Medication use, adherence and asthma control in ambulatory patients attending the chest clinic of a tertiary facility in southwestern Nigeria
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Abstract
Background: Asthma is a chronic illness with rising prevalence and socio-economic burden in resourcepoor countries. Better understanding of its management and periodic assessment of therapy adherence and asthma control is therefore essential.
Objectives: To evaluate treatment recommendations, medication adherence and asthma control among cohort of ambulatory asthmatic patients.
Methods: A cross-sectional questionnaire-guided interview among asthma patients attending chest clinic of University College Hospital, Ibadan, southwestern Nigeria, between March and May 2015, and a review of patients' medical records for asthma-specific clinical parameters. Socio-demographic information, allergen and anti-asthmatic therapies were explored. Morisky Adherence Predictor Scale and Royal College of Physicians Three Questions were used to evaluate adherence and asthma control, respectively. Data were summarised using descriptive statistics. Chi-square and Mann-Whitney U test were used for categorical and ranked variables, respectively at p<0.05.
Results: Majority, 59 (67.8%) were using fixed-dose combination of inhaled corticosteroids and long-acting β2 agonist plus add-on inhaled short-acting bronchodilator. Twenty-four percent were adjudged adherent. Intentional non-adherence was most common, 55 (64.0%). Forgetfulness (40; 46.0%) was the most common unintentional non-adherence. Forty (46.0%) had good asthma control compared to 86(98.9%) who perceived their asthma to be well-controlled. Summarily, dust (55; 54.4%) was the most commonly cited allergen.
Conclusions: Medication adherence and asthma control among studied population were suboptimal. Frequent use of add-on inhaled short-acting bronchodilator with controller medication partly suggest continuing experience of in-between acute exacerbations by patients. Thus, a need for caregivers to consistently ensure therapy adherence at every patient-provider encounter, so as to guarantee improved asthma control.
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References
Global initiative for asthma [GINA] (2012) Pocket guide for asthma management and prevention for adults and children older than five years: A pocket guide for physicians and nurses based on the global strategy for asthma management and prevention. Medical communication resources, Inc. Available at: http://www.ginasthma.org. Accessed April 20, 2015.
Ait-Khalid N, Enarson DA, Chiang CY, Marks G, Bissell K (2008). Management of asthma: A guide to the essentials of good clinical practice. 3rd ed. Paris, France; International Union Against Tuberculosis and Lung Disease: pp1-100
Ferguson G, Deniz Y, Reisner C (2006). Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respiratory Medicine 100:1139-1151.
The Global Asthma Report (2012). The International Union against Tuberculosis and Lung Disease. Availableat: http://www.globalasthmareport.org/sites/default/files/Global_Asthma_Report_201pdf. Accessed April 20, 2015
Desalu OO, Oluboyo PO, Salami AK (2009). The prevalence of bronchial asthma among adults in Ilorin, Nigeria. African Journal of Medicine and Medical Sciences 38(2):149–154.
Erhabor GE, Agbroko SO, Bamgboye P, Awopeju OF (2006). Prevalence of asthma symptoms among university students 15-35 years of age in Obafemi Awolowo University Ile-Ife Osun State. Journal of Asthma 43(2):161–164.
Ibeh CC, Ele PU (2002). Prevalence of bronchial asthma in adolescent in Anambra State, Nigeria. Nigerian Journal of Internal Medicine 5:23–26.
Falade AG, Olawuyi JF, Osinusi K, Onadeko BO (1998). Prevalence and severity of symptoms of asthma, allergic rhino-conjunctivitis and atopic eczema in secondary school children in Ibadan Nigeria. East Africa Medicine Journal. 75:695–698.
Masoli M, Fabian D, Holt S, Beasley R (2004). Global Burden of Asthma. Available at:
http://ginasthma.Com/ReportItem.asp?l1=2&l2=2&intId=95. Accessed October 19, 2015.
Sumino K, Cabana MD (2013). Medication adherence in asthma patients. Current Opinion in Pulmonary Medicine 9:49-53.
Rabe KF, Adachi M, Christopher K.W. Lai CKW, Soriano JB, Paul A. Vermeire PA, Weiss KB, Weiss ST (2004). Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. Journal of Allergy and Clinical Immunology 114:40–47.
Bender BG, Bender SE (2005). Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires. Immunology and Allergy Clinics of North America 25:107.
Rand CS, Wise RA (1994). Measuring adherence to asthma medication regimens. American Journal of Respiratory and Critical Care Medicine 149:S69.
Williams LK, Joseph CL, Peterson EL, Wells K Wang M, Chowdhry VK, Walsh M Campbell J Rand CS, Apter AJ, Lanfear DE, Tunceli K, Pladevall M (2007). Patients with asthma who do not fill their inhaled corticosteroids: a study of primary nonadherence. Journal of Allergy and Clinical
Immunology 120:1153.
Dima AL, Hernandez G, Cunillera O, Ferrer M, de Bruin M; ASTRO-LAB group (2015). Asthma inhaler adherence determinants in adults: systematic review of observational data. European Respiratory Journal 45:994.
Creer TL (1991). Understanding and dealing with noncompliance in asthma. Journal of Respiratory Diseases 12:S43.
Kohler CL, Davies SL, Bailey WC (1996). Selfmanagement and other behavioral aspects of asthma. Current Opinion in Pulmonary Medicine
:16.
National Asthma Education and Prevention Program (2007). Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. Journal of Allergy and Clinical Immunology 120 (5 Suppl):S94-138.
Global Initiative for Asthma. Geneva (2010). Global Strategy for Asthma Management and Prevention. Available at: http://www.ginasthma.org. Accessed April 20, 2015.
O'Byrne PM (2010). Global guidelines for asthma management: summary of the current status and future challenges. Polish Archives of Internal Medicine 120(12):511-517.
National Institutes of Health, National Heart, Lung, and Blood Institute (1997). Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma. Public Health Service, Bethesda, MD. Publication No. 97-4051.
Rabe KF, Vermeire PA, Soriano JB, Maier WC (2000). Clinical management of asthma in 1999: The Asthma Insights and Reality in Europe (AIRE) study. European Respiratory Journal 16:802-807.
Green R, Davis G, Price D (2008). Perceptions, impact and management of asthma in South Africa: A patient questionnaire study. Primary
Care Respiratory Journal 17:212-216.
Al-Busaidi N, Soriano JB (2011). Asthma Control in Oman: National Results within the Asthma Insights and Reality in the Gulf and the Near East (AIRGNE) Study. Sultan Qaboos University Medical Journal 11:45-51.
Ozoh OB, Bandele OE, Chukwu C, Okubadejo N (2010). Correlation between the Asthma Control Test Score and FEV1 in Nigerians With Bronchial Asthma. Chest 138:146A-146A.
Desalu OO, Fawibe AE, Salami AK (2012). Assessment of the level of asthma control among adult patients in two tertiary care centers in
Nigeria. Journal of Asthma 49:765-672.
Thoonen BPA , Schermer TRJ, van den Boom G, Molema J, Folgering H, Akkermans RP, R Grol R, van Weel C, van Schayck CP (2003). Selfmanagement of asthma in general practice, asthma control and quality of life: a randomised controlled trial. Thorax 58:30–36.
Poureslami IM, Rootman I, Balka E, Devarakonda R, Hatch J, Fitzgerald JM (2007). A systematic review of asthma and health literacy: a culturalethnic perspective in Canada. Mediscape General Medicine 9:40
Onyedum CC, Ukwaja, KN, Desalu OO, Ezeudo C (2103). Challenges in the Management of Bronchial Asthma Among Adults in Nigeria: A Systematic Review. Annals of Medical and Health Science Research 3(3):324–329.
Alzahrani YA, Becker EA (2016). Asthma Control Assessment Tools. Respiratory Care 61(1):106- 116. Epub 2015 Nov 10. Review.
Thomas M, Gruffydd-Jones K, Stonham C, Ward S, Macfarlane TV (2009). Assessing asthma control in routine clinical practice: use of the Royal College of Physicians '3 questions'. Primary Care Respiratory Journal 18(2):83-88.
Pearson MG, Bucknall CE, editors (1999). Measuring clinical outcome in asthma: a patientfocused approach. Royal College of Physicians,London; Pp 46
Morisky DE, Green LW, Levine DM (1986). Concurrent and predictive validity of a selfreported measure of medication adherence. Medical care 24:67-74.
Raosoft sample size calculator. Available at: . Accessed March 16, 2015
Fawibe AE, Joseph KJ, Olaosebikan OF, , Oluboyo PO, Desalu OO (2011). General practitioner reported follow-up visits among asthma patients in North Central Nigeria. Annals of Africa Medicine 10:209-13.
Umoh VA, Ekott JU, Ekwere M, Ekpo O (2013). Asthma control among patients in Uyo South Eastern Nigeria. Indian Journal of Allergy, Asthma and Immunology 27:27-32.
Kelloway JS, Wyatt RA, Adlis SA (1994). Comparison of patients' adherence with prescribed oral and inhaled asthma medications.
Archives of Internal Medicine 154(12):1349-1352
Dekker FW, Dieleman FE, Kaptein AA, Mulder JD (1993). Adherence with pulmonary medication in general practice. European Respiratory Journal 6(6):886-890
Desalu OO, Onyedum CC, Adeoti AO, Ozoh OB, Fadare JO, Salawu FK, Danburam A, Fawibe AE, Adewole OO (2013). Unmet needs in asthma
treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria. Pan African Medicine Journal 16:20.
Postma DS, O'Byrne PM, Pedersen S (2011). Comparison of the effect of low-dose Ciclesonide and fixed-dose fluticasone propionate and
salmeterol combination on long-term asthma control. Chest 139:311–318.
Saleh JA (2008). Combination therapy in asthma: a review. Nigerian Journal of Medicine 17(3):238-243.
Juniper EF, Kline PA, Vanzieleghem MA, Ramsdale EH, O'Byrne PM, Hargreave FE 1(990). Effect of long-term treatment with an inhaled
corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. The American
Review of Respiratory Disease 142:832-836.
Szefler S, Weiss S, Tonascia J (2000). The Childhood Asthma Management Program Research Group? Long-term effects of budesonide or nedocromil in children with asthma. New England Journal of Medicine 343:1054-63.
Chowdhury BA, Dal Pan G (2010). The FDA and safe use of long-acting beta-agonists in the treatment of asthma. New England Journal of Medicine 362(13):1169–01171.
Weatherall M, Wijesinghe M, Perrin K, Harwood M, Beasley R (2010). Meta-analysis of the risk of mortality with salmeterol and the effect of
concomitant inhaled corticosteroid therapy. Thorax 65(1):39–43.
Apter, AJ, Reisine ST, Affleck G, Barrows E, Zuwallack RI (1998). "Adherence with Twice-daily Dosing of Inhaled Steroids" American Journal of Respiratory and Critical Care Medicine 157:1810-1817.
Thoonen BP, Schermer TR, Van Den Boom G, Molema J Folgering H Akkermans RP, Grol R, Van Weel C Van Schayck CP (2003). Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial. Thorax 58:30.
Cromer BA (1991). Behavioral strategies to increase compliance in adolescents. In: Cramer JA, Spilker B, editors. Patient compliance in
medical practice and clinical trials. New York: Raven Press; pp. 99–105.
Stewart MA (1995). Effective physician–patient communication and health outcomes: a review. Canadian Medical Association Journal 152:1423–1433.
Hassan Mahboub BH, Santhakumar S, Soriano JB, Pawankar R (2010). Asthma insights and reality in the United Arab Emirates. Annals of Thoracic Medicine 5:217-21.
Gruffydd-Jones K, Hollinghurst S, Ward S, Taylor G (2005). Targeted routine asthma care in general using telephone triage. British Journal of General Practice 55:918-923.
Ten Brinke A, Sterk PJ Masclee AA Spinhoven P Schmidt JT Zwinderman AH, Rabe KF, Bel EH (2005). Risk factors of frequent exacerbations in difficult to-treat asthma. European Respiratory Journal 26:812-828.
Hermosa JL, Sanchez CB, Rubio MC, Minguez MM, Walther JL (2010). Factors associated with the control of severe asthma. Journal of Asthma 47:124-130.
Lemanske RF, Busse NW (2010). Asthma: clinical expression and molecular mechanisms. Journal of Allergy and Clinical Immunology 125:S95-102.
Roy A, Lurslurchachai L, Halm EA, Li XM and Wisnivesky JP (2010). Complementary and Alternative Medication Use and Adherence to Inhaled Corticosteroid among Inner-city Asthmatics.Annals of Allergy, Asthma and Immunology 104(2):132–138.
Slader CA Reddel HK Jenkins CR Armour CL, BosnicAnticevich SZ (2006). Complementary and alternative medicine use in asthma: Who is using what? Respirology 11:373
Barnes PM, Bloom B, Nahin R (2008). Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report. 2008:12
Haughney J, Barnes G, Partridge M, Cleland J (2004). The Living & Breathing study: a study of patients' views of asthma and its treatment.
Primary Care Respiratory Journal 13:28-35.
Chapman KR, Boulet LP, Rea RM, Franssen E (2008). Suboptimal asthma control: prevalence, detection and consequences in general practice. European Respiratory Journal 31:320-325.
Adisa R, Fakeye TO, Fasanmade A (2011). Medication adherence among ambulatory patients Zoller DP, Bond CA (2005). Assessing medication with type 2 diabetes in a tertiary healthcare setting in adherence in the elderly; which tools to use in clinical southwestern Nigeria, Pharmacy Practice 9:72-81. practice? Drug Aging 22:231-55.
MacLaughin EJ, Raehi CL, Treadway AK, Sterling TL