Adherence to inhaled corticosteroid use and local adverse events in persistent asthma

Jasmina I Ivanova, Howard G Birnbaum, Matthew Hsieh, Andrew P Yu, Brian Seal, Thys van der Molen, Srinivas Emani, Richard A Rosiello, Gene L Colice
American Journal of Managed Care 2008, 14 (12): 801-9

OBJECTIVES: To measure adherence to inhaled corticosteroid (ICS) therapy using prescription claims and a patient survey, to identify local adverse events (LAEs) from the patient perspective and from medical records, and to evaluate the association between LAEs and adherence to ICS therapy.

STUDY DESIGN: Survey administration and claims-based and medical record-abstracted data.

METHODS: Patients aged 6 to 64 years with persistent asthma (defined using an established algorithm) and at least 2 ICS prescriptions were selected from a claims database (1999-2006) of a central Massachusetts medical group practice. Prescription claims were used to calculate the ICS medication possession ratio (MPR). A survey obtained information about patient-reported adherence to ICSs using the Morisky scale and a visual analog scale (VAS) and about LAEs using the validated Inhaled Corticosteroid Questionnaire. Medical records of survey respondents were abstracted for LAEs.

RESULTS: Among 372 survey respondents, 2.7% met the claims-based measure of good adherence (MPR, > or =80%). Patient-reported adherence was much higher; 20.7% of patients were highly adherent based on the Morisky scale (score, 0) and 55.4% based on the VAS (score, > or =80%). Medical record review identified 27.2% of patients having at least 1 LAE within 1 year after the ICS index date, but 47.3% of patients reported being bothered at least "quite a lot" by LAEs. Multivariate analysis indicated that unpleasant taste was significantly related to lower adherence based on the Morisky scale (P = .02).

CONCLUSIONS: Patient-reported adherence and LAEs were higher than those measured from claims or medical records. Unpleasant taste seems to be associated with lower adherence based on the Morisky scale.

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