THE IMPORTANCE OF COMPLIANCE IN ASTHMA

Compliance with asthma therapy is currently poor. Research shows a non-compliance rate of 30 to 70 per cent with inhaled and oral therapy for both adults and children. (1)

Poor compliance contributes significantly to asthma morbidity and mortality.

Compliance with preventive therapy is worse than with relievers, because patients do not experience immediate effects. (2) But failure to use anti-inflammatory therapy on a regular basis may lead to permanently impaired lung function. (2)

The basis of good compliance is understanding and knowledge about asthma and its treatment. If a patient understands the value of their therapy and the need to use it regularly, they are more likely to comply. (2)

Compliance is significantly affected by the frequency of treatment. More patients comply with twice-daily therapy than with medication that must be taken four times a day. (2)

Monitoring daily bronchodilator use is important because it is one of the criteria used to assess asthma control, and may form the basis of a decision to change therapy. So it is important that asthmatic patients are able to give health professionals an accurate account of how much medication they have taken. (3)

Several studies show that children and adults have more accurate dose records when they use the Diskhaler than when using reservoir powder devices. (3,4)

Selecting an inhaler which suits the patient and which they can operate correctly is crucial in ensuring that they use it regularly. Features which may be important in choosing an inhaler include:

• easy to use
• dose monitoring to indicate whether a dose has been taken and the number of doses left
• reliable delivery giving reproducible doses
• aesthetically pleasing and unobtrusive
• easy to carry about
• range of therapies and strengths available (so the patient can use the same inhaler even when their GP decides to change their drug or dose)
• acceptable cost.

Assessing compliance both in the surgery and in clinical trials is unreliable and difficult. Dose-monitoring facilities, such as numbered blisters of drug in an inhaler device, can help.

Patients are more likely to comply with treatment if they have been involved in decisions, and feel in control of the situation. The ability to count doses may help them to monitor their own therapy, and provide an easy reminder if they forget a dose in a similar way to a calendar pack.

References

1. Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Resp Crit Care Med 1994,149; S69-76.
2. Asthma: Improving compliance, reducing the burden, Shire Hall Publishing, 1995; ISBN 1899891 00 5.
3. Repper J, Callow J, Bond CM. The accuracy of asthmatic children's drug usage records using two breath-actuated dry-powder inhalers. Br J Clin Res 1994; 5: 147-55.
4. Thomas HL, Thomas MJ. A comparison of patient compliance with inhaled corticosteroid therapy taken either by the Diskhaler (beclomethasone dipropionate) or a reservoir powder device (budesonide). Br J Clin Res 1994; 5: 139-146