Milder asthmatics often forgo inhaler treatment

NEW YORK (Reuters Health) - Patients with milder forms of asthma are less likely than those with more severe disease to get their prescriptions filled for steroid inhalers, new research suggests.

"It is well accepted that on average patients do not take their medications as prescribed, especially medications used to treat chronic conditions, such as asthma," Dr. L. Keoki Williams, of Henry Ford Health System in Detroit, and colleagues write. "However, less well known is the rate at which patients fail to fill their prescriptions," a behavior referred to as "primary nonadherence."

As reported in the Journal of Allergy and Clinical Immunology, the researchers examined the rates of primary nonadherence, and associated factors, among asthmatic patients in a large health maintenance organization in southeast Michigan.

The patients ranged in age from 5 to 56 years, had at least one prescription for a steroid inhaler and had at least 3 months of follow-up after receiving the prescription. The team used electronic prescription information and pharmacy claims data to estimate adherence.

A total of 1,064 asthma patients were included in the study. Of these patients, 8 percent never filled their prescription.

Less frequent use of drugs such as Proventil (albuterol), an indicator of milder asthma, was predictive of not filling a prescription for a steroid inhaler. Other predictors included younger age, female sex, and African-American race.

In addition, the authors found that the patient factors associated with primary nonadherence appeared to differ by race and ethnicity.

"Understanding how perceptions of medication necessity or concerns differ between groups, as well as which components of the patient-physician interaction engender adherence to recommendations, are important next steps for research and improvement in this area," they conclude.

SOURCE: Journal of Allergy and Clinical Immunology, November 2007.