title: Compliance with inhaled medication and self-treatment guidelines following a self-management programme in adult asthmatics.
abstract: Two of the principal components of self-management are compliance with medication and adherence to self-treatment guidelines. The aim of this study was to evaluate compliance objectively. Twenty two adult asthmatics attended a self-management programme. During a 2 week run-in period, compliance with inhaled steroids and peak expiratory flow (PEF) were electronically-registered. For PEF this resulted in a personal best value (PBV). Subsequently, patients attended four educational group sessions. During the four weeks of follow-up, patients were instructed to measure their PEF on a fixed day of the week and when they experienced an increase in symptoms. If PEF fell below 80% of PBV, patients had to double their use of inhaled steroids; if PEF fell below 60%, they had to start a short course of oral steroids. During run-in, mean compliance was 83% and compliance per patient varied from 6 to 106%. During follow-up, on days without exacerbation, compliance with inhaled steroids increased by 12% (95% confidence interval (95% CI) 3-21%) compared to run-in, ranging 21-200%. On days when patients should have doubled their inhaled steroids, compliance decreased by 28% (95% CI -39 to -17), and compliance ranged 46-94%. Of the 10 patients who should have doubled their medication, only three did so, whilst four increased the use of inhaled steroids but only by one or two puffs; three patients did not alter their behaviour. In five patients (24%) PEF fell below 60% of their PBV, after which four started prednisolone (self-report). In conclusion, even after a formal self-management programme, patients with asthma comply only partially to self-treatment guidelines. Most are willing to increase, but not double, their inhaled steroids. This suggests that more emphasis is needed to reassure patients about the safety of inhaled steroids.
authors.affiliation: Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van der Palen
authors.forename: J J
authors.initials: JJ
authors.lastname: Klein
authors.forename: M M
authors.initials: MM
authors.lastname: Rovers
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data; D010349:Patient Compliance; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate; D012646:Self Administration; D012648:Self Care; D013256:Steroids; D013997:Time Factors
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids