if they had an ICS dispensed within the 60 days prior to their pneumonia index event or matched person-moment. Secondary analyses investigated the risk of pneumonia according to ICS dose and type. Rate ratios and rate differences were both estimated through a quasi-cohort approach.
Results:
The cohort included 152,412 subjects, of whom 1928 had a pneumonia event during follow-up. There was an increased risk of pneumonia associated with current-use of ICS (RR 1.83; 95% CI 1.57-2.14) or an excess risk of 2.03 cases per 1000 person-years (RD 1.44; 95% CI 1.03 to 1.85). There was an excess pneumonia risk with low doses (RR 1.60; 95% CI 1.06-2.45), moderate doses (RR 1.53; 95% CI 1.12-2.08), high doses (RR 1.96; 95% CI 1.64-2.34), and with budesonide (RR 2.67; 95% CI 2.05-3.49) and fluticasone (RR 1.93; 95% CI 1.58-2.36), relative to no-use. When accounting for potential protopathic bias, the risk with current use of ICS was attenuated (RR 1.48; 95% CI 1.22 to 1.78).
Conclusion:
ICS use in asthma patients appears associated with an increased risk of pneumonia and is present for both budesonide and fluticasone.
Asthma is a chronic respiratory disease characterized by respiratory symptoms, airway inflammation, airway obstruction and airway hyper-responsiveness. Asthma is common and directly affects 10% of Australians, 1–5% of adults in Asia and 300 million people worldwide. It is a heterogeneous disorder with many clinical, molecular, biological and pathophysiological phenotypes. Current management strategies successfully treat the majority of patients with asthma who have access to them. However, there is a subset of an estimated 5–10% of patients with asthma who have severe disease and are disproportionately impacted by symptoms, exacerbations and overall illness burden. The care required for this relatively small proportion of patients is also significant and has a major impact on the healthcare system. A number of new therapies that hold promise for severe asthma are currently in clinical trials or are entering the Australian and international market. However, recognition of severe asthma in clinical practice is variable, and there is little consensus on the best models of care or how to integrate emerging and often costly therapies into current practice. In this article, we report on roundtable discussions held with severe asthma experts from around Australia, and make recommendations about approaches for better patient diagnosis and assessment. We assess current models of care for patient management and discuss how approaches may be optimized to improve patient outcomes. Finally, we propose mechanisms to assess new therapies and how to best integrate these approaches into future treatment.
Objective:
Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management.
Methods:
We conducted key informant interviews with 21 inner-city classroom teachers from 3(rd) to 5(th) grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data.
Results:
Seven themes representing teachers' perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management.
Conclusions:
Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students' asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.
Written asthma action plans are an essential part of effective asthma management, but very few adult patients have them. The key components of a written asthma action plan are how to recognise deteriorating asthma, what treatment to use and when to seek medical help. A section on the first aid to give in an emergency can also be included. An action plan should be simple and personalised. Most plans advise patients to increase the dose and frequency of their inhaled treatments. Oral corticosteroids are advised for severe exacerbations. Asthma action plans should be reviewed at least once a year.
Background:
Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation.
Objective:
The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting.
Methods:
This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression.
Results:
Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959).
Conclusion:
Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly, personalized treatment approaches including novel biologic treatments.
Although it is a key-recommendation of all recent asthma guidelines, self-management education is still insufficiently offered in primary care settings.
To demonstrate the benefits of an educational program offered at the site of primary care (Family Medicine Clinics- FMC) by trained asthma educators on patient outcomes and healthcare use.
This was a one-year pre-post intervention study. Patients with a diagnosis of mild to moderate asthma were enrolled from six FMC. After an initial encounter by the educator, an assessment of educational needs and a spirometry were done, followed by 3 follow-up visits at 4-6 weeks, 4-6 months and one year. Expiratory flows, asthma control criteria, knowledge about asthma, adherence to medication and healthcare and medication use were assessed at each visit.
Data from 124 asthma patients (41M/83F), aged 55 ± 18 years, were analyzed. After initiating the intervention, there was a progressive increase in asthma knowledge and an improvement in medication adherence. The number of unscheduled visits for respiratory problems went from 137 to 33 (P < 0.0001), the number of antibiotic treatments from 112 to 33 (P = 0.0002) and the number of oral corticosteroids treatments from 26 to 8 (NS). Marked improvements were observed in regard to inhaler technique and provision of a written action plan.
This study shows that an educational intervention applied at the site of primary care can result in significant improvements in patient asthma outcomes and reduce unscheduled visits and inappropriate use of medications such as antibiotics.
Copyright © 2015 Elsevier Ltd. All rights reserved.
We aimed to gain insight into antihypertensive medication adherence on the basis of a well-developed behavior theory.
A cross-sectional study of Chinese hypertensive patients was conducted using the health belief model as a theoretical framework.
The HBM explained 48.8% of the variance in antihypertensive medication adherence with an overall prediction accuracy was 82.8%. After adjusting for controlling factors, the HBM explained 50.5% of the variance in antihypertensive medication adherence with an overall prediction accuracy of 86.2%. Higher levels of perceived susceptibility (p=0.017), cues to action (p=0.034), and self-efficacy (p=0.002) and a lower level of perceived barriers (p<0.001) were significantly associated with better antihypertensive medication adherence. The risk factors of older age (p=0.037), longer duration of HTN (p=0.003), longer duration of drug use (p=0.001), and taking a combination of antiplatelet agents (p<0.001) were significantly associated with better antihypertensive medication adherence and influenced different HBM constructs.
The HBM is reliable in predicting medication adherence among Chinese hypertensive patients. Intervention programs in clinical practice could be guided by the relationship between risk factors and HBM constructs and antihypertensive medication adherence.
This study provides a structured understanding of the relationships between risk factors and HBM constructs and antihypertensive medication adherence.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Issues are raised by the persistent concern with achieving rigor in qualitative research, including the rigidity that often characterizes the search for validity in qualitative work and the threat to validity that the search for reliability may pose. Member validation is highlighted as a technique that exemplifies not only the practical, but also the profoundly theoretical, representational, and even moral problems raised by all procedures aimed at ensuring the trustworthiness of qualitative work.
Background:
Studies measuring inhaled corticosteroid (ICS) adherence frequently report adherence rates below 50%. Although asthma is common in adolescents, few studies have explored determinants of ICS adherence in adolescents. The objective of this study was to examine adherence and related factors in adolescent ICS users.
Methods:
Adolescent ICS users, aged 12-18 years, were randomly recruited from a sample of 94 community pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research to complete an online questionnaire. The survey contained questions on asthma control, self-reported adherence, medication beliefs and medication knowledge. Data were collected between April and August 2013.
Results:
Complete questionnaire data were received from 182 adolescents of which 40% reported to be adherent. Approximately 40% of the participants perceived strong needs, whilst only 10% was highly concerned about adverse effects regarding their ICS use. Good adherence was significantly associated with asthma control (OR: 2.1, 95% CI: 1.1-4.1). Necessity beliefs and sufficient medication knowledge were associated with better adherence (p < 0.05).
Conclusion:
Our results suggest that by improving knowledge about asthma treatments and stimulating positive perceptions towards medicines, especially regarding the necessity of medication use, better adherence rates might be achieved.
Current approaches to measuring people’s everyday usage of technology-based media and other computer-related activities have proved to be problematic as they use varied outcome measures, fail to measure behavior in a broad range of technology-related domains and do not take into account recently developed types of technology including smartphones. In the present study, a wide variety of items, covering a range of up-to-date technology and media usage behaviors. Sixty-six items concerning technology and media usage, along with 18 additional items assessing attitudes toward technology, were administered to two independent samples of individuals, comprising 942 participants. Factor analyses were used to create 11 usage subscales representing smartphone usage, general social media usage, Internet searching, e-mailing, media sharing, text messaging, video gaming, online friendships, Facebook friendships, phone calling, and watching television in addition to four attitude-based subscales: positive attitudes, negative attitudes, technological anxiety/dependence, and attitudes toward task-switching. All subscales showed strong reliabilities and relationships between the subscales and pre-existing measures of daily media usage and Internet addiction were as predicted. Given the reliability and validity results, the new Media and Technology Usage and Attitudes Scale was suggested as a method of measuring media and technology involvement across a variety of types of research studies either as a single 60-item scale or any subset of the 15 subscales.
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult-to-treat asthma and severe treatment-resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment-resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult-to-control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult-to-control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma.
Background:
In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known.
Methods:
With the use of primary care data from The Health Improvement Network, we identified people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection.
Results:
A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection (P < .001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days.
Conclusions:
People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.
Poor adherence to medication regimens may be contributing to the recent increase in asthma morbidity and mortality. We examined patient characteristics that may influence adherence to twice-daily inhaled steroid regimens. Fifty adults with moderate to severe asthma completed questionnaires examining sociodemographics, asthma severity, and health locus of control. Adherence was electronically monitored for 42 d. Following monitoring, patients' understanding of asthma pathophysiology and the function of inhaled corticosteroids were assessed. Patient beliefs about the effectiveness and convenience of these medications, and their perception of communications with their clinician were measured. Mean adherence was 63% ± 38%; 54% of subjects recorded at least 70% of the prescribed number of inhaled-steroid actuations. Factors associated with poor adherence were less than 12 yr of formal education (p < 0.001), poor patient–clinician communication (p < 0.001), household income less than $20,000 (p = 0.002), Spanish as primary language (p = 0.005), and minority status (p = 0.007). In a multiple logistic regression analysis, less than 12 yr of formal education (OR: 6.72; CI: 1.10 to 41.0) and poor patient–clinician communication (OR: 1.2; CI: 1.01 to 1.55) were independently associated with poor adherence. These results emphasize the importance of socioeconomic status and adequate patient–clinician communication for adherence to inhaled-steroid schedules.
Effective asthma control is as dependent on patient behavior as it is on guideline-based asthma therapies. More than for many chronic illnesses, asthma management requires patients to be actively engaged in multiple self-management behaviors, including self-monitoring of symptoms, use of an asthma action plan, environmental control practices, and regular adherence with pharmacotherapy using appropriate device technique. When patients are appropriately adherent with these multiple recommendations there is a strong evidence-base that asthma can be very effectively controlled.1