Nonadherence in the era of severe asthma biologics and thermoplasty

被引:85
作者
Lee, Joy [1 ]
Tay, Tunn Ren [1 ]
Radhakrishna, Naghmeh [1 ]
Hore-Lacy, Fiona [1 ]
Mackay, Anna [1 ]
Hoy, Ryan [1 ,2 ]
Dabscheck, Eli [1 ,3 ]
O'Hehir, Robyn [1 ,3 ]
Hew, Mark [1 ,2 ]
机构
[1] Alfred Hosp, Allergy Asthma & Clin Immunol, 55 Commercial Rd, Melbourne, Vic 3181, Australia
[2] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
[3] Monash Univ, Cent Clin Sch, Allergy Immunol & Resp Med, Melbourne, Vic, Australia
关键词
RANDOMIZED CONTROLLED-TRIAL; INHALED CORTICOSTEROIDS; SYSTEMATIC ASSESSMENT; CLINICAL-TRIALS; TREAT ASTHMA; ADHERENCE; DIFFICULT; OUTCOMES; COMORBIDITIES; OMALIZUMAB;
D O I
10.1183/13993003.01836-2017
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Nonadherence to inhaled preventers impairs asthma control. Electronic monitoring devices (EMDs) can objectively measure adherence. Their use has not been reported in difficult asthma patients potentially suitable for novel therapies, i.e. biologics and bronchial thermoplasty. Consecutive patients with difficult asthma were assessed for eligibility for novel therapies. Medication adherence, defined as taking > 75% of prescribed doses, was assessed by EMD and compared with standardised clinician assessment over an 8-week period. Among 69 difficult asthma patients, adherence could not be analysed in 13, due to device incompatibility or malfunction. Nonadherence was confirmed in 20 out of 45 (44.4%) patients. Clinical assessment of nonadherence was insensitive (physician 15%, nurse 28%). Serum eosinophils were higher in nonadherent patients. Including 11 patients with possible nonadherence (device refused or not returned) increased the nonadherence rate to 31 out of 56 (55%) patients. Severe asthma criteria were fulfilled by 59 out of 69 patients. 47 were eligible for novel therapies, with confirmed nonadherence in 16 out of 32 (50%) patients with EMD data; including seven patients with possible nonadherence increased the nonadherence rate to 23 out of 39 (59%). At least half the patients eligible for novel therapies were nonadherent to preventers. Nonadherence was often undetectable by clinical assessments. Preventer adherence must be confirmed objectively before employing novel severe asthma therapies.
引用
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页数:10
相关论文
共 43 条
[1]  
[Anonymous], 2013, Adherence to Long-Term Therapies: Evidence for Action, DOI DOI 10.4028/WWW.SCIENTIFIC.NET/AMM.321-324.1779
[2]   Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: A randomized controlled trial [J].
Apter, Andrea J. ;
Wang, Xingmei ;
Bogen, Daniel K. ;
Rand, Cynthia S. ;
McElligott, Sean ;
Polsky, Daniel ;
Gonzalez, Rodalyn ;
Priolo, Chantel ;
Adam, Bariituu ;
Geer, Sabrina ;
Ten Have, Thomas .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2011, 128 (03) :516-U122
[3]   Will New Anti-eosinophilic Drugs Be Useful in Asthma Management? No [J].
Barnes, Peter J. .
CHEST, 2017, 151 (01) :17-20
[4]   Adherence: The Goal to Control Asthma [J].
Boulet, Louis-Philippe ;
Vervloet, Daniel ;
Magar, Yves ;
Foster, Juliet M. .
CLINICS IN CHEST MEDICINE, 2012, 33 (03) :405-+
[5]   Persistency of response to omalizumab therapy in severe allergic (IgE-mediated) asthma [J].
Bousquet, J. ;
Siergiejko, Z. ;
Swiebocka, E. ;
Humbert, M. ;
Rabe, K. F. ;
Smith, N. ;
Leo, J. ;
Peckitt, C. ;
Maykut, R. ;
Peachey, G. .
ALLERGY, 2011, 66 (05) :671-678
[6]   Are randomized clinical trials good for us (in the short term)? Evidence for a "trial effect" [J].
Braunholtz, DA ;
Edwards, SJL ;
Lilford, RJ .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2001, 54 (03) :217-224
[7]  
British Thoracic Society Scottish Intercollegiate Guidelines Network, 2014, BRIT GUID MAN ASTHM
[8]  
Castro M, 2015, LANCET RESP MED, V3, P355, DOI [10.1016/S2213-2600(15)00042-9, 10.1016/S2213-2600(15)00119-8]
[9]   The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial [J].
Chan, Amy H. Y. ;
Stewart, Alistair W. ;
Harrison, Jeff ;
Camargo, Carlos A., Jr. ;
Black, Peter N. ;
Mitchell, Edwin A. .
LANCET RESPIRATORY MEDICINE, 2015, 3 (03) :210-219
[10]   International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma [J].
Chung, Kian Fan ;
Wenzel, Sally E. ;
Brozek, Jan L. ;
Bush, Andrew ;
Castro, Mario ;
Sterk, Peter J. ;
Adcock, Ian M. ;
Bateman, Eric D. ;
Bel, Elisabeth H. ;
Bleecker, Eugene R. ;
Boulet, Louis-Philippe ;
Brightling, Christopher ;
Chanez, Pascal ;
Dahlen, Sven-Erik ;
Djukanovic, Ratko ;
Frey, Urs ;
Gaga, Mina ;
Gibson, Peter ;
Hamid, Qutayba ;
Jajour, Nizar N. ;
Mauad, Thais ;
Sorkness, Ronald L. ;
Teague, W. Gerald .
EUROPEAN RESPIRATORY JOURNAL, 2014, 43 (02) :343-373