Adherence to asthma medication: A partnership

A major problem in chronic disease management is patient adherence to his/her prescribed regimen. Health professionals are constantly challenged to adequately inform their patients about their prescribed regimen and the importance of adhering to these medications and its program, even in the absence of symptoms, to enhance both the quality of life and health outcomes of their patients.

Adherence to prescribed therapy had been identified as a major factor in successful asthma management. However, in spite of the significant advances in developing asthma medications and the introduction of asthma management plans, it still appears that adherence to asthma medications tend to be very poor with the reported rates of nonadherence ranging from 30 to 70 percent.

But what do we mean by adherence? Adherence focuses more on the commitment to the regimen where the therapy (medication) is the controlling factor. There is at least reasonable negotiation between members of the asthma care team (physicians) and the person with asthma (patient). On the other hand, compliance implies that the patient will follow the doctor’s orders and he/she (patient) is in a less informed position and has little or no input into the doctor’s management strategy.

The goal of asthma management is to achieve and maintain symptom control and risk reductions.

Medications to treat asthma are classified into two categories: the controllers and the relievers.

1) Controllers are medications taken daily on a long-term basis to keep asthma symptoms under control.

2) Relievers, on the other hand, are medications used on an as-needed basis, as these act rapidly to reverse bronchoconstriction and relieve symptoms of breathlessness.

“The principal determinant of best health outcomes of asthmatics is a partnership—relationship with his/her physician.” Shared decision for asthma medication and dose choices between the physician and patient is the pivotal link in influencing patient behavior change when in comes to adherence in his/her asthma medication management.

In the patient, who subsequently manifests nonadherence, the physician/clinician should explore the possible factors that contribute to the patient’s nonadherence to his/her asthma medications such as: the patient’s attitude toward their asthma and understanding of his/her disease, the priority of health in his/her life in including financial considerations, and his/her health beliefs and prior experiences.

A symptom-free existence and dramatically improved quality of life are the benefits gained when adherence to asthma management plans and treatment regimens are achieved by the patient. Conveying these potential benefits, of improving adherence to prescribed asthma therapy, is indeed a challenge to the health professionals and likewise, to the patient. In the end it entails both parties, the physician and the patient, to exert their utmost to gain the maximum results, as stated earlier.

Dr. Shirley Jane Chua-Panganiban is section head of Critical Care at the Institute of Pulmonary Medicine in St. Luke’s Medical Center, Quezon City. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.