Beliefs About Inhalers Impact Treatment Adherence, Asthma Control

Patient beliefs about the necessity of asthma treatment can influence treatment adherence and asthma control, according to a new study.

Amy Hai Yan Chan, MD, of the University College London, the Asthma UK Centre for Applied Research, and the University of Auckland Faculty of Medical and Health Sciences, and colleagues conducted the research because “poor adherence to inhaled corticosteroids increases asthma morbidity and mortality and is influenced by patients’ treatment beliefs.”

The researchers conducted a point-in-time survey of 1312 patients who had asthma and received inhaled corticosteroids alone or in combination with a long-acting β2-agonist. All patients were aged 18 years or older and lived in the United States or Europe, with 24% of patients living in Germany, 21% in the United States, 21% in France, 16% in Spain, 10% in Italy, and 9% in the United Kingdom.

Dr. Chan and colleagues collected data on clinical characteristics such as treatment adherence and asthma control from patients and clinicians. Patients completed the Beliefs about Medicines Questionnaire, which was adapted for inhaled corticosteroids.

Most patients (78%) agreed in a self-reported survey that inhaler use protected them from worsening asthma, while 64% agreed that their health at present was dependent on the inhaler. However, only 37% of patients thought their life would be “impossible” without inhaler use, the researchers reported.

Almost half of the patients (40%) were “sometimes worried about long-term effects” of inhaler use, while 36% were worried about becoming “too dependent on their inhaler,” and 28% were “generally worried” about using the inhaler, according to Dr. Chan and colleagues.

Nearly one-third of patients (31.2%) reported they felt there was a low level of necessity for inhaler use, while 25.8% reported a combination of low necessity and low concern regarding inhaler use, and 5.3% reported a combination of low necessity and high concern about inhaler use.

Patients who had doubts about the necessity of inhaled corticosteroids had significantly lower self-reported adherence (P<0.001) and clinician-reported adherence (P=.003), as did those who had high levels of concern about inhaled corticosteroids (P<0.001; P<0.001, respectively). Those who had high necessity beliefs and high levels of concern about inhaler use “reported poorer control” of asthma (P=.037; P<.001, respectively), according to the researchers.

“Poor adherence in asthma remains a barrier to optimal outcomes,” Dr. Chan and colleagues concluded. “Guidelines should recommend that clinicians consider patients’ treatment beliefs to promote adherence in asthma, as associations between beliefs, adherence, and outcomes were found in all countries.”

Chan AHY, Katzer CB, Pike J, Small M, Horne R. Medication beliefs, adherence and outcomes in people with asthma: the importance of treatment beliefs in understanding inhaled corticosteroid nonadherence – a retrospective analysis of a real-world dataset. J Allergy Clin Immunol Glob. 2022. doi:10.1016/j.jacig.2022.09.006