The Prevalence of Nonadherence in Difficult Asthma
The Prevalence of Nonadherence in Difficult Asthma
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DOI：
10.1164/rccm.200902-0166oc
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发表时间：
2009-11-01
影响因子：
24.7
通讯作者：
Heaney, Liam G.
中科院分区：
文献类型：
--
作者：
Gamble, Jacqueline;Stevenson, Michael;Heaney, Liam G.
理由随着治疗严重难治性哮喘的新型昂贵疗法的出现，针对适当的患者变得重要。一个重要的问题是识别当前治疗的不依从性。难治性哮喘患者不依从治疗的程度以前没有报道过。目的：研究专家门诊转诊的难治性哮喘患者不依从皮质类固醇药物治疗的患病率，并研究依从性差与哮喘预后的关系。方法：全科医生过去6个月吸入联合治疗和短效β-受体阻滞剂的处方续药记录将激动剂与初始处方进行比较并以百分比表示。使用血浆泼尼松龙和皮质醇测定水平来检查这些措施在评估口服泼尼松龙依从性方面的实用性。患者的人口统计学，住院，肺功能，口服泼尼松龙课程，和生活质量的数据进行了分析，以确定与减少药物adherence.Measurements和主要结果的变量：共182例进行了评估。63名患者（35%）填写了50%或更少的吸入药物处方; 88%的患者在最初拒绝后承认吸入治疗依从性差。21%的患者填写了超过100%的处方，45%的受试者填写了51%至100%的处方。23的51例（45%）口服类固醇被发现是nonadherence.Conclusions：一个显着比例的患者难以控制的哮喘仍然不遵守皮质类固醇治疗。客观的替代和直接的依从性测量应该作为困难的哮喘评估的一部分，在预测昂贵的新生物疗法之前是很重要的。
Rationale With the advent of new and expensive therapies for severe refractory asthma, targeting the appropriate patients is important. An important issue is identifying nonadherence with current therapies. The extent of nonadherence in a population with difficult asthma has not been previously reported.Objectives: To examine the prevalence of nonadherence to corticosteroid medication in a population with difficult asthma referred to a Specialist Clinic and to examine the relationship of poor adherence to asthma outcome.Methods: General practitioner prescription refill records for the previous 6 months for inhaled combination therapy and short-acting beta-agonists were compared with initial prescriptions and expressed as a percentage. Blood plasma prednisolone and cortisol assay levels were used to examine the utility of these measures in assessing adherence to oral prednisolone. Patient demographics, hospital admissions, lung function, oral prednisolone courses, and quality of life data were analyzed to indentify the variables associated with reduced medication adherence.Measurements and Main Results: A total of 182 patients were assessed. Sixty-three patients (35%) filled 50% or fewer inhaled medication prescriptions; 88% admitted poor adherence with inhaled therapy after initial denial. Twenty-one percent of patients filled more than 100% of presciptions, and 45% of subjects filled between 51 and 100% of prescriptions. Twenty-three of 51 patients (45%) prescribed oral steroids were found to be nonadherent.Conclusions: A significant proportion of patients with difficult-to-control asthma remained nonadherent to corticosteroid therapy. Objective surrogate and direct measures of adherence should be performed as part of a difficult asthma assessment and are important before prescibing expensive novel biological therapies.