Original Articles: Asthma, Lower Airway DiseasesImpact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients
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INTRODUCTION
Daily use of inhaled corticosteroids (ICS) is the cornerstone of the evidence-based management of persistent asthma.1 However, despite strong evidence supporting their efficacy and consensus guidelines advocating their use, asthma remains poorly controlled in many patients, particularly in minorities in inner-city communities.2, 3, 4
Medications work only if they are taken, and suboptimal adherence is widespread. There is a large literature showing rates of adherence with ICS therapy in adults
Study Sites, Participants, and Data Collection
We used data from a multisite, prospective, observational cohort study of minority adults with persistent asthma that has been previously described.21 Adults with a physician diagnosis of persistent asthma were recruited from the general internal medicine clinics of Mount Sinai Hospital in East Harlem, New York, New York, and Robert Wood Johnson Medical Center, New Brunswick, New Jersey. Patients were excluded if they had a smoking history of at least 10 pack-years or chronic obstructive lung
Patient Participation and Response Rates
Two hundred sixty-one of the overall cohort of 318 patients (82.1%) were prescribed daily ICS. We completed the 1-month follow-up survey on medication use with 259 patients (99.2%) and the 3-month interview with 201 (77.0%). Characteristics of the 261 participants are given in Table 1. The mean patient age was 48 years (range, 20–87 years), 82% were women, 57% were Hispanic, 30% were black, and 20% completed the survey in Spanish. Asthma morbidity was significant, with 12% reporting a history
DISCUSSION
This prospective, multisite, inner-city asthma cohort study sought to understand the impact of a broad spectrum of medication beliefs on the use of ICS—the cornerstone of evidence-based asthma care. In a group of predominantly minority, low-income patients with high asthma morbidity who all had a usual ambulatory provider, the rate of prescription of ICS was 88%. This rate is higher than that in many studies,5, 6, 7, 8, 9 but it still reflects underuse of anti-inflammatory therapy in high-risk
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Disclosures: Authors have nothing to disclose.
Funding Sources: This study was funded by the National Institute on Aging and the Center for the Study of Health Beliefs and Behaviors (RO1 HS09973), the Agency for Healthcare Research and Quality (K08 HS013312), and the Health Resources and Services Administration (CFDA 93-895).