Inhaled Corticosteroids Nonadherence Research Articles

Asthma in pregnant woman and its management : a review

Asthma is the most common comorbidity in pregnant women and gives 30% of exacerbation experience. The other 30% will see improvement of their symptoms, and the rest will not see the changes. Exacerbations have become a major clinical concern in pregnant women. Medical concerns for the mother and the childbirth included low birth weight, preeclampsia, and preterm delivery. The major goal is to keep asthma under control to ensure mother's health and well-being, as well as fetal growth. Controlling asthma and preventing exacerbations are the main goals of asthma treatment during pregnancy. Treatment for asthma should ideally begin before conception. This is to avoid day-time and night-time symptoms, as well as to keep lung function. Furthermore, fetal oxygenation is a crucial factor during the pregnancy. With a few exceptions, asthma drugs are basically the same in pregnancy as they are in non-pregnant people. Inhaled corticosteroids (ICS) are often used as a controlling treatment. Budesonide is the recommended ICS. Short-acting β-agonist (SABA) preferable as reliever in acute asthma and to relieve exacerbation. As an add-on therapy for medium to high dose ICS, long-acting β-gonists (LABA) is often used. Virus infections and ICS nonadherence are the two most common causes of asthma exacerbations during pregnancy.

Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore

Objective To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children. Methods We conducted a 60-day pilot study among patients 2–18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes. Results Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8–15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence. Conclusions This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation. Supplemental data for this article is available online at at

Factors Associated with Nonadherence to Inhaled Corticosteroids for Asthma During Pregnancy

Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. To determine factors associated with {1} nonadherence to ICS in early-mid pregnancy (cross-sectional) and {2} persistent nonadherence to ICS during pregnancy (longitudinal). Data used come from 3 prospective studies (2004-2019) involving women with asthma recruited by 23 weeks' gestation (N= 1614). Demographics, asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions during follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS during at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS during pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in pregnancy.

Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma.

Background:Inhaled corticosteroids (ICS) are the foundation of asthma management. However, ICS non-adherence is common. Black adults have lower ICS adherence than white adults, which likely contributes, in part, to the asthma disparities that Black adults experience.Objective:To explore how Black adults with uncontrolled asthma and their primary care providers communicated about ICS non-adherence and used shared decision-making to identify strategies to increase ICS use.Design:Eighty routine clinical visits for uncontrolled asthma were audio recorded and inductively analyzed using methods adapted from grounded theory methodology.Participants:Study participants included 80 Black adults (83% female) largely low-income (83% Medicaid) and their 10 primary care providers. The study settings were 2 Federally Qualified Health Centers.Key Results:Three overarching themes were identified: (1) ICS misuse and lack of knowledge; (2) external influences informed personal misconceptions about ICS; and (3) patient-provider communication to individualize plan of care.Conclusions:Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence. Future research should include PCP training on strategies that support patient-centered care, such as communication, shared decision-making and patient engagement.

Asthma and Pregnancy

Asthma is probably the most common serious medical disorder that may complicate pregnancy. A third of pregnant women with asthma will experience worsening of their symptoms, a third will see improvement of their symptoms and a third will see no change. The primary goal is to maintain optimal control of asthma for maternal health and well-being as well as fetal maturation. Vital patient education should cover the use of controller medication, avoidance of asthma triggers and early treatment of asthma exacerbations. Proper asthma management should ideally be started in the preconception period. Since smoking is probably the most modifiable risk factor of asthma, pregnant woman should avoid active and passive smoking. Acute asthma exacerbation during the first trimester is associated with an increased risk of congenital malformations. Poorly controlled asthma is associated with low birth weight, preeclampsia, and preterm birth. Medications used for asthma control in the non-pregnant population are generally the same in pregnancy with a few exceptions. Inhaled corticosteroids (ICS) are the preferred controller therapy. Budesonide is the preferred ICS. Long-acting B-agonists (LABA) are the preferred add-on therapy to medium to high dose ICS. Major triggers for asthma exacerbations during pregnancy are viral infections and ICS nonadherence.

Inhaled Corticosteroid Nonadherence and Immediate Avoidable Medical Events in Older Adults with Chronic Pulmonary Ailments

This study examined the association between nonadherence to inhaled corticosteroids and risk of an immediate avoidable medical event (emergency department visit and hospitalization) in elderly patients with chronic pulmonary ailments. The study comprised a cross-sectional analysis comparing patients with and without avoidable medical event occurrence in each year for adherence preceding the event, and a case-crossover analysis examining the same patient's adherence in years with and without events. The cross-sectional study showed risk odds reductions of nearly 20% in the partially adherent patient, and 40% in the adherent patient compared to the nonadherent patient, after controlling for potential group differences.