Oral asthma medication: what is the most effective adherence to treatment for patient with severe asthma

Asthma, one of the most common chronic respiratory conditions among adults and children, is associated with high morbidity and high costs for healthcare ¹.
In asthma, good adherence is typically defined as taking 70-80% of prescribed doses².
Poor medication adherence has been linked to an increased risk of asthma exacerbations, which has been shown to increase mortality, increase costs for patients and the health care system, and lower quality of life¹.

Asthma condition is characterized by inflammation and narrowing of the airways, leading to symptoms such as wheezing, coughing, breathing issues, and chest discomfort. While inhalers are commonly used for asthma management, there are oral medications available that can be used as an asthma treatment plan. Medication adherences play an important role in managing asthma effectively and preventing symptoms, exacerbations, and complications ^1,3.

Oral medication for asthma exacerbations

Asthma exacerbations can be a potentially life-threatening condition. While there are several effective oral medications for long-term asthma management, the primary treatment involves the use of inhalers or nebulizers to deliver medications directly to the lungs. Oral medications are not typically the first-line treatment for acute asthma exacerbations, as they may take longer to take effect compared to the inhaled medications¹.

However, in certain conditions where inhaled medications are not readily available or the person is not able to use them effectively, oral medication can be considered as preferred treatment. Some examples of oral medications that may be used in specific cases include:

Oral corticosteroids: These medications, such as prednisolone, are potent anti-inflammatory drugs that help reduce airway inflammation and relieve symptoms during an asthma attack. They are often prescribed in a short-term to quickly bring the asthma attack under control ¹.
Leukotriene modifiers: These medications, such as montelukast, zafirlukast, work by blocking the actions of leukotrienes, which are inflammatory substances involved in asthma. Leukotrienes modifiers are not as effective as oral corticosteroids for acute exacerbations, they may be used as an alternative treatment in certain cases ⁴.

It is important to note that the use of oral medications during an asthma exacerbation must be decided and supervised by a doctor. They assess the severity of the flare-up and determine the most appropriate treatment strategy based on individual circumstances.

Factors influencing adherence to asthma medication

Health care providers should investigate about patients’ beliefs and concerns regarding their disease and the medication(s) used to treat it to comprehend the reasons for poor adherence. There are three main categories of factors that contribute to poor adherence ^5,6.

Treatment related factors: Inability to initiate treatment due to medication side effects. In most cases, initiating (that is, when a patient takes their first dose of a medication that has been prescribed to them) is a binary event in which patients start taking their medication or do not. For instance, proper inhaler technique is essential to optimal therapy delivery and, as a result, a crucial component of adherence. Inability to implement treatment and inability to adhere to the treatment are other treatment related factors that leads to poor adherence ⁵.
Intentional or deliberate factors: Intentional factors contribute to the poor adherence by making patient’s perception that treatment is not necessary. Some patients may have strong belief in natural remedies, leading them to neglect their reliance on prescribed asthma medication. When individuals experience a reduction in asthma symptoms, they may intentionally discontinue their medication usage, assuming they no longer need it ⁶.
Unintentional factors: These factors contribute to the poor adherence when a patient decide unknowingly. For instance, forgetting to take medication doses or follow the prescribed schedule is a common unintentional factor. Improper inhaler technique or difficulty in using inhalers correctly can impact medication adherence. A complicated medication schedule, involving multiple medications can make it challenging for patients to adhere consistently ⁶.

Asthma medication adherence in paediatric

Managing asthma medication adherence in paediatrics is crucial for effective asthma control and reducing the risk of asthma exacerbations. Here are some key recommendations to promote medication adherence in children with asthma:

Effective communication: Effective communication with the child and their guardians is important. The healthcare provider should explain the purpose of the medications, their effects, and their importance in controlling asthma symptoms. They should also address any concerns or misunderstandings the child or carer may have ^7,8.
Simpler drug regimen: The drug regimen should be as simple as possible so that administration is easy, and confusion is minimized. The use of combination inhalers that contain both a controller medication (an inhaled corticosteroid) and a rescue medication (a short-acting beta agonist) can simplify the treatment plan ⁵.
Proper use of inhalation: It is important to teach the child and caregiver proper inhalation techniques. Improper technique of the inhaler can lead to an insufficient dose of the drug and a decrease in the effectiveness of the drug. Demonstrate and observe proper technique during clinical visits and provide written instructions for reference ⁶.
Proper treatment plan: Asthma treatment must be adapted to the severity of the child’s symptoms, age, and ability to use an inhaler. The health care provider should work with the child and caregiver to develop a treatment plan that fits the child’s lifestyle and preferences, making it more likely that they will adhere to prescribed medications ^5,8.
Address potential barriers: Identify and address potential barriers for the child or guardian. These may include forgetfulness, cost of medication, fear of side effects or lack of understanding of the importance of continued medication use. Work with the child and caregiver to find solutions to these obstacles ^5,9.
Regular check-up: Schedule regular follow-up visits to monitor your child’s asthma control, assess medication use, and address any concerns or questions. This provides an opportunity to confirm the importance of adherence to treatment and to make the necessary changes in the treatment plan ⁵.

Technology to improve asthma medication adherence

Improving adherence to asthma medications is critical to effectively managing the condition and preventing exacerbations. Fortunately, several technological solutions can help. here are some examples ¹⁰:

Patient education and resources: Online environments and digital resources provide educational materials, videos, and interactive content to improve asthma awareness and self-management skills. The available information can help people understand the importance of inclusion and manage their condition ⁸.
Smart inhalers: Smart inhalers are devices that connect to regular inhalers and use sensors to monitor medication use. They can provide real-time feedback to patients, reminding them to take their medication and ensuring correct inhalation technique. Smart inhalers can also store information such as the time and date of medication use, which can be shared with healthcare providers to monitor and adjust treatment plans ¹¹.
Mobile applications: Mobile applications for asthma management can be used to track medication schedules, send reminders, and provide educational resources. These apps can also be integrated with smart inhalers to record medication usage and inhalation patterns. Some apps even offer personalized asthma plans and allow users to track their symptoms and triggers ⁹.
Wearable devices: Wearables, such as smart watches or fitness trackers, can help track your physical activity levels and provide information about potential triggers for asthma symptoms. By tracking activity patterns, asthmatics can better understand how exercise affects their condition and adjust their treatment regimen accordingly ¹².
Telemedicine and remote monitoring: Telemedicine services enable remote consultation with healthcare professionals, allowing patients to receive guidance and support from the comfort of their own homes. Remote monitoring techniques can also be used to assess lung function and track symptoms over time. These tools can help healthcare providers identify early warning signs and adjust treatment plans as needed ^9,13.

It is very important to consult with your healthcare professional for personal advice and guidance on how to manage your asthma and improve medication adherence while using such technologies.

To read more about “Adherence in asthma – a victim of the episodic nature of the disease” click here

Conclusion

Adherence to oral asthma medications plays an important role in the effective management and control of asthma symptoms. Poor adherence to oral asthma medications can lead to worsening symptoms, increased risk of asthma attacks, and reduced quality of life for asthmatics. However, when the importance of adherence is understood and strategies to improve adherence are implemented, patients can experience better asthma control and better overall health.

Ultimately, achieving optimal adherence to oral asthma medications requires collaboration between patients, healthcare providers, and the entire healthcare system. By addressing barriers to adherence and implementing effective strategies, we can empower people with asthma to take control of their condition and live healthier, more fulfilling lives. Improvements in medication can reduce asthma symptoms, reduce healthcare utilization, and improve long-term outcomes, highlighting the importance of this issue in asthma management.

“Asthma is treatable and well can be controlled.”- Cathy Freeman