Asthma Medication Adherence Research Articles

Effect of an Asthma Exacerbation on Medication Adherence

Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence. To measure asthma medication adherence in the 12 months after an asthma exacerbation and the influence of care type (specialist vs primary care provider) as well as social economic status on adherence. We measured portion of days covered (PDC) during the 12 months before and after an exacerbation in a cohort of patients with asthma who were aged 18 years and older. Subanalyses looked at PDC in those who had more than one exacerbation after the sentinel exacerbation, by type of care received (primary care, allergist or pulmonologist, or no care) during both periods and by socioeconomic status (SES), defined as the lower quartile of annual income for the group. In a cohort of 1,697 patients, PDC improved significantly (from 0.44 to 0.53; P < .001) after an asthma exacerbation. Improvement in PDC was even greater (from 0.45 to 0.57; P < .001) if they had more than one exacerbation after the sentinel exacerbation. Being seen by a specialist after the exacerbation but not before it, resulted in the greatest improvement in PDC (0.17 mean change). Patients not seen by a specialist either before the exacerbation or after had a mean change of just 0.07. Those with a lower SES had an overall lower PDC before the exacerbation (0.37 vs 0.43) but saw a similar improvement in the PDC compared with those in a higher SES (0.09 vs 0.10). An asthma exacerbation is associated with a significant and sustained effect on medication adherence.

Assessment of Real-World Escalation to Biologics in US Patients With Asthma

Previous studies indicate that suboptimal medication adherence may contribute to uncontrolled asthma. Global Initiative for Asthma (GINA) guidelines recommend treatment escalation to biologics for patients with uncontrolled asthma despite adherence to high-dose maintenance medication and who have eosinophilic/allergic biomarkers or require maintenance oral corticosteroids. This study aimed to describe the clinical status of patients with asthma escalated to biologic therapy. This retrospective claims database analysis enrolled US patients with asthma who were escalated to biologics between January 2016 and June 2020. Exacerbations, control status, GINA step, and maintenance medication adherence during the 12 months before biologic therapy initiation were analyzed. Asthma control was assessed using both the European Respiratory Society/American Thoracic Society (ERS/ATS) and Stempel criteria. Adherence was defined as the proportion of days covered (PDC) by maintenance medication claims. Of 1786 patients escalated to biologics, 506 were included for analysis. During the 12 months before escalation, 346 patients had confirmed exacerbations. Uncontrolled asthma status was estimated in 55% and 70% of patients (ERS/ATS and Stempel criteria, respectively). GINA step was inferred for 395 patients: 154 were at step 2, 11 at step 3, 104 at step 4, and 126 at step 5. Of 403 patients with maintenance medication claims, 63% had suboptimal maintenance medication adherence (PDC <80%). In this study, most patients initiating biologic therapy had mild-to-moderate asthma or suboptimal maintenance medication adherence, possibly indicating inappropriate escalation. Incorporating objective medication adherence monitoring into existing guidelines may reduce inappropriate escalation to biologics.

Self-Determination Theory and Preventive Medication Adherence: Motivational Considerations to Support Historically Marginalized Adolescents With Asthma

Using self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence. Data were from adolescents (n=260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12-16 years) had physician-diagnosed persistent asthma or poor control. Adolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables. Many factors interfere with adolescent medication-taking. Clinicians' efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.

Improving Medication Adherence in Asthma.

In little over a generation, the ingenuity of scientists and clinician researchers has developed inhaled medications and pathway-specific biological agents that control the inflammation and physiology of asthma. Unfortunately, whether it is because of cost or difficulty understanding why or how to use inhaled medications, patients often do not take these medications. The consequences of poor treatment adherence, loss of control and exacerbations, are the same as if the condition remained untreated. Furthermore, poor adherence is difficult to detect without direct measurement. Together this means that poor treatment adherence is easily overlooked and, instead of addressing the cause of poor adherence, additional medicines may be prescribed. In other words, poor treatment adherence is a risk for the patient and adds cost to healthcare systems. In this article, we discuss the rationale for and the delivery of successful interventions to improve medication adherence in asthma. We contextualize these interventions by describing the causes of poor treatment adherence and how adherence is assessed. Finally, future perspectives on the design of new interventions are described.

Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework.

BackgroundAsthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population.ObjectiveThe purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs.MethodsWe will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant’s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing–based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months.ResultsAt study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed.ConclusionsAAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging.International Registered Report Identifier (IRRID)PRR1-10.2196/37946

Partnering to Improve Pediatric Asthma Quality.

Partnering to Improve Pediatric Asthma Quality.

Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study

BackgroundThe COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma.ObjectiveThis retrospective cohort study assessed changes from in-person to virtual care during the pandemic. In patients with persistent asthma, compared with the same period before the pandemic.MethodsKaiser Permanente Colorado members aged 18 to 99 years with persistent asthma were evaluated during two periods (March to October 2019 and March to October 2020). Comparison of asthma exacerbations (hospitalizations, emergency department visits, and courses of oral prednisone) and asthma medication metrics were evaluated between the two periods and by type of care received during the pandemic (no care, virtual care only, in-person care only, or a mix of virtual and in-person care). Population characteristics by type of care received during the pandemic were also evaluated.ResultsAmong 7,805 adults with persistent asthma, those who used more virtual care or sought no care during the pandemic were younger and had fewer comorbidities, mental health diagnoses, or financial barriers. Exacerbations decreased (0.264 to 0.214; P <.001) as did courses of prednisone (0.213 to 0.169). Asthma medication adherence (0.53 to 0.54; P <.001) and the asthma medication ratio, a quality-of-care metric (0.755 to 0.762; P = .019), increased slightly. Patients receiving a mix of in-person and virtual care had the highest rate of exacerbations (0.83) and a lower asthma medication ratio (0.74) despite having the highest adherence (.57).ConclusionsDespite an increase in virtual care, asthma exacerbations decreased except among individuals who received both in-person and virtual care, likely because they had more severe disease.

A response to COVID-19 school closures: The feasibility of a school-linked text message intervention as an adaptation to school-supervised asthma therapy.

School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention. The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention. In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes. Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity.

FACTORS AFFECTING UNCONTROLLED ASTHMAAMONG CHILD PATIENTS IN DAMMAM, AL-KHOBAR, 2020

INTRODUCTIONAsthma is a chronic inammatory disease that usually begins at the early stages of life. The recurrent attacks of breathlessness and wheezing are characteristics of asthma and the severity of the signs varies from one person to another. AIM This study aimed to evaluate the most factors affecting control of asthma among child patients seen in public health and its relation to ER visits and admission. Patients and methods This is a cross-sectional study conducted among children who had a documented diagnosis of bronchial asthma conrmed by the le obtained from the Ministry of Health, Armed Forces Hospital, and King Fahad University Hospital in Dammam and Alkhobar. A selfadministered questionnaire was distributed among study subjects and written informed consent was explained to the parents. Asthma Control Test (ACT) questionnaire was used to measure the level of asthma control. RESULTS 119 children with asthma were able to recruit (50.4% males vs 49.6% females). The most commonly used for the treatment of asthma was inhalers (93.3%) specically Ventolin (64%) while the proportion of patients who were using nebulizers at home was 40.3%. Uncontrolled asthma was found among 25.2% and low adherence to medication was found among 84.9%. There was an inverse signicant correlation being observed between asthma control score and medication adherence score (r=-518; p&lt;0.001). Factors associated with uncontrolled asthma were a history of allergy, 2 times or less admission to hospital, and the use of nebulizers at home. CONCLUSIONWhile one-fourth of children had uncontrolled asthma, however, their adherence to medication was low. Children with a previous history of allergy, those with increased hospital admission, and those who were using nebulizers at home had an increased risk of uncontrolled asthma.

Predictive factors of non-adherence to asthma medication in pregnancy.

Background. Adherence to asthma medications is a significant problem among pregnant women. Objective. To evaluate asthma medication adherence in pregnant women and to determine the factors that may predict non-adherence in a real-life setting. Methods. A cross-sectional study was performed with pregnant women with asthma followed in a specialized asthma consultation at the Pulmonology Department, between 2014 and 2019. Sociodemographic and clinical variables were collected. Structured telephone interviews were conducted to determine regular medication use during pregnancy. Multiple logistic regression was used to identify predictive factors of asthma medication non-adherence (cessation or dose reduction). Results. A total of 82 pregnant women were included: mean age of 31.3 ± 6.5 years, non-adherence was detected in 29% (n = 24). Multivariable logistic regression analysis revealed that mild asthma during pregnancy (OR, 4.8; 95% CI 1.4-17.1, p = 0.015) and single, separated or divorced mothers (OR, 4.0; 95% CI 1.3-11.8, p = 0.014) were independent predictors of poor adherence to asthma medications. Conclusions. Asthma severity and marital status can strongly predict the asthma medication non-adherence in pregnant females. These findings may help improve asthma education strategies to promote.

Asthma control and medication adherence among asthmatic outpatients in Vietnam: A cross-sectional study

Asthma control and medication adherence among asthmatic outpatients in Vietnam: A cross-sectional study

A Targeted Approach to Improve Asthma Control Using Community Pharmacists.

Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice. Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes. Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data. Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079). Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.

The lived experience of adherence to asthma medication in young adults (18–34 years)

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 and 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) 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.

The relationship between objective app engagement and medication adherence in asthma and COPD: a retrospective analysis

Digital health tools can promote disease self-management, but the association of smartphone app engagement and medication adherence is unclear. We assessed the relationship between objective smartphone app engagement and controller medication use in adults with asthma and COPD. We retrospectively analyzed data from participants enrolled in a digital self-management platform for asthma and COPD. Eligible adults had a smartphone and a paired electronic medication monitor (EMM). Longitudinal, mixed-effects logistic regressions estimated the relationship between daily app engagement (app opens, session duration) and daily controller medication use. Data from 2309 participants (71% asthma; 29% COPD) was analyzed. Opening the app (vs. not opening the app) was associated with significantly greater odds (OR (95% CI)) of using controller medications in asthma (2.08 (1.98, 2.19)) and COPD (1.61 (1.49, 1.75). Longer session duration was also associated with greater odds of using controller medications in asthma and COPD, but the odds of use attenuated with longer session duration in COPD. This study presents a novel assessment of the relationship between objectively-measured smartphone app engagement and controller medication use in asthma and COPD. Such insights may help develop targeted digital health tools and interventions.

Paediatric Severe Asthma Biologics Service: From Hospital to Home

To assess whether biologics could be given safely at home in children with severe asthma, including measuring spirometry and quality of life.Children with severe asthma who had received omalizumab or mepolizumab and were willing to administer medication by supervised video calls in London, England, during the coronavirus disease 2019 pandemic from April to July 2020.In the study, children were identified who previously received at least 3 doses of biologics in the clinic or hospital setting safely with no reactions, were deemed suitable by a multidisciplinary team, and had no previous experience with home medication administration. Patients and their caretakers were trained for 1 to 2 hours, after which clinical nurse specialists virtually observed them during home medication administration. Patients and their families were given a home spirometer that measured forced expiratory volume in 1 second and forced vital capacity (FVC) to track asthma status. They were then managed every 2 to 4 weeks, with video calls to assist with medication dosing, assess asthma control, determine if oral corticosteroids (OCSs) were required or unscheduled health care visits, and determine general well-being the preceding 4 weeks.A total of 16 of 23 patients with a median age of 14.5 years (6 to 18 years) fulfilled the criteria for homecare and consented. A total of 14 adolescents independently completed home administration, and 2 required community nursing to administer the medication. Seven patients who did not participate in home administration served as the control group. Video calls with medication dosing were completed on 75 occasions. The drug was administered improperly on 2 of 75 occasions. Spirometry was used before each virtual appointment to assess asthma control. Patients and parents felt confident with video monitoring at the time of injection and felt relieved that they did not have to travel to the hospital for drug administration. Overall, patients felt monitoring devices were easy to use. Both Asthma Control Test and mini Pediatric Asthma Quality of Life Questionnaire scores improved within the first 3 months during home administration.Home administration of biologics with virtual monitoring is feasible and acceptable for patients and their families.Mepolizumab and omalizumab are available for home infusion for children ≥12. There is concern over which patients will be the “right” patient for this treatment method. Indeed, during the height of the coronavirus disease 2019 pandemic, home infusion options would have been beneficial. Although the number of patients with home infusions is small in this study, it does suggest a valuable combination of parameters to follow at home with a portable forced expiratory volume in 1 second meter and asthma control tests. Video supervision and telehealth is a practical option, ensures safety and support for families, and reinforces asthma medication adherence. Telehealth administration of biologics could reduce severe asthma attacks, increase patient satisfaction and convenience, and decrease the burden of coming to the hospital/clinic for the severe child with asthma.

A multimodal approach to improve asthmatic adolescents' self-efficacy in Taiwan.

An efficient asthma self-management for adolescents must be based on adolescents' needs, increase self-efficacy and adherence to treatment. The effects of such program are likely be dose dependent. To examine the impact of the dose-effect of multiple components on an asthma self-management program for adolescents aged 12-18 years in Taiwan. A scoring system was developed to classify intervention groups into high- (19-23), medium- (11-18) and low (&lt; 11) dose according to the number of components completed by participants. The impacts of the dose level on outcomes of asthma self-efficacy, prevention behaviors, asthma medication adherence, and asthma symptoms were examined. Our results suggest that a high dose of the intervention can improve adolescents' self-efficacy, asthma prevention behavior, and medication adherence. Trial Registration No: ACTRN12613001294741.

From the Pages of AllergyWatch: February 2022

For this issue of From the Pages of AllergyWatch, I have selected reviews with a focus on “Technology for the Clinic,” the theme of this month's Annals of Allergy, Asthma & Immunology. The first, with comments from Dr Knox, investigates the use of sensor-based electronic inhalers to monitor asthma medication adherence. The next, with comments from Dr Lee, reveals the sensitivity and specificity of the peanut components in the diagnosis of peanut allergy in infants. The third, with comments from Dr Joshi, evaluates the rate of recurrent symptoms after positive oral food challenges in patients with peanut allergy.

The mediating role of trust in physician and self-efficacy in understanding medication adherence in severe asthma

ObjectiveTo investigate the relationships between beliefs about medication, trust in physician, self-efficacy, and medication adherence in severe asthma patients. MethodsA sample of 117 patients with a diagnosis of Severe Asthma on Step 4 or 5 of GINA assessment of control treatment ladder completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), Trust in Physician Scale (TIPS), and Self-Efficacy in Taking Medication (SEAMS). ResultsOur study found that medication adherence was associated with trust in physician (p = 0.033); factor one of beliefs about medication - Necessity of taking medication (BMQ1-Necessity: p = 0.025); and two factors of self-efficacy in taking medication (SEAMS1-Difficulty: p = 0.001; SEAMS2-Uncertain: p = 0.005). Furthermore, two factors of self-efficacy and trust in physician together significantly mediated the relationship between beliefs about medication and medication adherence in a serial multiple mediator model. ConclusionsBeliefs about medication are fundamental in affecting asthma patients’ trust in physician and self-efficacy, which in turn impact medication adherence. Clinical implicationsInterventions being developed to improve medication adherence may benefit from emphasizing on asthma patients' concerns about overuse and harm of medication. In addition, education program targeting to improve provider-patient relationship could help with patients’ confidence in taking medication.

Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review

BackgroundPoor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth.ObjectiveThis review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma.MethodsA systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed.ResultsIn total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects.ConclusionsThe mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study

BackgroundSevere asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.MethodsThis was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.ResultsWithin the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.ConclusionsTherapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.