Improving patient adherence with asthma self-management practices: what works?

Abstract

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 However, multiple studies have found that poor adherence with asthma self-management is very common and a significant contributor to inadequately controlled asthma.2 Studies in adult and pediatric asthma patients suggest that adherence with controller therapies range from 30-70%.3 Less than half of families with asthma complete prescribed environmental control measures to reduce exposure to triggers such as appropriate cleaning measures,4 and dust mite covers, and only one in five families report willingness for pet removal5. Furthermore, up to 55% of patients with asthma still have frequent exposure to nicotine, despite intensive intervention. 6 Poor adherence to asthma self-management guidelines contributes to greater asthma morbidity and mortality.7 Medication nonadherence has been associated with increased symptoms and healthcare utilization8 and more frequent oral steroid bursts.9 Exposure to secondhand smoke has been associated with lower quality of life scores, greater rescue inhaler use, lower lung function, and greater risk for emergency room visits, hospitalization and intensive care unit admission.10 Because of the central role adherence plays in effective asthma control it is critical for clinicians to pay as much attention to patient behavior as to pharmacotherapy. We outline below key factors in promoting optimal patient adherence.