Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids
in the U-BIOPRED Cohort.
Alahmadi, Fahad H; Simpson, Andrew J; Gomez, Cristina; Ericsson, Magnus; Thörngren, John-Olof; Wheelock, Craig E; Shaw, Dominic E; Fleming, Louise J; Roberts, Graham; Riley, John; Bates, Stewart; Sousa, Ana R; Knowles, Richard; Bansal, Aruna T; Corfield, Julie; Pandis, Ioannis; Sun, Kai; Bakke, Per S; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Horvath, Ildiko [Horváth, Ildikó (Tüdõgyógyászat), author] Department of Pulmonology
(SU / FM / C); Krug, Norbert; Montuschi, Paolo; Singer, Florian; Wagers, Scott; Adcock, Ian M; Djukanovic, Ratko; Chung, Kian Fan; Sterk, Peter J; Dahlen, Sven-Erik; Fowler, Stephen J ✉; U-BIOPRED Study Group [Collaborative Organization]; Adcock, I M [Collaborator]; Ahmed, H [Collaborator]; Auffray, C [Collaborator]; Bakke, P [Collaborator]; Bansal, A T [Collaborator]; Baribaud, F [Collaborator]; Bates, S [Collaborator]; Bel, E H [Collaborator]; Bigler, J [Collaborator]; Bisgaard, H [Collaborator]; Boedigheimer, M J [Collaborator]; Bønnelykke, K [Collaborator]; Brandsma, J [Collaborator]; Brinkman, P [Collaborator]; Bucchioni, E [Collaborator]; Burg, D [Collaborator]; Bush, A [Collaborator]; Caruso, M [Collaborator]; Chaiboonchoe, A [Collaborator]; Chanez, P [Collaborator]; Chung, F K [Collaborator]; Compton, C H [Collaborator]; Corfield, J [Collaborator]; D'Amico, A [Collaborator]; Dahlèn, B [Collaborator]; Dahlén, S E [Collaborator]; De Meulder, B [Collaborator]; Djukanovic, R [Collaborator]; Erpenbeck, V J [Collaborator]; Erzen, D [Collaborator]; Fichtner, K [Collaborator]; Fitch, N [Collaborator]; Fleming, L J [Collaborator]; Formaggio, E [Collaborator]; Fowler, S J [Collaborator]; Frey, U [Collaborator]; Gahlemann, M [Collaborator]; Geiser, T [Collaborator]; Goss, V [Collaborator]; Guo, Y [Collaborator]; Hashimoto, S [Collaborator]; Haughney, J [Collaborator]; Hedlin, G [Collaborator]; Hekking, P W [Collaborator]; Higenbottam, T [Collaborator]; Hohlfeld, J M [Collaborator]; Holweg, C [Collaborator]; Horváth, I [Horváth, Ildikó (Tüdõgyógyászat), Collaborator] Department of Pulmonology
(SU / FM / C); Howarth, P [Collaborator]; James, A J [Collaborator]; Knowles, R G [Collaborator]; Knox, A J [Collaborator]; Krug, N [Collaborator]; Lefaudeux, D [Collaborator]; Loza, M J [Collaborator]; Lutter, R [Collaborator]; Manta, A [Collaborator]; Masefield, S [Collaborator]; Matthews, J G [Collaborator]; Mazein, A [Collaborator]; Meiser, A [Collaborator]; Middelveld, R J M [Collaborator]; Miralpeix, M [Collaborator]; Montuschi, P [Collaborator]; Mores, N [Collaborator]; Murray, C S [Collaborator]; Musial, J [Collaborator]; Myles, D [Collaborator]; Pahus, L [Collaborator]; Pandis, I [Collaborator]; Pavlidis, S [Collaborator]; Postle, A [Collaborator]; Powel, P [Collaborator]; Praticò, G [Collaborator]; Valls, M Puig [Collaborator]; Rao, N [Collaborator]; Riley, J [Collaborator]; Roberts, A [Collaborator]; Roberts, G [Collaborator]; Rowe, A [Collaborator]; Sandström, T [Collaborator]; Schofield, J P R [Collaborator]; Seibold, W [Collaborator]; Selby, A [Collaborator]; Shaw, D E [Collaborator]; Sigmund, R [Collaborator]; Singer, F [Collaborator]; Skipp, P J [Collaborator]; Sousa, A R [Collaborator]; Sterk, P J [Collaborator]; Sun, K [Collaborator]; Thornton, B [Collaborator]; van Aalderen, W M [Collaborator]; van Geest, M [Collaborator]; Vestbo, J [Collaborator]; Vissing, N H [Collaborator]; Wagener, A H [Collaborator]; Wagers, S S [Collaborator]; Weiszhart, Z [Collaborator]; Wheelock, C E [Collaborator]; Wilson, S J [Collaborator]
European Union’s Seventh Framework Programme(FP7/2007-2013)
Although estimates of suboptimal adherence to oral corticosteroids in asthma range
from 30% to 50%, no ideal method for measurement exists; the impact of poor adherence
in severe asthma is likely to be particularly high.What is the prevalence of suboptimal
adherence detected by self-reporting and direct measures? Is suboptimal adherence
associated with disease activity?Data were included from individuals with severe asthma
taking part in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory
Disease Outcomes) study and prescribed daily oral corticosteroids. Participants completed
the Medication Adherence Report Scale, a five-item questionnaire used to grade adherence
on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and
metabolites by liquid chromatography-mass spectrometry.Data from 166 participants
were included in this study: mean (SD) age, 54.2 (± 11.9) years; FEV1, 65.1% (± 20.5%)
predicted; female, 58%; 37% completing the Medication Adherence Report Scale reported
suboptimal adherence; and 43% with urinary corticosteroid data did not have detectable
prednisolone or metabolites in their urine. Good adherence by both methods was detected
in 49 of the 142 (35%) of participants in whom both methods were performed; adherence
detection did not match between methods in 53%. Self-reported high adherers had better
asthma control and quality of life, whereas directly measured high adherers had lower
blood eosinophil levels.Low adherence is a common problem in severe asthma, whether
measured directly or self-reported. We report poor agreement between the two methods,
suggesting some disassociation between self-assessment of medication adherence and
regular oral corticosteroid use, which suggests that each approach may provide complementary
information in clinical practice.
