Understanding beliefs about inhaled medication in patients with persistent asthma: A cross-sectional analysis of the INSPIRERS studies

Background: Identifying factors influencing adherence, such as patients’ beliefs about medication, is essential for effective asthma management. This study aims to assess and gain insight into the beliefs of patients with asthma regarding inhaled medication. Methods: This is a secondary analysis of the INSPIRERS studies. Patients aged ≥13 y.o., with persistent asthma and a prescription for inhaled controller were recruited from 60 primary and secondary care centres in Portugal from 2017 to 2020. Demographic and clinical characteristics were collected in a face-to-face visit. The Specific-Beliefs about Medicine Questionnaire was administered 1-week later by telephone interview. Mann-Whitney U and Kruskal-Wallis tests were used to explore relations between patients’ beliefs and characteristics. Results: A total of 552 participants (mean 32.8 ± 17.3 y.o.; 64.5% female) were analysed. The Necessity score (Median 19[p25-p75 16,22]) was significantly higher than the Concerns score (15 [16,22], p<0.001), resulting in a positive Necessity-Concern differential (Median 4 [0,7]). Acceptance (high necessity, low concerns) characterized 61% of participants, while 19% were ambivalent (high necessity, high concerns). Adolescents exhibited lower Necessity (Median 16 vs 20; p<0.001) and Concerns scores (Median 11 vs 15; p=0.002) than adults. In primary care setting, patients had significantly lower Necessity (Median 18 vs 19; p=0.027) and Concerns (Median 14 vs 15; p=0.05) compared to the secondary care. Conclusions: A predominantly positive perception of inhaled asthma medication necessity was found, although ambivalence or indifference exists in about 1/5 of patients. Our findings highlight the importance of personalized approaches to address beliefs and optimise patient education.