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Adherence to Asthma Self-Management Often Poor

Patient adherence to asthma self-management varies, but it is often poor with adherence tending to increase in proportion to the severity and duration of an asthmatic episode.

Researchers in New Zealand suggest this underscores the importance of self-management among patients with severe asthma.

"Symptoms are more important than peak expiratory flow (PEF) in prompting patients to alter treatment," say investigators from the University of Otago in Dunedin and Christchurch Hospital.

They analysed diary data from 165 patients participating in an earlier two-year study. In that study, participants regularly revised their asthma self-management plans in combination with PEF and symptoms to manage intercurrent episodes. They recorded changes in diaries.

Self-management included instructions on when to increase inhaled corticosteroid dosage or start oral prednisone as asthmatic episodes increased in severity.

In their analysis, the researchers identified when patients increased dosage or started prednisone. The changes were correlated to those in PEF and/or symptoms.

Patient adherence for increasing corticosteroid use was dependent on asthma severity, the found. It ranged from 78 percent during severe episodes to 31 percent during mild, short events.

Patients adhered to prednisone guidelines on 56 percent of occasions indicating use.

Significant changes in PEF were absent on 41 percent of occasions for corticosteroid dosage increase and 48 percent of occasions for prednisone use.

Investigators concluded that symptoms prompted patient intervention more frequently than changes in PEF.
Respirology, 2002; 7: 133-139. "Adherence to asthma self-management plans with inhaled corticosteroid and oral prednisone: A descriptive analysis"

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