title: Patterns of corticosteroid medication use: non-adherence can be effective in milder asthma.
abstract: OBJECTIVE
  To identify specific patterns of corticosteroid use and examine their relationship with asthma outcomes.
  
  
  METHODS
  An adherence questionnaire was developed and applied in a population-based observational survey; this compared unscheduled care visits and asthma quality of life for adherent and non-adherent patient groups within 176 patients from a semi-rural UK practice.
  
  
  RESULTS
  Three main patterns of medication use were identified: Regular; Regular-but-less (Low-Dosing); and Symptom-Directed variation. For mild-to-moderate asthma (BTS treatment step 2), non-adherence produced acceptable outcomes, not significantly different from outcomes for adherent patients. For more severe asthma, regular adherence was more effective, resulting in significantly less unscheduled visits.
  
  
  CONCLUSIONS
  The results suggest that flexible 'symptom-directed' medication use and patient-initiated dose reduction may be viable alternatives to regular medication for a number of lower severity patients. For milder asthma, clinicians should perhaps focus their efforts on patients with poor asthma outcomes, rather than poor adherence.
authors.affiliation: Peninsula Medical School (Primary Care), Postgraduate Medical Centre, Barrack Road, Exeter EX2 5DW, UK. Colin.Greaves@pms.ac.uk
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hyland
authors.forename: David M G
authors.initials: DM
authors.lastname: Halpin
authors.forename: Susan
authors.initials: S
authors.lastname: Blake
authors.forename: David
authors.initials: D
authors.lastname: Seamark