Corticosteroid use after hospital discharge among high-risk adults with asthma.

Despite the efficacy of corticosteroid therapy, patients hospitalized for asthma exacerbations are at high risk for re-exacerbation and death after discharge. The objective of this prospective cohort study was to evaluate adherence to inhaled corticosteroids (ICS) and oral corticosteroids (OCS) after discharge in adults hospitalized for asthma exacerbations. ICS and OCS were equipped with electronic medication monitors and were provided at discharge. Adherence (use/prescribed use x 100%) was measured by self-report and canister weight (ICS), pill count (OCS), and electronic medication monitors (both ICS and OCS) 2 weeks after discharge. Poor adherence was defined as adherence of less than 50%. The Asthma Control Questionnaire was used to assess symptom control. Sixty patients were enrolled (age 42.2 years, 98.3% African American, 65.0% female, 46.7% with history of near-fatal asthma). Electronically measured adherence to both corticosteroids dropped to approximately 50% within 7 days of discharge. Poor adherence to both corticosteroids predicted significantly worse symptom control (p = 0.04). Self-report, canister weight, and pill count all had low sensitivity (29.2%, 65.0%, and 7.7%, respectively) for detecting poor adherence. We conclude that adherence to ICS and OCS deteriorates within days of hospital discharge but may not be recognized in a substantial proportion of patients.

[1]  E. Vermeire,et al.  A systematic review of adherence with medications for diabetes: response to Cramer. , 2004, Diabetes care.

[2]  J. Cramer.  A systematic review of adherence with medications for diabetes. , 2004, Diabetes care.

[3]  J. Farley,et al.  Assessment of adherence to antiviral therapy in HIV-infected children using the Medication Event Monitoring System, pharmacy refill, provider assessment, caregiver self-report, and appointment keeping. , 2003, Journal of acquired immune deficiency syndromes.

[4]  Muhammad Mamdani,et al.  Adherence with statin therapy in elderly patients with and without acute coronary syndromes. , 2002, JAMA.

[5]  J. Tu,et al.  Adherence With Statin Therapy in Elderly Patients With and Without Acute Coronary Syndromes , 2002 .

[6]  H. Burge,et al.  The role of indoor allergen sensitization and exposure in causing morbidity in women with asthma. , 2002, American journal of respiratory and critical care medicine.

[7]  A. Woodcock,et al.  Synergism between allergens and viruses and risk of hospital admission with asthma: case-control study , 2002, BMJ : British Medical Journal.

[8]  L. Hendeles,et al.  Accuracy of three electronic monitors for metered-dose inhalers. , 2002, Chest.

[9]  G. Hickson,et al.  Corticosteroid prescription filling for children covered by Medicaid following an emergency department visit or a hospitalization for asthma. , 2001, Archives of pediatrics & adolescent medicine.

[10]  R. Hays,et al.  A Comparison Study of Multiple Measures of Adherence to HIV Protease Inhibitors , 2001, Annals of Internal Medicine.

[11]  Barbara Turner,et al.  Improving on a Coin Toss To Predict Patient Adherence to Medications , 2001, Annals of Internal Medicine.

[12]  S. Sullivan,et al.  The health economics of asthma and rhinitis. I. Assessing the economic impact. , 2001, The Journal of allergy and clinical immunology.

[13]  K. Chung,et al.  Compliance with an oral asthma medication: a pilot study using an electronic monitoring device. , 2000, Respiratory medicine.

[14]  R C Peveler,et al.  Compliance with tricyclic antidepressants: the value of four different methods of assessment. , 2000, British journal of clinical pharmacology.

[15]  B. Rowe,et al.  Corticosteroids for preventing relapse following acute exacerbations of asthma. , 2000, The Cochrane database of systematic reviews.

[16]  S. Spector,et al.  Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. American Thoracic Society. , 2000, American journal of respiratory and critical care medicine.

[17]  G H Guyatt,et al.  Development and validation of a questionnaire to measure asthma control. , 1999, The European respiratory journal.

[18]  S. Thomas,et al.  Asthma hospitalizations and mortality in Chicago: an epidemiologic overview. , 1999, Chest.

[19]  B. Rowe,et al.  Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial. , 1999, JAMA.

[20]  Claude Lenfant,et al.  National Asthma Education and Prevention Program: Expert Panel Report 2. Guidelines for the diagnosis and management of asthma: Translating research for clinicians and patients , 1999 .

[21]  C. Rand,et al.  Validation of the Doser, a new device for monitoring metered-dose inhaler use. , 1998, The Journal of allergy and clinical immunology.

[22]  R. Zuwallack,et al.  Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences. , 1998, American journal of respiratory and critical care medicine.

[23]  P. Gergen,et al.  Race, income, urbanicity, and asthma hospitalization in California: a small area analysis. , 1998, Chest.

[24]  L. Kampe,et al.  Prediction of relapse within eight weeks after an acute asthma exacerbation in adults. , 1998, Journal of clinical epidemiology.

[25]  Askar H. Choudhury,et al.  Associations between respiratory illness and PM10 air pollution. , 1997, Archives of environmental health.

[26]  M. Cowles,et al.  Long-term metered-dose inhaler adherence in a clinical trial. The Lung Health Study Research Group. , 1995, American journal of respiratory and critical care medicine.

[27]  P. Mayo,et al.  Demographic influences on asthma hospital admission rates in New York City. , 1994, Chest.

[28]  N. Pearce,et al.  Markers of risk of asthma death or readmission in the 12 months following a hospital admission for asthma. , 1992, International journal of epidemiology.

[29]  R. Patterson,et al.  The diagnosis of potentially fatal asthma in hospitalized adults. Patient characteristics and increased severity of asthma. , 1992, Chest.

[30]  O. Sharma,et al.  Asthma mortality in a metropolitan county hospital, a 38-year study. , 1991, Allergy proceedings : the official journal of regional and state allergy societies.

[31]  S. Teutsch,et al.  Investigation of a cluster of deaths of adolescents from asthma: evidence implicating inadequate treatment and poor patient adherence with medications. , 1989, The Journal of allergy and clinical immunology.

[32]  J. Cramer,et al.  How often is medication taken as prescribed? A novel assessment technique. , 1989, JAMA.

[33]  R. Beaglehole,et al.  A case-control study of deaths from asthma. , 1986, Thorax.

[34]  Noncompliance and prevarication in life threatening adolescent asthma. , 1986, New England and regional allergy proceedings.

[35]  Sublett Jl,et al.  Non-compliance in asthmatic children: a study of theophylline levels in a pediatric emergency room population. , 1979 .