Patient-reported Side Effects, Concerns and Adherence to Corticosteroid Treatment for Asthma, and Comparison with Physician Estimates of Side-effect Prevalence: a UK-wide, Cross-sectional Study

Overview

Journal NPJ Prim Care Respir Med

Specialties Public Health
Pulmonary Medicine

Date 2015 Jul 10

PMID 26158805

Citations 64

Authors

Vanessa Cooper

Leanne Metcalf

Jenny Versnel

Jane Upton

Samantha Walker

Rob Horne

Affiliations

Soon will be listed here.

Abstract

Background: Non-adherence to corticosteroid treatment has been shown to reduce treatment efficacy, thus compromising asthma control.

Aims: To examine the experiences of treatment side effects, treatment concerns and adherence to inhaled (ICS) and oral corticosteroids (OCS) among people with asthma and to identify the degree of concordance between clinician estimates of side effects and the prevalence reported by patients.

Methods: Asthma UK members were sent validated questionnaires assessing treatment concerns, experiences of side effects and adherence. Questionnaires measuring clinicians' estimates of the prevalence of corticosteroid side effects were completed online.

Results: Completed questionnaires were returned by 1,524 people taking ICS, 233 taking OCS and 244 clinicians (67% of clinicians were primary care nurses). Among people with asthma, 64% of those taking ICS and 88% of those taking OCS reported ⩾ 1 side effect. People reporting high adherence to ICS (t = -3.09, P<0.005) and those reporting low adherence to OCS (t = 1.86, P < 0.05; one-tailed test) reported more side effects. There was a disparity between clinicians' estimates of the frequency of side effects and the frequency reported by people with asthma: e.g., although 46% of people taking ICS reported sore throat, clinicians estimated that this figure would be 10%. Patients who reported side effects had stronger concerns about both ICS (r = 0.46, P < 0.0001) and OCS (r = 0.50, P < 0.0001). Concerns about corticosteroids were associated with low adherence to ICS (t = 6.90, P < 0.0001) and OCS (t = 1.71; P < 0.05; one-tailed test).

Conclusions: An unexpectedly large proportion of people with asthma experienced side effects and had strong concerns about their treatment, which compromised adherence. These findings have implications for the design of interventions to optimise asthma control through improved adherence.

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References

Brown C, Battista D, Bruehlman R, Sereika S, Thase M, Dunbar-Jacob J . Beliefs about antidepressant medications in primary care patients: relationship to self-reported adherence. Med Care. 2005; 43(12):1203-7. DOI: 10.1097/01.mlr.0000185733.30697.f6. View

Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B . Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000; 343(5):332-6. DOI: 10.1056/NEJM200008033430504. View

Horne R, Buick D, Fisher M, Leake H, Cooper V, Weinman J . Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART. Int J STD AIDS. 2004; 15(1):38-44. DOI: 10.1258/095646204322637245. View

Partridge M, van der Molen T, Myrseth S, Busse W . Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med. 2006; 6:13. PMC: 1483837. DOI: 10.1186/1471-2466-6-13. View

Barnes P, Pedersen S, Busse W . Efficacy and safety of inhaled corticosteroids. New developments. Am J Respir Crit Care Med. 1998; 157(3 Pt 2):S1-53. DOI: 10.1164/ajrccm.157.3.157315. View

Ponieman D, Wisnivesky J, Leventhal H, Musumeci-Szabo T, Halm E . Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients. Ann Allergy Asthma Immunol. 2009; 103(1):38-42. DOI: 10.1016/S1081-1206(10)60141-X. View

COCHRANE G, Horne R, Chanez P . Compliance in asthma. Respir Med. 1999; 93(11):763-9. DOI: 10.1016/s0954-6111(99)90260-3. View

Menckeberg T, Bouvy M, Bracke M, Kaptein A, Leufkens H, Raaijmakers J . Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2007; 64(1):47-54. DOI: 10.1016/j.jpsychores.2007.07.016. View

Kaplan A, Small I . Our patients' fears may be getting the better of them: how do we deal with it?. Prim Care Respir J. 2011; 20(3):233-4. PMC: 6549857. DOI: 10.4104/pcrj.2011.00068. View

10.

Rabe K, Vermeire P, Soriano J, Maier W . Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J. 2001; 16(5):802-7. DOI: 10.1183/09031936.00.16580200. View

11.

Mora P, Berkowitz A, Contrada R, Wisnivesky J, Horne R, Leventhal H . Factor structure and longitudinal invariance of the Medical Adherence Report Scale-Asthma. Psychol Health. 2011; 26(6):713-27. DOI: 10.1080/08870446.2010.490585. View

12.

Peters S, Jones C, Haselkorn T, Mink D, Valacer D, Weiss S . Real-world Evaluation of Asthma Control and Treatment (REACT): findings from a national Web-based survey. J Allergy Clin Immunol. 2007; 119(6):1454-61. DOI: 10.1016/j.jaci.2007.03.022. View

13.

Colloca L, Miller F . The nocebo effect and its relevance for clinical practice. Psychosom Med. 2011; 73(7):598-603. PMC: 3167012. DOI: 10.1097/PSY.0b013e3182294a50. View

14.

Pinnock H, Thomas M, Tsiligianni I, Lisspers K, Ostrem A, Stallberg B . The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010. Prim Care Respir J. 2010; 19 Suppl 1:S1-20. PMC: 6602279. DOI: 10.4104/pcrj.2010.00021. View

15.

Neame R, Hammond A . Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford). 2005; 44(6):762-7. DOI: 10.1093/rheumatology/keh587. View

16.

Fukushima C, Matsuse H, Tomari S, Obase Y, Miyazaki Y, Shimoda T . Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone. Ann Allergy Asthma Immunol. 2003; 90(6):646-51. DOI: 10.1016/S1081-1206(10)61870-4. View

17.

Clatworthy J, Bowskill R, Parham R, Rank T, Scott J, Horne R . Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework. J Affect Disord. 2008; 116(1-2):51-5. DOI: 10.1016/j.jad.2008.11.004. View

18.

Elliott R, Barber N, Clifford S, Horne R, Hartley E . The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm World Sci. 2007; 30(1):17-23. DOI: 10.1007/s11096-007-9134-y. View

19.

Haughney J, Price D, Kaplan A, Chrystyn H, Horne R, May N . Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008; 102(12):1681-93. DOI: 10.1016/j.rmed.2008.08.003. View

20.

Toogood J, Jennings B, Baskerville J, Anderson J, JOHANSSON S . Dosing regimen of budesonide and occurrence of oropharyngeal complications. Eur J Respir Dis. 1984; 65(1):35-44. View