Patterns of corticosteroid medication use: non-adherence can be effective in milder asthma

To identify specific patterns of corticosteroid use and examine their relationship with asthma outcomes.

An adherence questionnaire was developed and applied in a population-based observational survey; this compared unscheduled care visits and asthma quality of life for adherent and non-adherent patient groups within 176 patients from a semi-rural UK practice.

Three main patterns of medication use were identified: Regular; Regular-but-less (Low-Dosing); and Symptom-Directed variation. For mild-to-moderate asthma (BTS treatment step 2), non-adherence produced acceptable outcomes, not significantly different from outcomes for adherent patients. For more severe asthma, regular adherence was more effective, resulting in significantly less unscheduled visits.

The results suggest that flexible 'symptom-directed' medication use and patient-initiated dose reduction may be viable alternatives to regular medication for a number of lower severity patients. For milder asthma, clinicians should perhaps focus their efforts on patients with poor asthma outcomes, rather than poor adherence.