Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here?

File Description SizeFormat 
Dekhuijzen adherence review revised tracked.docxFile embargoed until 12 January 201977.5 kBMicrosoft Word    Request a copy
Title: Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here?
Author(s): Dekhuijzen, R
Lavorini, F
Usmani, OS
Van Boven, JFM
Item Type: Journal Article
Abstract: Nonadherence to treatment, and its associated health and economic burden, is particularly problematic in asthma and chronic obstructive pulmonary disease management because of heterogeneous patient populations and the need for an inhaled route of drug administration. Symptom variability, comorbidities, and device switching further add to suboptimal adherence rates. As opposed to controlled clinical trials, real-life studies show consistently low inhaler adherence in daily practice, yet exact adherence rates have long been affected by disagreement on standardized definitions. The recently developed Ascertaining Barriers to Compliance taxonomy helps to address adherence research disparities by identifying 3 phases of adherence (initiation, implementation [including correct inhaler technique], and discontinuation). This review considers the reasons for and impact of suboptimal adherence, together with summaries of key studies that demonstrate how improving adherence can reduce exacerbations, inhaled corticosteroid use (in cases of better inhaler technique), hospitalizations, and treatment costs. Strategies to help ensure optimal adherence are discussed, including the choice of a patient-tailored inhaler, patient empowerment, education and training, and the potential of electronic monitoring and digital technology. It is concluded that a combined effort from payers, health care professionals, and manufacturers could make a real difference to asthma and chronic obstructive pulmonary disease control, as well as to health care budgets.
Publication Date: 1-May-2018
Date of Acceptance: 2-Nov-2017
URI: http://hdl.handle.net/10044/1/57220
DOI: https://dx.doi.org/10.1016/j.jaip.2017.11.027
ISSN: 2213-2198
Publisher: Elsevier
Start Page: 785
End Page: 793
Journal / Book Title: Journal of Allergy and Clinical Immunology: In Practice
Volume: 6
Issue: 3
Copyright Statement: © 2017 American Academy of Allergy, Asthma & Immunology. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Adherence
Asthma
Chronic obstructive pulmonary disease
Clinical outcomes
Devices
Economic outcomes
Electronic monitoring
Strategies
Training
Adherence
Asthma
Chronic obstructive pulmonary disease
Clinical outcomes
Devices
Economic outcomes
Electronic monitoring
Strategies
Training
Publication Status: Published
Conference Place: United States
Embargo Date: 2019-01-12
Online Publication Date: 2018-01-12
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



Items in Spiral are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons