Alahmadi, Fahad H; Simpson, Andrew J; Gomez, Cristina; Ericsson, Magnus; Thörngren, John-Olof; Wheelock, Craig; Shaw, Dominic E; Fleming, Louise J; Roberts, Graham; Riley, John; Bates, Stewart; Sousa, Ana R; Knowles, Richard; Bansal, Aruna T; Corfield, Julie; Pandis, Ioannis; Sun, Kai; Bakke, Per S; Caruso, Massimo; Chanez, Pascal; ... (2021). Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort. Chest, 160(1), pp. 53-64. Elsevier 10.1016/j.chest.2021.02.023
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BACKGROUND
Although estimates of suboptimal adherence to oral corticosteroids in asthma range from 30% to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high.
RESEARCH QUESTIONS
What is the prevalence of suboptimal adherence detected by self-reporting and direct measures? Is suboptimal adherence associated with disease activity?
STUDY DESIGN AND METHODS
Data were included from individuals with severe asthma taking part in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study and prescribed daily oral corticosteroids. Participants completed the Medication Adherence Report Scale, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid chromatography-mass spectrometry.
RESULTS
Data from 166 participants were included in this study: mean (SD) age, 54.2 (± 11.9) years; FEV1, 65.1% (± 20.5%) predicted; female, 58%; 37% completing the Medication Adherence Report Scale reported suboptimal adherence; and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in the 35% of participants in whom both methods were performed; adherence detection did not match between methods in 53%. Self-reported high adherers had better asthma control and quality of life, whereas directly measured high adherers had lower blood eosinophil levels.
INTERPRETATION
Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods, suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
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