Should patients with persistent severe asthma be monitored for medication adherence?

BACKGROUND Poor asthma outcomes often result from patients not following physician medication recommendations (ie, nonadherence). Estimates suggest that 50% of patients with asthma do not follow physician medication recommendations. OBJECTIVE To examine the rationale for making available objective medication adherence monitors for physicians to improve the quality of care for patients with severe persistent asthma. METHODS Review of the literature was undertaken in the following areas related to asthma: cost, morbidity, adherence, adherence monitoring, outcomes, and guidelines. RESULTS Patients with severe asthma are at risk for nonadherence because of (1) the use of multiple medications to control symptoms, (2) coexisting disease states, (3) the occurrence of depression and anxiety, and (4) the high cost of care. Research studies have demonstrated the effectiveness of objective monitoring as part of multiple clinical strategies to improve adherence and reduce morbidity and the cost of asthma care. Without objective adherence monitoring, physicians may not accurately assess nonadherence as the cause of treatment failure. This may lead to inappropriate increases in therapy, diagnostic studies, and consultations and may leave the patient at risk for persistent symptoms, morbidity, and death. CONCLUSION By correctly assessing nonadherence as the cause of treatment failure in patients with not only severe asthma but mild and moderate disease as well, practicing physicians may improve the quality of care provided.