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Validation of the inhaler adherence questionnaire.

Brett G Toelle1,2, Guy B Marks3,4,5, Stewart M Dunn6

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A new 4-item Inhaler Adherence Questionnaire (IAQ) effectively measures patient adherence to inhaled corticosteroids. This simple tool aids in assessing medication adherence for asthma management.

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AdherenceAsthmaComplianceInhaler useQuestionnaire

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Area of Science:

  • Pulmonary Medicine
  • Clinical Pharmacy
  • Health Services Research

Background:

  • Electronic monitoring is the gold standard for adherence, but device availability is limited for many inhalers.
  • There is a need for simple, broadly applicable tools to assess patient adherence to inhaled medications.
  • This study focused on validating the Inhaler Adherence Questionnaire (IAQ).

Purpose of the Study:

  • To validate the Inhaler Adherence Questionnaire (IAQ) for assessing adherence to prescribed inhaled corticosteroids.
  • To determine the utility of a simple tool for measuring medication adherence across various inhaler devices.

Main Methods:

  • Seventy-four adults with asthma using daily inhaled corticosteroids (ICS) participated.
  • Adherence was measured using a 6-item IAQ and electronic monitoring of ICS use via a pressurized Metered Dose Inhaler (pMDI) over 6 weeks.
  • Participants were unaware that adherence was the primary focus to reflect usual self-management.

Main Results:

  • A modified 4-item IAQ showed improved internal consistency after removing two poorly validated questions.
  • Higher IAQ scores (3-4) correlated with higher adherence rates (67.4-73.7% days adherent).
  • A cut-point of 2 or less on the IAQ demonstrated 73% sensitivity and 80% specificity for detecting non-adherence (AUC = 0.764).

Conclusions:

  • The modified 4-item IAQ is a simple, quick, and effective tool for measuring adherence to daily inhaled medication.
  • Validation supports the IAQ's utility in research settings for assessing adherence.
  • Further validation in clinical practice is recommended for this inexpensive tool.