[Adherence to therapy in bronchial asthma]

Asthma is a chronic disease requiring regular use of controller medication (e.g. inhaled corticosteroids at step 2 of treatment guidelines) to improve symptoms and prevent exacerbations. However, inadequate patient adherence/compliance to prescribed treatment regimens is a major cause of poor clinical outcome. Adherence rates in these patients are generally about 50%. Typically, adherence with reliever medication is better than with controller medications. Poor compliance most often results in infrequent and lower than prescribed taking of medication. While older age or female gender are fixed factors, some modifiable characteristics which can achieve better adherence include formal education, higher socioeconomic status, belief that asthma is a serious illness, fewer concerns about the side effects of their medication, shortened and simple treatment regimens (including the prescription of inhaled fixed-combination devices), patient-oriented devices for inhalation therapy, and good patient-physician relationship. There is no gold standard for quantifying patient adherence. In general, direct measures of assessing patient behavior, such as direct observation or electronic inhaler monitoring, give a more accurate, valid indication than indirect methods such as patient diaries, self-reporting, weighting of inhaler devices or doctors' judgment. An understanding of the barriers that impede guideline adherence, described in this article, is necessary before programs are designed to initiate changes in the practices of the treating doctor.