Asthma patients' self-reported behaviours toward inhaled corticosteroids

Laforest, Laurent; El Hasnaoui, Abdelkader; Pribil, Céline; Ritleng, Cécile; Osman, Liesl M.; Schwalm, Marie-Sophie; Le Jeunne, Philippe; Van Ganse, Eric

doi:10.1016/j.rmed.2009.03.010

« Previous Next »Respiratory Medicine
Volume 103, Issue 9 , Pages 1366-1375, September 2009

Asthma patients' self-reported behaviours toward inhaled corticosteroids

Laurent Laforest
- CHU Lyon, Unité de Pharmacoépidémiologie, Service de Neurologie, Hôpital Pierre Wertheimer, 59 Boulevard Pinel, 69677 Bron, France
Abdelkader El Hasnaoui
- Epidemiology Department, GSK Laboratory, 100 Route de Versailles, 78163 Marly-le-Roi, France
Céline Pribil
- Epidemiology Department, GSK Laboratory, 100 Route de Versailles, 78163 Marly-le-Roi, France
Cécile Ritleng
- CHU Lyon, Unité de Pharmacoépidémiologie, Service de Neurologie, Hôpital Pierre Wertheimer, 59 Boulevard Pinel, 69677 Bron, France
Liesl M. Osman
- University of Oxford, NDM Strategic, Nuffield Department of Medicine, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
Marie-Sophie Schwalm
- Cegedim, 90–92 Route de la Reine, 92100 Boulogne-Billancourt, France
Philippe Le Jeunne
- Cegedim, 90–92 Route de la Reine, 92100 Boulogne-Billancourt, France
Eric Van Ganse
- CHU Lyon, Unité de Pharmacoépidémiologie, Service de Neurologie, Hôpital Pierre Wertheimer, 59 Boulevard Pinel, 69677 Bron, France
- Corresponding author. Unité de Neuro-épidémiologie et de Pharmaco-épidémiologie, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677 BRON Cedex, France. Tel.: +33 (0) 472 129 709; fax: +33 (0) 472 129 714.

Received 27 October 2008; accepted 12 March 2009. published online 27 April 2009.

Summary

Background

Patient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated.

Methods

Asthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified.

Results

During the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR=3.36, 95%CI=[1.47–7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR=0.24, 95%CI=[0.08–0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR=0.35, 95%CI=[0.13–0.89]).

Conclusions

Our study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy.

Keywords: Adherence, Asthma, Inhaled corticosteroids, Survey