Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt

BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.

OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.

METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.

RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.

CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.

MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.

My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: “Why didn’t you take your ICS”?, but they will probably have to do another study to get this question answered.

CHANGE IN THE AIR

A federal ban on ozone-depleting chlorofluorocarbons (CFCs), to conform to the Clean Air Act, is, ironically, affecting 22.9 million people in the United States who suffer from asthma, says Scientific American. Generic inhaled albuterol — the most commonly prescribed short-acting asthma medication that requires CFCs to propel it into the lungs — will no longer be legally sold after December 21, 2008.

As more patients see their prescriptions change and costs go up — the reformulated brand-name alternatives can be three times as expensive, raising the cost to about $40 per inhaler — many question why this ban must begin before generics become available. Some skeptics point to the billions of dollars to be gained by the three companies, GlaxoSmithKline, Schering-Plough and Teva, holding the patents on the available HFA-albuterol inhalers.

However, the main public health issue may not be the drug’s chemistry, but rather the side effects of the economics:

Multiple studies have shown that raising costs leads to poorer adherence to treatment; one study discovered that patients took 30 percent less antiasthma medication when their co-pay doubled.

In the case of a chronic disease such as asthma, it is particularly difficult to get people to follow regular treatment plans.

The choice to forgo medication could affect more than just the patient; for example, in a pregnant mother with untreated asthma, less oxygen is delivered to the fetus, which could lead to congenital problems and premature birth.

Considering that the disease disproportionately strikes the poor, what seemed to be a good, responsible environmental decision might in the end exact an unexpected human toll, says Scientific American.

Source: Emily Harrison, “Change in the Air: Banning CFC-driven inhalers could levy a toll on asthma sufferers,” Scientific American, August 2008.

COMMENTS:
This might be a little cheap reposting a post from another source, but I thought it was interesting. This has happened before: he government steps in to help a cause, and ends up hurting someone else. Surprisingly adherence with asthma medication in low already – since asthmatics who feel good, do not take their medications in general. It is only when they have an attack that they reach for their inhalers. Of course raising the price of medications affects adherence as well – perhaps there will be a subsidy to help asthmatics or there will be a protest to let the CFCs still be used in inhalers?