Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort

Title: Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort
Authors: Alahmadi, FH
Simpson, AJ
Gomez, C
Ericsson, M
Thörngren, J-O
Wheelock, C
Shaw, DE
Fleming, LJ
Roberts, G
Riley, J
Bates, S
Sousa, AR
Knowles, R
Bansal, AT
Corfield, J
Pandis, I
Sun, K
Bakke, PS
Caruso, M
Chanez, P
Dahlén, B
Horvath, I
Krug, N
Montuschi, P
Singer, F
Wagers, S
Adcock, IM
Djukanovic, R
Chung, KF
Sterk, PJ
Dahlen, S-E
Fowler, SJ
U-BIOPRED Study Group
Item Type: Journal Article
Abstract: BACKGROUND: Whilst estimates of sub-optimal adherence to oral corticosteroids in asthma range from 30 to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high. RESEARCH QUESTIONS: 1. What is the prevalence of suboptimal adherence detected using self-reporting and direct measures? 2. Is suboptimal adherence associated with disease activity? STUDY DESIGN AND METHODS: Data were included from individuals with severe asthma taking part in the U-BIOPRED study prescribed daily oral corticosteroids. Participants completed the MARS, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid-chromatography mass spectrometry. RESULTS: Data from 166 participants were included in this study, mean (SD) age 54.2 (11.9) years, FEV1 65.1 (20.5) % predicted, 58% female. 37% completing the MARS reported sub-optimal adherence, and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 35% participants who had both performed; adherence detection did not match between methods in 53%. Self-reported high-adherers had better asthma control and quality of life, whereas directly-measured high-adherers had lower blood eosinophils. INTERPRETATION: Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
Issue Date: Jul-2021
Date of Acceptance: 2-Feb-2021
DOI: 10.1016/j.chest.2021.02.023
ISSN: 0012-3692
Publisher: American College of Chest Physicians (ACCP)
Start Page: 53
End Page: 64
Journal / Book Title: Chest
Volume: 160
Issue: 1
Copyright Statement: Crown Copyright © 2021 Published by Elsevier Inc. under license from the American College of Chest Physicians. . This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence
Sponsor/Funder: Commission of the European Communities
Funder's Grant Number: 115010
Keywords: adherence
urinary corticosteroids
U-BIOPRED Study Group
Urinary corticosteroids
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Conference Place: United States
Online Publication Date: 2021-02-18
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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