Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort

Fahad H Alahmadi, Andrew J Simpson, Cristina Gomez, Magnus Ericsson, John-Olof Thörngren, Craig E Wheelock, Dominic E Shaw, Louise J Fleming, Graham Roberts, John Riley, Stewart Bates, Ana R Sousa, Richard Knowles, Aruna T Bansal, Julie Corfield, Ioannis Pandis, Kai Sun, Per S Bakke, Massimo Caruso, Pascal ChanezBarbro Dahlén, Ildiko Horvath, Norbert Krug, Paolo Montuschi, Florian Singer, Scott Wagers, Ian M Adcock, Ratko Djukanovic, Kian Fan Chung, Peter J Sterk, Sven-Erik Dahlen, Stephen J Fowler

Risultato della ricerca: Contributo in rivistaArticolo in rivista


BACKGROUND: 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.RESEARCH QUESTIONS: What is the prevalence of suboptimal adherence detected by self-reporting and direct measures? Is suboptimal adherence associated with disease activity?STUDY DESIGN AND METHODS: 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.RESULTS: 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.INTERPRETATION: 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.
Lingua originaleEnglish
pagine (da-a)53-64
Numero di pagine12
Stato di pubblicazionePubblicato - 2021


  • adherence
  • asthma
  • urinary corticosteroids


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