Reasons for Intentional Noncompliance

Many human actions are based on reason. Some patients weigh up the advantages (better asthma control) and disadvantages (inconvenience and cost) of taking their medicine as recommended and decide to do otherwise. Although from the physician s perspective, the patient may not be acting in a rational way, the patient nevertheless thinks that he or she is rational and has come to the best decision. There are several reasons why patients decide consciously to take more or less medicine than recommended. For some patients who have a busy lifestyle, the advantage of 

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For others it is the financial cost of the medicine. Indeed many patients undermedicate specifically as a cost cutting measure. It should be noted that the factors determining cost-benefit analysis may differ between asthmatic adults and parents of children with asthma. Parents may be more prepared to spend money on their children than themselves, though in some health care systems the cost of medicines for the child is free. 

Where cost is a factor in noncompliance, the patient may attempt to ration medication by adopting a constant reduced dose. The physician can help the patient in some cases by change of prescription to a more cost-effective (for the patient) regimen—though this may not be possible within the constraints of the health care system. Because patients are often embarrassed to admit to difficulties paying for medications, the first step in addressing this barrier to compliance is sensitivity and open communication (prior to prescribing) that directly assesses if cost constraints are present. 

There are circumstances where it is in the patient s financial interest to have symptoms or at least to report symptoms. Patients who realize they can use their asthma to obtain a state benefit (e.g., the Disability Living Allowance in the U.K.) may either overreport symptoms or undermedicate specifically to obtain this benefit. Of course, not aU patients use their asthma in this way, but the possibility should be considered if decisions are in the process of being made about state benefit A reduction in symptoms after the decision is made is a possible indicator of benefit-induced symptom reporting. 

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