Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma

Asthma Research and Practice

Britt Overgaard Nielsen¹  Ulla Møller Weinreich²  Frodi Fridason Jensen³  Kjell E. J. Håkansson³  Charlotte Suppli Ulrik⁴ 

[1] Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark;Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark;The Clinical Institute, Aalborg University, Aalborg, Denmark;Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark;Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark;Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;

关键词: Foster score;    Medication possession ratio;    Controller medication;    Asthma;    Self-assessed adherence;    Patient-reported outcome;   

DOI  :  10.1186/s40733-021-00072-2

来源: Springer

【 摘 要 】

BackgroundAdherence to inhaled corticosteroids (ICS) in asthma is vital for disease control. However, obtaining reliable and clinically useful measures of adherence remains a major challenge. We investigated the association between patient-reported adherence and objectively measured adherence based on filled prescriptions with inhaled corticosteroids in adults with asthma.MethodsIn total, 178 patients with asthma were asked to self-assess adherence during routine visits at a respiratory outpatient clinic. Self-assessment was performed using Foster score (“How many days in a 7-day week do you take your medication as prescribed?”, with the answer divided by 7). Objective adherence was calculated as medication possession ratio (MPR). Bivariate and multivariable linear regression, adjusted for age, sex, FEV1, GINA treatment step, excessive use of SABA, and history of exacerbations were used for analyses.ResultsOf the included patients, 87.6% reported a Foster score of 100%, while the mean ICS MPR was 54.0% (SD 25%). Complex regimens such as twice-daily dosing or dual inhaler-use were associated with lower adherence (p = 0.015 and p < 0.001, respectively).Foster score was predictive of ICS MPR, with an absolute 32% increase in MPR between patients reporting Foster scores of 0 and 100% (95% CI 13–50%, p < 0.001). Female sex predicted higher ICS MPR (p = 0.019). Previous asthma-related hospitalization(s) predicted lower ICS MPR (p = 0.039).ConclusionAlthough a weak association was found between Foster score and ICS MPR, findings do not support the use of Foster score, and by that self-reported adherence, as a reliable marker of controller adherence in asthma due to significant mismatch between patient-reported adherence and MPR. Future studies should address the complex interplay between patient-reported and objectively assessed adherence to controller medication in asthma.

【 授权许可】

CC BY