Patterns and determinants of compliance with inhaled steroids in adults with asthma.
BACKGROUND
Patient compliance with inhaled corticosteroids (ICS) in asthma is considered to be suboptimal.


OBJECTIVE
To describe the patterns of compliance with ICS and identify factors determining the compliance to ICS in adults with asthma.


METHODS
Based on a review of the literature and interviews with asthmatic patients who require the regular use of ICS, potential determinants of compliance to ICS were identified. Questionnaires related to these determinants were then administered to a cohort of patients from three subspecialty clinics, including two from university-affiliated centres. Patients with mild-to-moderate asthma who were 15 years of age and older and required (from the physician's point of view) ICS as maintenance medication because of persistent asthma were included in the study. Patients were followed for a period of 12 weeks. Compliance was measured using electronic devices.


RESULTS
Data from 124 patients (51 men; mean age 47+/-15 years; mean prescribed daily dose of ICS [fluticasone propionate] 643+/-385 microg) were analyzed. On average, the patients took 72+/-24% of their prescription. Four patterns of compliance were observed and are described: 1A -- regular compliance (n = 29); 1B -- irregular compliance (n = 37); 2A -- regular noncompliance (n = 24); and 2B -- irregular noncompliance (n = 34). Among the potential predictors of noncompliance, age was the only significant predictor (compliance increased with increasing age). There was no difference in asthma control between compliant and noncompliant patients.


CONCLUSIONS
Compliance to ICS in patients with asthma is often suboptimal and difficult to predict. The observations suggest that some asthmatics may be overtreated with ICS.
Centre de recherche, Hôpital Laval, Institut universitaire de Cardiologie et de pneumologie de l'Universite Laval, Ste-Foy, Qubec, Canada. Yves.Lacasse@med.ulaval.ca
Yves
Y
Lacasse
Hélène
H
Archibald
Pierre
P
Ernst
Louie-Philippe
LP
Boulet
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents