Monday, October 27, 2008

Medication Adherence and Asthma Symptoms Abstract

Today's Medication Adherence related abstract comes from The HighWire Press. My comments are at the end.

Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt

BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.

OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.

METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.

RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.

CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.

This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.

My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: "Why didn't you take your ICS"?, but they will probably have to do another study to get this question answered.

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