Asthma compliance with treatment

Discuss the factors that predict poor compliance with asthma treatment. 

Discuss the factors that predict poor compliance with asthma treatment. Adherence to prophylactic asthma medications is affected by many factors ... 

Milgrom H, Bender B, Ackerson L, Bowry P, Smith B, Rand C. 1996. Non-compliance and treatment failure in children with asthma . J. Allergy Clin. Immunol. 98 1051-1057. 

Patient beliefs about illness and therapy are strongly rooted within cultural norms that may be discordant with the traditional biomedical model of the physician. Pachter has described clinical encounters as an interaction between two cultures—the culture of medicine and the culture of patients (51). When there are differences between the patient s explanatory model for the causes and treatments of asthma and that of the physician, the resulting miscommunication can lead to poor compliance with therapy. Some patients may elect to use home remedies as an adjunct to prescribed regimens, or reject prescribed therapies outright, and these practices will not usually be revealed in the standard consultation. 

Hyland ME, Kenyon CAP, Allen R, Howarth P. Diary keeping in asthma comparison of written and electronic methods. Br Med J 1993 306 487 89 Kelloway JS, Wyatt RA, Adlis SA. Comparison of patients compliance with prescribed oral and inhaled asthma medications. Arch Intern Med 1994 154 1349-1352. Steiner JF, Fihn SD, Blair B, Inut TS. Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol 1991 44 1361-1371. Chmelik F Doughty A. Objective measurements of compliance in asthma treatment. Ann Allergy 1994 73 527-532. 

P2"Agonists are widely used in the symptomatic treatment of asthma. Although both oral and aerosol formulations of these bronchodilators have been available for many years, advances have occurred in deUvery technology with the development of dry powder aerosols (qv) (see Drug delivery systems) (28). The ease of usage of these breath-activated systems has improved patient compliance and therapeutic response. There are several detailed reviews on p2-agonist therapy of bronchial asthma (29—31), and on the stmcture-activity relationships of this class of drugs (32). 

Poor compliance has detrimental effects, as the occasional or systematic omission of a dose excludes the patient to benefit from the expected effects. Lack of compliance in patients who need a chronic treatment with inhaled glucocorticosteroids or inhaled long-acting Pj-agonists may result in a less optimal control of the disease and persistent morbidity from asthma (20). It is also a major cause of apparent treatment failure (21) and causes excess in mortality (22). 

Dompeling E, van Grunsven PM, van Schayck CP, Folgering H, Molema J, van Weel C. Treatment with inhaled steroids in asthma and chronic bronchitis long term compliance and inhaler technique. Fam Pract 1992 9 161-166. 

Pulmonary administration of medicines currently has the primary objective to achieve local effects in the respiratory tract of patients with chronic diseases like asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). For half a century, inhalation therapy has been the cornerstone in the management of these diseases and the often life-time therapies aim to suppress inflammatory processes and bacterial infection in order to reduce hospitalisations and to improve the patient s quality of life. They also give relief to the patient in moments of bronchoconstriction. The advantages of pulmonary administration of medicines for local treatment are well known. The active substances are delivered directly to the site of action which leads to a faster response than via the systemic route. It may also result in higher local active substance concentrations and this could reduce the total dose by as much as a factor 10 compared to oral or intravenous administration. This has the advantage that systemic side effects are reduced and in combination with being a non-invasive method of administration, inhalation therapy may lead to better patient compliance. 

---