Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients.
BACKGROUND
Daily inhaled corticosteroid (ICS) use is the cornerstone of asthma management, although it is often suboptimal, especially in inner-city populations.


OBJECTIVE
To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time.


METHODS
Asthma history, medication beliefs, and ICS therapy adherence were determined in a prospective, observational cohort. Medication beliefs were based on self-regulation and self-efficacy theory. Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale, a validated 10-item instrument, at baseline and at 1 and 3 months. Repeated-measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age, sex, race, and asthma severity.


RESULTS
The 261 patients were low-income minorities with high rates of asthma hospitalization, emergency department visits, intubation, and oral corticosteroid use. Adherence with ICS therapy was stable across time, with 70% of patients saying that they used ICS all or most of the time when asymptomatic. Most patients (82%) thought it was important to use ICS when asymptomatic, although 49% worried about side effects and 37% worried about becoming addicted. Although 82% felt confident in using ICS, 7% felt that their regimen was hard to follow. In multivariable analyses, the odds of adherence increased for those who felt that using ICS when asymptomatic was important (odds ratio [OR], 4.15) and for those who were confident in using ICS (OR, 2.23) and decreased by worries about side effects (OR, 0.52) or feeling the regimen was hard to follow (OR, 0.48).


CONCLUSIONS
Several positive and negative beliefs about ICS were associated with adherence. Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes.
Ponieman
Diego
D
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Wisnivesky
Juan P
JP
Leventhal
Howard
H
Musumeci-Szabó
Tamara J
TJ
Halm
Ethan A
EA
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D002947:Cities / Q000706:statistics & numerical data; D015331:Cohort Studies; D004493:Education / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009515:New Jersey; D009519:New York City; D016017:Odds Ratio; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring
D000305:Adrenal Cortex Hormones