Asthma therapy compliance poor in many patients

Despite the high risk of exacerbation and even death, high-risk patients discharged after asthma hospitalizations often prematurely stop using prescribed corticosteroids, researchers report in the American Journal of Respiratory and Critical Care Medicine.

As lead investigator Dr. Jerry A. Krishnan told Reuters Health, "despite multiple tangible supports to optimize patient self-management, including free medications and intensive education, we found that adults hospitalized for asthma exacerbations very rapidly discontinue corticosteroids after discharge...Patients were using only about half the prescribed dose within seven days of hospital discharge."

Krishnan of the Johns Hopkins Asthma and Allergy Center, Baltimore, and colleagues came to this conclusion after a prospective study of 60 asthma patients followed for a two-week period after hospital discharge.

To track use of inhaled and oral corticosteroids after discharge, electronic medication monitors were used along with canister weighing, pill counts and self reports.

Electronic measurement showed that adherence dropped to about 50 percent within seven days. Moreover, self-reports and pill counts were not reliable in detecting poor adherence.

Krishnan added that "patients who had worse asthma control two weeks after hospital discharge were also the ones, in general, who were less adherent to corticosteroids."

"Finally," he said, "commonly used measures of adherence, such as asking patients how much medication they are taking, do not reliably exclude non-adherence."

SOURCE: American Journal of Respiratory Critical Care Medicine, December 15, 2004.