Many Asthma Patients Do Not Follow Their Medication Plans

In 2017, an expert commission organized by lancet reviewed the current state of asthma care. This commission identified poor medication adherence as one of the major barriers between people with asthma and improved disease outcomes. The commission wrote that the devotion was “the biggest elephant in the room”. “While there is a sham commitment to optimizing baseline management, little is often done in practice beyond asking the patient if they are receiving treatment.”

According to research in European Journal of RespiratoryMore than half of all asthma patients do not take their medication as directed. Some other surveys put the figure as high as 80%. Clinicians who treat people with asthma confirm that many do not follow their medication plans. Asthma specialist and professor at Northwestern University Feinberg School of Medicine, Dr. “Personally, I would say compliance is an issue for at least 50% of patients,” says Ruchi Gupta.

The problem of poor adherence is so common that experts aren’t sure what percentage of asthmatics actually have severe asthma. This is because the condition is defined by its uncontrollability; If more people with severe asthma take their medication as instructed, it is likely that a significant proportion of them will get their asthma under control and as a result will no longer be eligible for a diagnosis of severe asthma.

However, increasing adherence to treatment is much easier said than done. Part of the problem, Gupta says, is that even those with severe asthma can feel fine most of the time. Asthma has been called a “fluctuating disease” because its symptoms are tidal. Treatment usually requires a person to take more than one oral or inhaled medication daily, even if they are not experiencing symptoms. “Leave a few every day, it’s challenging for anyone to even take medication,” says Gupta. As with many severe asthma sufferers, having to do this for years is pretty overwhelming. Even a missed dose may contribute to an exacerbation, but there is usually a delay between the missed dose and symptom flares. Therefore, people do not attribute the risks of non-compliance to asthma exacerbations.

Forgetting a dose is just one of the reasons people with severe asthma don’t take their medication as prescribed. In some cases, compliance issues may result from the care provider’s faults. In other cases, the patient may consciously decide not to take their medication. Professor and pulmonary specialist at Newcastle University in Australia, Dr. “The causes of improper fit are multifactorial,” says Vanessa McDonald.

The consequences of inadequate commitment are often serious and sometimes dire. With symptom exacerbations, discontinuation of the drug increases the patient’s risk of going to the emergency room. By some estimates, 60% of asthma-related hospital visits are caused by inadequate medication adherence. Medication interruptions also increase a patient’s risk of asthma-related death. The World Health Organization estimates that 250,000 people die prematurely from asthma each year.

Here, McDonald and other asthma experts break down the different factors that contribute to poor medication adherence. They also detail the latest measures to increase compliance, including new technologies, advances in treatment, and improvements in provider-patient interactions.

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Examining the problem of insufficient commitment

Sometimes people with asthma forget to take their medication. When you consider that inhaled corticosteroids (one of the most common treatments for severe asthma) sometimes need to be taken twice a day, it’s easy to see how even hard-working patients can forget an occasional dose.

Another barrier to perfect adhesion is operator error; Inhaling asthma medication is not as simple as swallowing a pill. “Breath [asthma] Drugs require considerable skill and practice,” the authors of a 2015 article wrote European Journal of Respiratory. “Even if the drugs are taken daily, the accumulation in the lungs will be low with the wrong inhalation technique.”

Clinicians say they often encounter such problems. “After inhaling corticosteroids, do they hold their breath for 10 seconds to make sure the drug has penetrated deep into the lungs?” asks Co-director of the severe asthma program at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School. Jonathan Gaffin. These are the types of technical errors that can lead to flares. This is also an area where failure can partly fall on the patient care team. Researchers have found that compliance rates increase when people with severe asthma receive prior education and medication training.

Miscommunication between patient and provider can also reduce compliance. People with severe asthma who are younger or have less formal training are more likely to experience delays in medication use, and there is evidence that some patient groups may not fully understand their care provider’s instructions or treatment plan rationale.

Many of these are categorized as unintentional forms of non-commitment. However, in some cases, patients consciously choose not to take their medication. “There is intelligent or deliberate non-compliance, whereby patients make deliberate decisions to either stop treatment, change the way they take it, or even ever neglect to start the prescribed treatment,” McDonald says. There are several reasons why people deliberately choose not to take their medication. McDonald says concerns about side effects are one of them, and this is another area where better patient-provider communication comes into play. If a person knows exactly what to expect from medications and also fully understands the risks of non-compliance – not only symptom exacerbations but also an increased risk of hospitalization and fatal complications – this knowledge can improve compliance.

Aversion to drugs is another cause of intentional non-compliance. “Not wanting to rely on daily medication is a common reason,” says McDonald. Financial constraints are another thing, he says. Some asthma medications are expensive, and a patient’s insurance may not cover enough costs to make the medication affordable for them.

The wide variety of factors that cause poor commitment is one reason why it remains such a pervasive and intractable problem. But there are solutions.

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New tools and techniques for better adhesion

It is clear that traditional approaches to starting the treatment of severe asthma (a doctor telling the patient what to take and how to take it, followed by occasional checkups) do not get the job done. A newer tactic supported by research gives patients more control and more input in the creation of their medication plans.

For example, a 2010 randomized controlled trial found that when clinicians and patients discussed the benefits, risks, and costs of different treatment plans—not only to alleviate symptoms but also to comply with the patient’s own priorities—adherence to treatment increased significantly after one year. higher compared to the traditional top-down relationship, where the clinician chooses the treatment plan alone. “Involving people with severe asthma in shared decision-making can help improve adherence to treatment,” says McDonald.

There is also evidence that patients with severe asthma who are treated by a multidisciplinary team of specialists, not just in the primary care setting, are more likely to adhere to medication plans. “This team may include a pulmonologist, an allergist, a nurse specialist, and some form of mental health support,” says Gaffin. Through the lens of their diverse expertise, this team can help uncover and address issues that lead to drug discontinuation. This team can also ensure that a person’s medication plan is part of a more comprehensive approach to asthma control (which may include lifestyle and environmental adjustments) that may be more effective.

Internet or smartphone-based reminders are another solution supported by some preliminary research. According to a study conducted in 2021 Scientific ReportsPairing a self-management app with an inhaler attached electronic medication monitor (or EMM that monitors whether a person is taking their medication) has led to powerful compliance improvements. The app not only alerted the patient when to take their medication, but also provided feedback on inhaler use and continuing education materials. Newer “intelligent” drug delivery devices are also useful. According to research in the newspaper Asthmasmart nebulizers can adapt to a person’s unique breathing pattern and respiratory capacity to ensure the right amount of medication is deposited deep within the user’s lungs.

Finally, new forms of treatment reduce the patient’s dependence on inhaled drugs. Biology is the big story in this field. These drugs, given by injection every few weeks, work by targeting the immune cells, proteins, genes or pathways that underlie asthma symptoms. Respiratory medicine specialist at King’s College London, Dr. “These were totally transformative,” says David Jackson. “A new biologic has been added to our arsenal almost every year since 2017, and the number of patients with uncontrolled asthma has dwindled.” Biological drugs are usually administered in the office. Combined with a relatively infrequent dosing schedule, this additional layer of provider oversight makes adherence much more likely. However, the cost of these drugs is still quite high and not all patients are good candidates.

Read more: What You Need to Know About Recent Advances in Managing Severe Asthma

an urgent problem

According to the most recent data from the US Centers for Disease Control and Prevention, roughly 6% of children and 8% of adults in the US have asthma. The prevalence of the disease has been on the rise since 2001, and while there are signs that this increase is stabilizing, recent research has revealed that severe asthma may be more common now than in past years.

This may be due to the gradual aging of the American people. Older adults with asthma are more likely to experience severe and uncontrolled illness, and the country’s average age and proportion of adults aged 65 and over is growing steadily and is expected to increase further in the coming years. All this indicates that the number of Americans with severe asthma will not decrease, but will increase, and therefore solving the problem of non-compliance will become even more important in the years to come. “Being older is associated with better intentional compliance, but unintentional non-adherence can be a problem in this age group due to problems with the use of inhalers and age-related factors such as poor vision, decreased dexterity to use inhalers correctly, and decreased ability to inhale medication deeply,” he says. McDonald’s

He and other experts say there is no magic wand solution to the compliance problem; It is a multifactorial challenge that will require a multifaceted response. But with the further development, refinement, and implementation of the tools we have today—some combination of smarter tools, better medications, and improved provider-patient communication—asthmaticians hope they can greatly improve compliance among people with severe asthma. .

There is work to be done, but there is reason to believe that major improvements are on the way or are already here.

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