Effect of health education on compliance in asthma

Non-compliance is a major problem in the treatment of any chronic disease. Asthma is one such chronic disease where non-compliance is a major problem. Several factors for non-compliance like cost of the drugs and relief of symptoms on taking medications for a short time are common to all chronic diseases but in asthma, inhalational therapy especially in elderly because of senile changes, economic factors and comorbidities is an added factor. Health education can improve the compliance. So a study was undertaken to observe the causes of non-compliance in asthmatics, to compare these causes in elderly and young asthmatics and to see the effect of health education on non-compliance in asthmatics. One hundred patients of bronchial asthma, group A consisting 50 patients > or = 65 years old and group B 50 patients < 40 years attending tuberculosis and chest diseases hospital, Patiala were studied. Initial compliance and reasons for non-compliance, initial usage of inhalational devices and their techniques of inhalation were studied. Patients were educated on asthma and inhalational techniques.These patients were followed up at 15th day, 1st, 2nd and 3rd months for changes in compliance and lung functions. At the initial stage, non-compliance was observed in 30 patients (60%) amongst elderly and only 15 patients (30%) amongst the young. Cause for non-compliance was cost in 6, memory in 11, both cost and memory in 7 and relief of symptoms in 6 in elderly and 4, 0, 0 and 11 in young respectively. Only 23 patients (40%) amongst the elderly and 33 patients (66%) amongst the young were put on inhalational therapy. There were statistically significant differences between elderly and young with respect to all the above factors. Out of these 23 elderly, only 7 (30.4%) were confident of the technique of inhalation and demonstrated it correctly.The health education resulted in significant improvement in compliance in both the groups, but more so in the young. The compliance for medications improved from a baseline of 40% to 88% amongst elderly and from 70% to 96% amongst young. There was an improvement in the confidence and technique of inhalation from 44% to 86% amongst elderly and from 64% to 98% amongst young at follow-ups. Mean PEFR improved statistically significantly from 75.25% to 81.13% in elderly and 84.38% to 89.74% in young asthmatics. However, during the follow-up at 2nd month, it was realised that 7 patients amongst elderly and 1 amongst young could not be sustained on inhalational medications because of the cost factor, therefore they were put on only oral medications which were supplied free of cost to them and thus at followup at 3rd month, these patients were not on inhalational medications any more.