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Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma
Frodi Fridason Jensen1, Kjell E J Håkansson2, Britt Overgaard Nielsen3
1Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.
Asthma Research and Practice
|June 1, 2021
Summary
Patient self-reported adherence to inhaled corticosteroids (ICS) in asthma is not a reliable indicator of actual medication possession. Objective measures like prescription refills show a significant mismatch, highlighting challenges in assessing asthma medication adherence.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Medicine
Background:
- Adherence to inhaled corticosteroids (ICS) is crucial for effective asthma management.
- Reliable measurement of patient adherence to ICS remains a significant clinical challenge.
- This study assesses the correlation between self-reported and objectively measured ICS adherence in adults with asthma.
Purpose of the Study:
- To investigate the association between patient-reported adherence (Foster score) and objectively measured adherence (medication possession ratio - MPR) to inhaled corticosteroids (ICS) in adult asthma patients.
- To evaluate the clinical utility of self-reported adherence as a marker for controller medication adherence.
- To identify factors influencing ICS adherence in asthma patients.
Main Methods:
- 178 adult asthma patients completed self-reported adherence using the Foster score during clinic visits.
- Objective adherence was determined by calculating the medication possession ratio (MPR) based on filled prescriptions for ICS.
- Statistical analyses included bivariate and multivariable linear regression, controlling for covariates like age, sex, FEV1, GINA treatment step, SABA use, and exacerbation history.
Main Results:
- A high percentage of patients (87.6%) reported 100% adherence (Foster score), contrasting with a mean ICS MPR of 54.0%.
- Complex medication regimens (e.g., twice-daily dosing, dual inhaler use) were linked to reduced adherence.
- While Foster score showed a weak predictive value for MPR, a significant discrepancy exists between self-reported and objective adherence measures.
Conclusions:
- Self-reported adherence using the Foster score is not a reliable indicator of inhaled corticosteroid (ICS) adherence in asthma patients.
- Significant mismatches between patient self-assessments and objective adherence data (MPR) challenge the clinical utility of self-reported measures.
- Further research is needed to understand the complex relationship between patient-reported and objectively assessed adherence to controller medications in asthma.
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