Adherence with long-term asthma management in patients who experienced hospitalized asthma exacerbation.
BACKGROUND
In Japan, the number of asthma deaths has been gradually decreasing. However, in the management of asthma, there are still some problems originating from patient-related factors and iatrogenic factors, both of which should be further analyzed.


METHODS
We investigated clinical and background characteristics of 164 patients with asthma who were admitted to our hospital with acute exacerbations, by reviewing their clinical records.


RESULTS
Fifty-two patients had received long-term management (LTM) based on the guidelines (the LTM group), while 112 had not (the non-LTM group). In patients whose asthma severity had been intermittent (step 1), the proportion of severe and near fatal exacerbations was significantly higher in the non-LTM group than in the LTM group. However, even in the LTM-group, 23% of mild persistent (step 2) and 38% of moderately and severely persistent (step 3 & 4) patients had severe or near fatal exacerbations. In these patients, the peak expiratory flow rate significantly improved after discharge, and poor adherence was also significantly higher in the non-LTM group than in the LTM group. A multivariate analysis revealed that the factors associated with poor adherence were: 1) no history of previous admission due to asthma exacerbation; 2) the patient was male; and 3) the patient was young (<60 years).


CONCLUSIONS
In the LTM group, re-evaluation of the actual severity of asthma and prompt treatment corresponding to the severity of disease should still be encouraged. In the non-LTM group, establishing countermeasures against factors causing poor adherence would be the next step in ensuring strong adherence with LTM.
Baba
Kenji
K
Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan. baken@aichi-med-u.ac.jp
Hattori
Tsutomu
T
Yagi
Takeo
T
Onoe
Kazuyuki
K
Kawai
Seiko
S
Yoshida
Kazuhito
K
Yamaguchi
Etsuro
E
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004630:Emergencies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000150:complications; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D020024:Leukotriene Antagonists; D013806:Theophylline