Everything old is new again ...
A new article in the Journal of Allergy and Clinical Immunology in Practice reviews a long-standing problem with the treatment of asthma and COPD patients; that being medication and treatment plan non-adherence/noncompliance *. Over the past 50 years despite all of the new innovations, inhalers, dosing, pharmacology, Biologics and phone apps, patients and caregivers still face poor outcomes based on non-adherence to medical regimens.
Perhaps we need to get back to basics.
The mainstay of treatment for asthma and COPD still remains inhaler use and the study found that compared with oral, injected, and transdermal routes of medication administration, inhaler use still has a high rate of non-adherence. Patients do not take inhaled prescribed medication every day as directed.
When patients don’t take their medicine their outcomes are worse - they get sick more frequently, require more urgent care visits and need to take more oral medications like oral steroids. The use of more medications carries with it the potential for more side effects. When medications are not taken and symptoms are increased, patients miss work and school. Patient’s quality of life is affected and they may not participate in sports. In addition, productivity at work may be affected.
A United States study reported that if patients took their inhaled medications such as an inhaled steroids as directed, up to 24% of asthma exacerbations may have been prevented .
There are many reasons that patients don’t take their medications and open lines of communication between caregivers and staff with patients and their families are needed to improve adherence and improve outcomes.
At the heart of it, patients need to understand that taking their medications every day has the potential to improve their asthma control while exposing them to the lowest dose of anti-inflammatory and limiting side effects.
Caregivers need to educate patients and families that while symptoms of asthma may be intermittent; asthma is a chronic disease of the lungs that needs to be taken care of every day.
Patients and doctors need to work together to identify and overcome common barriers such as:
1. Cost: Can patients afford their medications? Identifying co-pay assistance programs or lower tier drugs based on the insurance plan can be a big help
2. Apprehensions about taking medication every day. Discussing the risks and benefits of daily asthma management takes time and may require more frequent follow-up visits so we can gain trust.
3. Complicated regimens: Empowering patients with simple dosing regimens that are consistent with their lifestyle.
So how can we get better? Here are some areas that patients and their doctors can work on:
1. Better inhaler technique: Using inhalers correctly is more difficult than it seems and regular review of inhaler helps the medication get down into the airways and is one of the key points to better results.
2. Meeting individual needs: Some patients and families need more support and education than others. Again, perhaps they need more frequent visits and education time with staff. This may be especially important when asthma is first diagnosed or when there was a period of instability to help control their symptoms and gain control of their asthma.
3. Setting expectations: It’s important that patients and families know the expectations of treatment and understand that what optimum control their asthma is so that they are as symptom free as possible.
4. New Technology: Now days, there seems to be an app for everything, including health issues. Asthma is no different and there are a number of apps out there to help with medication reminders. Allergy Partners has developed its own app called APpal. It’s your personal asthma coach designed to help patients better understand and control asthma. Best of all its FREE to all Allergy Partners patients!
5. Regular measurement of lung function: Just like a person with hypertension measure blood pressure or a diabetic measures blood sugars, patients with asthma need to have their lung function checked on a regular basis. This simple test is a critical part of seeing if asthma is well controlled and helps determine the best treatment for the individual.
6. Communication: At the end of the day, re-focusing on frequent evaluation and communication remains one of the keys to improved asthma control.
Finally, it’s important to know that board certified asthma specialists, like those at Allery Partners, have a unique interest in helping patients understand the expectations and goals of treatment so they are empowered with the information and the tools to help them obtain the best asthma care possible.
By Dr. Randy Stoloff
Allergy Partners of Fayetteville
*Dekhuijzen R, Lavorini F, Usmani OS, van Boven JFM. Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here? [published online January 12, 2018]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2017.11.027