Are Treatment Adherence Factors Apparent in Patients with Asthma and to Physicians? Results from the APPaRENT 3 Survey

Introduction: Patient adherence to regular controller medication is critical for improving clinical outcomes in asthma, which is consistently associated with underlying pathophysiological inflammation. This survey aimed to identify types of treatment nonadherence and associated factors, including patient characteristics that predict poor adherence, in patients with asthma. Methods: This cross-sectional online survey involved patients with asthma and physicians managing such patients from Southeast Asia (Indonesia, Malaysia, Philippines, Thailand and Vietnam) and the Middle East (Saudi Arabia and United Arab Emirates) included in the Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma (APPaRENT) 3 study. Patients and physicians shared their attitudes and beliefs regarding treatment and adherence in asthma management. Results: Most patients (82%, 1108/1354) reported having ever received treatment with daily controller inhalers, whereas 38% used inhaled relievers at least once daily for symptomatic relief. Among those prescribed maintenance and reliever therapy, 93% were prescribed a separate inhaled reliever, with significant variation by country (P < 0.01). Erratic nonadherence (primary definition) was exhibited by 55% (462/845) of patients including those who reported at least sometimes forgetting inhaler use, with its prevalence increasing with worsening asthma severity. Nonerratic nonadherence was exhibited by 49% (415/847) of patients including those who reported using controller inhalers less than once daily. Physicians reported that 73% of patients adhered to the prescribed regular medication. Regression analysis examining both erratic (primary definition) and nonerratic nonadherence revealed that current inhaled reliever used was the only significant predictor of poor adherence (P = 0.04). Sensitivity analyses revealed that the predictors of poor adherence to controller inhaler varied depending on the definition of nonadherence employed in the study. Conclusion: This study revealed high rates of erratic and nonerratic nonadherence to regular controller inhalers in patients with asthma as well as discordance between adherence rates reported by patients and physicians.