Factors Determining Adherence to Inhaled Corticosteroids in Bronchial Asthma Patients at a Tertiary Care Hospital in India OC14-OC18
Correspondence
Dr. Deepak Aggarwal,
Associate Professor, Department of Pulmonary Medicine, Block-D, Level-5,
Government Medical College and Hospital, Sector-32, Chandigarh, India.
E-mail: drdeepak@hotmail.com
Introduction: Non-adherence to inhalation therapy is a vital but a controllable factor in asthma management that affects disease control. Despite its known importance, there is scarcity of data on adherence to Inhaled Corticosteroids (ICS) among Indian asthma patients.
Aim: To evaluate the prevalence of factors predicting medication (ICS) adherence in bronchial asthma using an objective adherence measure.
Materials and Methods: Stable bronchial asthma patients on ICS with or without inhaled bronchodilators were enrolled and their relevant demographic and clinical information was recorded. Adherence to ICS was calculated by using an objective method (dose counters/pill counting) as well as through self-reporting adherence. Certain pre-defined; patients, disease and therapy related factors were evaluated for their association with medication adherence using each adherence method separately.
Results: One hundred and three patients were enrolled in the study. Mean age of patients was 41.9±16 years. Females out numbered males in the ratio of 3:2. Medication adherence was seen in a total of 78 (75.7%) and 56 (72.7%) patients by self-reported adherence and objective measurement respectively. On applying multivariate logistic regression analysis, being literate, having poor forced expiratory volume in one second (FEV1), and knowledge about asthma were found to be independent determinants of adherence to ICS using both adherence methods. Use of Dry Powder Inhalers (DPI) was measured using subjective assessment and was found to be a significant factor.
Conclusion: Knowledge about medication adherence and literacy are two important patient related modifiable factors predicting adherence to ICS in Indian patients with asthma. Objective monitoring of medication adherence seems to be a better tool than self reported adherence for the evaluation of adherence to ICS in asthma.