Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

'Difficult-to-treat asthma' may be due to difficult-to-treat patients

26.10.2009
Difficult-to-treat asthma often may have more to do with patients who do not take their medication as instructed than ineffective medication, according to researchers in Northern Ireland.

"[A] significant proportion of patients with difficult asthma are poorly adherent to inhaled and oral corticosteroid therapy," wrote principal investigator, Dr. Liam Heaney, of Belfast City Hospital.

The results of the study were published in the November 1 issue of the American Journal of Respiratory and Critical Care Medicine, an official publication of the American Thoracic Society.

"Defining the scale and identifying non-adherence in this population is important given currently available and other imminent expensive biological therapies," said Dr. Heaney.

Dr. Heaney and colleagues obtained data from almost 200 patients who were referred to a tertiary referral clinic that specializes in treating difficult asthma. To assess compliance with inhaled corticosteroid therapy (ICT), they compared patient prescription to the patient's actual refill usage. They used blood plasma prednisolone and cortisol levels to evaluate oral medication adherence.

Of the 182 consecutive patients, 35 percent filled fewer than half of their prescribed inhaled combination therapy (ICT), 21 percent filled more than they were prescribed and 45 percent filled between half and all of the medication they were prescribed.

Furthermore, in patients who were on a maintenance course of oral prednisolone, blood levels of cortisol and prednisolone showed that nearly half (45 percent) were not taking the medication as prescribed. In follow-up conversations with the researchers, most admitted that they were inconsistent in the use of their medications. Of the 23 patients who were non-adherent to their oral prednisolone, 15—or 65 percent—were also non-adherent to their ICT.

"All subjects had initially denied poor medication adherence, and poor adherence only became apparent using a combination of surrogate and objective measures," said Dr. Heaney. "Of these patients who were referred for assessment and treatment of difficult asthma, many are actually not taking their treatment as prescribed, which would suggest an important first course of action in assessing difficult asthma may actually be verifying the patient's adherence to his or her treatment protocol. Determining whether the patient is taking medications as prescribed is of utmost importance before moving to more aggressive and expensive treatments. It is also crucially important in understanding true refractory disease and assessing responses to novel therapies, either in clinical trials or clinical practice."

Some patient characteristics were more strongly associated with nonadherence than others: women were less likely to be adherent than men, a finding that had been previously identified, but that Dr. Heaney cites as needing more investigation.

Another red flag may be a lower score on quality of life measures. Dr. Heaney and colleagues found that patients who filled fewer than half of their prescribed ICT scored significantly lower on the EuroQol and the Asthma Quality of Life Questionnaire. Furthermore, the number of prior hospital admissions within the past 12 months was significantly associated with non-adherence.

"In general, one might expect in more severe disease that a very poor asthma quality of life score suggesting high morbidity, would perhaps, result in better adherence, " said Dr. Heaney. "The same could be said for hospital admission, but the reasons for non-adherence are complex. However for clinicians, multiple hospital admissions should definitely flag probable non-adherence in difficult-to-treat cases."

"Non-adherence is a common problem, which is often hard to detect. In general, asking the patient or relying on clinical impression is useless, and objective or good surrogate measures should be utilized. However, we need to try and develop better objective tests for this problem, and we are currently looking at some novel techniques to do this," Dr. Heaney concluded.

Keely Savoie | EurekAlert!
Further information:
http://www.thoracic.org

More articles from Health and Medicine:

nachricht A 'half-hearted' solution to one-sided heart failure
24.11.2017 | Boston Children's Hospital

nachricht New study points the way to therapy for rare cancer that targets the young
22.11.2017 | Rockefeller University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New proton record: Researchers measure magnetic moment with greatest possible precision

High-precision measurement of the g-factor eleven times more precise than before / Results indicate a strong similarity between protons and antiprotons

The magnetic moment of an individual proton is inconceivably small, but can still be quantified. The basis for undertaking this measurement was laid over ten...

Im Focus: Frictional Heat Powers Hydrothermal Activity on Enceladus

Computer simulation shows how the icy moon heats water in a porous rock core

Heat from the friction of rocks caused by tidal forces could be the “engine” for the hydrothermal activity on Saturn's moon Enceladus. This presupposes that...

Im Focus: Nanoparticles help with malaria diagnosis – new rapid test in development

The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.

Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....

Im Focus: A “cosmic snake” reveals the structure of remote galaxies

The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.

Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...

Im Focus: Visual intelligence is not the same as IQ

Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.

That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Ecology Across Borders: International conference brings together 1,500 ecologists

15.11.2017 | Event News

Road into laboratory: Users discuss biaxial fatigue-testing for car and truck wheel

15.11.2017 | Event News

#Berlin5GWeek: The right network for Industry 4.0

30.10.2017 | Event News

 
Latest News

IceCube experiment finds Earth can block high-energy particles from nuclear reactions

24.11.2017 | Physics and Astronomy

A 'half-hearted' solution to one-sided heart failure

24.11.2017 | Health and Medicine

Heidelberg Researchers Study Unique Underwater Stalactites

24.11.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>