title: Primary adherence to controller medications for asthma is poor.
abstract: BACKGROUND
  Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.
  
  
  OBJECTIVE
  To compare adherence to the major controller medication regimens for asthma.
  
  
  METHODS
  This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).
  
  
  RESULTS
  Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting β-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.
  
  
  CONCLUSIONS
  Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.
authors.affiliation: 1 Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School.
authors.forename: Ann Chen
authors.initials: AC
authors.lastname: Wu
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.forename: Emma K
authors.initials: EK
authors.lastname: Larkin
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists
keywords: adherence; asthma; inhaled corticosteroids; leukotriene antagonists; medications