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Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort

Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort
Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort

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; FEV 1, 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.

adherence, asthma, urinary corticosteroids
0012-3692
53-64
Alahmadi, Fahad H
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Simpson, Andrew J
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Gomez, Cristina
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Ericsson, Magnus
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Thörngren, John-Olof
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Wheelock, Craig
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Shaw, Dominic E
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Fleming, Louise J
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Roberts, Graham
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Riley, John
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Bates, Stewart
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Sousa, Ana R
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Knowles, Richard
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Bansal, Aruna T
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Corfield, Julie
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Pandis, Ioannis
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Sun, Kai
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Bakke, Per S
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Caruso, Massimo
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Chanez, Pascal
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Dahlén, Barbro
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Horvath, Ildiko
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Krug, Norbert
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Montuschi, Paolo
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Singer, Florian
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Wagers, Scott
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Adcock, Ian M
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Djukanovic, Ratko
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Chung, Kian Fan
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Sterk, Peter J
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Dahlen, Sven-Erik
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Fowler, Stephen J
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U-BIOPRED Study Group
Alahmadi, Fahad H
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Simpson, Andrew J
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Gomez, Cristina
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Ericsson, Magnus
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Thörngren, John-Olof
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Wheelock, Craig
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Shaw, Dominic E
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Fleming, Louise J
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Roberts, Graham
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Riley, John
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Bates, Stewart
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Sousa, Ana R
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Knowles, Richard
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Bansal, Aruna T
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Corfield, Julie
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Pandis, Ioannis
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Sun, Kai
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Bakke, Per S
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Caruso, Massimo
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Chanez, Pascal
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Dahlén, Barbro
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Horvath, Ildiko
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Krug, Norbert
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Montuschi, Paolo
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Singer, Florian
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Wagers, Scott
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Adcock, Ian M
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Djukanovic, Ratko
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Chung, Kian Fan
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Sterk, Peter J
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Dahlen, Sven-Erik
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Fowler, Stephen J
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Alahmadi, Fahad H, Simpson, Andrew J, Gomez, Cristina, Ericsson, Magnus, Thörngren, John-Olof, Wheelock, Craig, Shaw, Dominic E, Fleming, Louise J, Roberts, Graham, Riley, John, Bates, Stewart, Sousa, Ana R, Knowles, Richard, Bansal, Aruna T, Corfield, Julie, Pandis, Ioannis, Sun, Kai, Bakke, Per S, Caruso, Massimo, Chanez, Pascal, Dahlén, Barbro, Horvath, Ildiko, Krug, Norbert, Montuschi, Paolo, Singer, Florian, Wagers, Scott, Adcock, Ian M, Djukanovic, Ratko, Chung, Kian Fan, Sterk, Peter J, Dahlen, Sven-Erik and Fowler, Stephen J , U-BIOPRED Study Group (2021) Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort. Chest, 160 (1), 53-64. (doi:10.1016/j.chest.2021.02.023).

Record type: Article

Abstract

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; FEV 1, 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.

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1-s2.0-S0012369221002889-main - Accepted Manuscript
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Accepted/In Press date: 2 February 2021
e-pub ahead of print date: 19 February 2021
Published date: 19 July 2021
Additional Information: Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.
Keywords: adherence, asthma, urinary corticosteroids

Identifiers

Local EPrints ID: 447514
URI: http://eprints.soton.ac.uk/id/eprint/447514
ISSN: 0012-3692
PURE UUID: bfbf4ae5-0365-4964-90f6-d4affaef3c3a
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612

Catalogue record

Date deposited: 15 Mar 2021 17:30
Last modified: 17 Mar 2024 06:23

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Contributors

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

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