Why some don't use asthma meds as directed

People's beliefs about the benefits and risks of their asthma medication may be key to their willingness to take it as directed, a new study finds.

The study, published in the Annals of Asthma, Allergy & Immunology, looked at adherence to inhaled corticosteroid medication among 261 low- income, minority asthma patients.

Inhaled corticosteroids reduce inflammation in the airways and are the cornerstone of managing chronic asthma. To be most effective, the drugs must be taken regularly, even when people are symptom-free.

But studies suggest that many adults do not take their inhaled corticosteroids regularly, and that the problem is more common among minority patients than their white counterparts.

In the current study, researchers found that 70 percent of patients said they used their inhaled corticosteroids all or most of the time.

Perhaps not surprisingly, those who believed it was "important" to take the drugs even when they were symptom-free were four times more likely to be compliant compared with patients who did not share that belief.

On the other hand, patients who worried about medication side effects were only half as likely to adhere to their treatment as those without those concerns.

Finally, patients who were confident in their ability to take their inhaled medication correctly were more than twice as likely to be compliant as those who lacked such self-confidence.

The findings point to several areas where healthcare providers could improve low-income, minority patients' medication compliance, according to the researchers, led by Dr. Diego Ponieman of the Mount Sinai School of Medicine in New York City.

Doctors and nurses could, for example, help boost patients' confidence by actively "coaching" them in how to take their medication properly, the researchers write.

In addition, they say, doctors should recognize that many patients worry about drug side effects and explicitly address those concerns.

The most common side effects of inhaled corticosteroids are considered relatively mild and include throat irritation and thrush, a yeast infection of the mouth.

The drugs are also much safer than the oral corticosteroids that may have to be given when a person has a serious asthma attack. So preventing attacks via inhaled corticosteroids is seen as a way of protecting patients from the risks of repeatedly using the oral versions - which include weight gain, elevated blood pressure and blood sugar, and decreased bone density.

By "bolstering positive beliefs and mitigating the negative ones," Ponieman and his colleagues write, doctors may be able to convince more patients to stick with their inhaled-corticosteroid regimen.

SOURCE: Annals of Asthma, Allergy & Immunology, July 2009.