Original Articles: Asthma, Lower Airway Diseases
Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients

https://doi.org/10.1016/S1081-1206(10)60141-XGet rights and content

Background

Daily inhaled corticosteroid (ICS) use is the cornerstone of asthma management, although it is often suboptimal, especially in inner-city populations.

Objective

To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time.

Methods

Asthma history, medication beliefs, and ICS therapy adherence were determined in a prospective, observational cohort. Medication beliefs were based on self-regulation and self-efficacy theory. Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale, a validated 10-item instrument, at baseline and at 1 and 3 months. Repeated-measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age, sex, race, and asthma severity.

Results

The 261 patients were low-income minorities with high rates of asthma hospitalization, emergency department visits, intubation, and oral corticosteroid use. Adherence with ICS therapy was stable across time, with 70% of patients saying that they used ICS all or most of the time when asymptomatic. Most patients (82%) thought it was important to use ICS when asymptomatic, although 49% worried about side effects and 37% worried about becoming addicted. Although 82% felt confident in using ICS, 7% felt that their regimen was hard to follow. In multivariable analyses, the odds of adherence increased for those who felt that using ICS when asymptomatic was important (odds ratio [OR], 4.15) and for those who were confident in using ICS (OR, 2.23) and decreased by worries about side effects (OR, 0.52) or feeling the regimen was hard to follow (OR, 0.48).

Conclusions

Several positive and negative beliefs about ICS were associated with adherence. Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes.

Section snippets

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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  • Cited by (0)

    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).

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