title: Adherence to asthma self-management plans with inhaled corticosteroid and oral prednisone: A descriptive analysis.
abstract: BACKGROUND
  Asthma self-management plans (SMP) are widely recommended for use, but there is little information regarding the degree of patient adherence to their instructions. The aim of the present study was to perform a descriptive analysis of patient responses to worsening asthma with regard to using individualized SMP.
  
  
  METHODS
  Diary data were obtained from an earlier 2 year study in which patients used regularly revised SMP in combination with daily recordings of peak expiratory flow (PEF) and symptoms to manage intercurrent asthma episodes. Based on PEF and symptom changes, the SMP contained instructions about increasing the dose of inhaled corticosteroid (ICS) or commencing oral prednisone during worsening asthma, depending on severity. Data from 165 patient diaries were analysed. First, documented responses to episodes of worsening asthma were matched against SMP instructions and adherence was determined using a priori criteria. Second, each occasion when the ICS dose was increased or prednisone was commenced was identified and changes in PEF and/or symptoms that may have led to these actions were sought.
  
  
  RESULTS
  Adherence for increasing the ICS dose was dependent on asthma severity, ranging from 78% during severe episodes to 31% during mild short-lived events. When oral prednisone was indicated, patients were adherent on 56% of occasions. Symptoms prompted intervention more frequently than changes in PEF. Significant changes in PEF were absent on 41 and 48% of occasions for ICS dose increase and oral prednisone use, respectively.
  
  
  CONCLUSIONS
  Adherence to asthma SMP is variable and often poor. It tends to increase in proportion to the severity and duration of an asthma episode. This underscores the importance of SMP in more severe asthma. Symptoms are more important then PEF in prompting patients to alter treatment. This ought to modify our approach in constructing individual asthma SMP.
authors: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Jonathan M
authors: JM
authors: Wraight
authors: Jan O
authors: JO
authors: Cowan
authors: Erin M
authors: EM
authors: Flannery
authors: G Ian
authors: GI
authors: Town
authors: D Robin
authors: DR
authors: Taylor
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011241:Prednisone