[Attitudes towards inhaled therapy in Algeria: Initial refusal and reluctant acceptance]

To estimate the frequency of initial refusal of inhaled treatment in Algerian pneumology outpatients and to describe the characteristics of patients presenting this refusal.

Multicenter cross-sectional study (September 2022 to January 2023) conducted in seven clinics. Attitudes were classified as immediate acceptance, difficult acceptance, or persistent refusal. Initial refusal combined the last two.

Three hundred eighty-five (385) patients were included (mean age 40.1±25.0 years; 49.9% male). Initial refusal occurred in 127/385 (33.0%), including 32/385 (8.3%) with persistent refusal; 95/127 (74.8%) accepted after discussion. Patients with initial refusal were younger, more often in a new initiation setting, and more likely to show poor disease acceptance. Immediate acceptance was more frequent when prescriptions included a long-acting beta-2 agonist or a fixed inhaled corticosteroid plus long-acting beta-2 agonist combination, and when the device was a capsule inhaler. It was also more frequent in patients previously exposed to inhaled therapy or with a close relative using an inhaler. Fears (adverse effects, dependence, stigma) and social influences were mainly reported by refusers; 54/127 (42.5%) cited close relatives as the main influence. Time devoted to information and advice was longer in the initial refusal group (6.39±3.33 vs. 4.00±2.00minutes).

One in three patients initially refuses inhaled therapy. Structured counselling at the time of prescribing, with attention to patients' beliefs and family influence, may help reduce these early refusals.