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Reluctance To Take Prescribed Asthma Medications Identified In Study

MILWAUKEE, WI -- May 14, 2003 -- Social distractions and fear of side effects are two of the main reasons African American adults don't take their asthma medication, according to a study in the May 2003 Journal of Allergy and Clinical Immunology (JACI). The JACI is the peer-reviewed journal of the American Academy of Allergy, Asthma and Immunology (AAAAI).

As a first step in designing an intervention to help improve asthma therapy in low income urban minorities, Maureen George, MSN, RN, CS, and colleagues from the University of Pennsylvania conducted focus groups with 15 low income, urban, African American adults with persistent asthma to assess the reasons they do not use prescribed asthma treatments.

Researchers sought to better understand the barriers to inhaled corticosteroid (IC) adherence the patients experience, identify strategies to improve IC adherence, and assess opinions regarding asthma providers and participation in clinical research.

Inhaled corticosteroids are recognized as the medications of choice for the treatment of chronic, persistent asthma by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung and Blood Institute (NHLBI). They are effective in reducing airway inflammation, hypersensitivity, swelling and mucous production.

From the focus groups, researchers discovered five primary themes characterizing barriers to IC use:

-- Reluctance to take medications on a daily basis - Some of the patients did not take their ICs when symptoms were absent. Patients believed that a self assessment of their asthma control was better than a visit to their health providers.

-- Social distractions - Medication use was disrupted in large households with many children and extended families. Unexpected visitors, telephone calls, unscheduled sleep or being too tired to retrieve mediation were common causes of omitted doses.

-- Challenges of being enrolled in a Medicaid managed care plan - Patients experienced difficulty in obtaining medication due to the plan's restricted formulary, needing prior authorization forms or letters of necessity from their asthma care provider. Also, gaps in therapy occurred due to mandatory waiting times for medication refills.

-- Inappropriate response to doses not taken on time - Patients indicated they had inadequate knowledge of how to respond to late medication doses. Focus groups patients inferred from previous experiences that it was safer to omit a does rather than to take a dose at too close of an interval.

-- Fear of steroid side effects - Focus group participants had an inaccurate understanding of IC therapy side effects. They did not consider daily dosing of any drug, but particular ICs, as either necessary or healthy. Patients worried that ICs could cause liver or kidney damage, infertility, and even cancer.

Improving communication between the healthcare provider and patient would assist in overcoming these barriers, researchers suggest. For example, the focus group participants believed that if they had accurate knowledge of side effects and knew the benefit of taking medication late instead of not at all, they would likelier do a better job with their IC therapy.

The patients also shared ideas for getting into the habit of taking medication on a regular basis by developing simple regimens, helping them to avoid social distractions. While these participants reported good relationships with their asthma care providers, they expressed a general distrust of the medical establishment and concern that information from side effects might be withheld from them.


SOURCE: American Academy of Allergy, Asthma and Immunology

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