Long-term adherence to inhaled corticosteroids: does it make a difference for asthma control?
AbstractBackground: Chronic conditions often require continued daily use of medication, yet adhering to these regimens is difficult to sustain long-term. In asthma, inhaled corticosteroids (ICs) help achieve and maintain asthma control but ICs adherence is suboptimal. Evidence is scarce regarding its long-term dynamics and role in managing asthma. We examined the longitudinal variation of ICs adherence and its effects on asthma control. Methods: A prospective cohort of persistent asthma patients (12-40 yrs) in France and the United Kingdom were followed up for 24 months by 4-monthly computer-assisted telephone interviews (CATIs), assessing ICs adherence and asthma control. We used longitudinal multilevel models to predict the risk of uncontrolled asthma based on within and between-patient variations in adherence, and patient and treatment characteristics. Findings: In 2416 CATIs from 542 patients (mean age 269 years, 53% women, 85% French), 33% used <60%, 14% 60-80%, 24% >80% of prescribed ICs; 29% were fully adherent. During follow-up, 111 patients maintained asthma control, and 151 remained uncontrolled; 135 maintained >80% adherence, and 131 remained below 80%. Patients with higher average adherence were less likely to report uncontrolled asthma (OR=0.70[0.56-0.86], p<.001), as were male patients (OR=0.60[0.40-0.92], p<.05). Higher baseline asthma severity and add-on therapies predicted uncontrolled asthma (OR=1.88[1.46-2.42], p<.001; OR=1.64[1.03-2.61] and 2.57[1.06-6.24], p<.05). Within-person adherence variation was unrelated to asthma control. Discussion: High adherence and good control proved difficult to achieve or maintain long-term. Between-person results suggest a protective effect of sustained adherence in managing asthma. The dynamic interplay between adherence and asthma control requires further investigation.
Copyright (c) 2017 A. Dima, E. van Ganse, L. Laforest, F. Jacoud, N. Texier, G.(. Stadler, M. de Bruin
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