Noncompliance with asthma therapy--are there solutions?
- Disease management
Compliance with medication is essential if treatment is to be effective. Noncompliance can include underuse, overuse, and erratic use of medication; underuse being the most frequently reviewed. Generally estimated to be around 10%-46%, noncompliance with asthma therapy is a serious problem and studies have shown that compliance with the mainstay of asthma treatment, inhaled corticosteroids, is low. Oral therapy offers better compliance with treatment, with many patients preferring tablets to inhalers. Different ways to monitor compliance include monitoring prescriptions, counting tablets, measuring levels of medication in blood or urine, and measuring canister weight, although none are fully effective. Contributing factors to noncompliance with treatment include side effects, lifestyle, social and economic factors, method of drug delivery, and dosing. The consequences of these include increased symptoms and asthma exacerbations, both of which can lead to increased morbidity. To improve compliance, causal factors need to be addressed; there is a need to educate patients and those who support them about the disease and the importance of following the physician's recommendations. Various self-management programs have also been established to improve patient compliance at a relatively low cost. Difficulties with treatment may be addressed by simplifying the treatment regimen using oral therapy. A relatively new class of oral agents, the leukotriene modifiers, is being increasingly used in clinical practice.