The Pharmaceutical Journal
Vol 276 No 7392 p310
18 March 2006

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Perceptions of whether asthma is chronic can affect compliance

Asking patients with asthma whether they believe they have the disease all the time can effectively identify those who do not manage their condition as a chronic disease, a US study has found (Chest 2006;129:573).

Researchers interviewed 198 adults admitted to hospital with asthma about their clinical history, disease beliefs and self-management behaviour. Overall, 53 per cent believed they only had asthma when they experienced symptoms and this belief was associated with a lower likelihood of maintaining treatment with inhaled corticosteroids all or most of the time. Men and patients older than 65 years were more likely to believe they did not have asthma when they did not experience symptoms, whereas those who had symptoms on most days were less likely to believe this, the researchers found.

“Conceptualising asthma as an acute, episodic illness may have an internal logic of its own perhaps driven by some unique characteristics of the disease,” the authors comment. They argue that the focus on attacks and relief, the experience of environmental triggers and the phenomenon of children outgrowing the condition undercut the notion that asthma is a chronic disease. “All of these may contribute to why such health beliefs about asthma are common and may be particularly difficult to disconfirm,” they conclude.

Hannah George, senior clinical pharmacist for respiratory medicine at the Royal Liverpool and Broadgreen University Hospital Trust, said that the research reflects what practitioners see in practice.

“When discussing treatment with asthma patients they often tell us they only use their inhalers on an ‘as required’ basis when they are feeling unwell and have troublesome symptoms, and not as we expect them to on a daily basis,” she said.

“As with a lot of other diseases, once a patient is feeling better and symptoms subside compliance quite often tends to tail off. All of this highlights the importance of educating the patient on the asthma disease process and its chronic nature, how each treatment works, why compliance is important and the consequences of non-compliance,” she added.