Relationship between perceived severity, adherence, and exacerbations in a community sample of people with asthma.

Clinical Research Results Abstract Title: Relationship between perceived severity, adherence, and exacerbations in a community sample of people with asthma.Authors: Hazel Dickinson, Rupert Jones, Michael Hyland. IntroductionThe aim of asthma treatment is good control, but some people have poor adherence to their maintenance treatment. Adherence is sometimes driven by worse symptoms; conversely poor adherence may result in worse asthma symptoms and exacerbations. We examined the relationship between the perceived severity, adherence, and exacerbations in a sample of people with asthma recruited outside of a medical context. MethodsPeople with asthma were invited to complete a short online survey if they were >17years and were receiving regular preventer therapy. They were recruited through social media and directly on university campuses. They were asked (a) to rate the asthma severity over the last 5 years (mild, moderate, severe), (b) adherence (following instructions or not following instructions), and (c) the number of courses of oral corticosteroids (OCS) in the previous year.Results539 people responded of whom 437 (81%) were female, 148 (28%) were aged 18-30 years, 309 (57%) were age 31- 60, and 82 (15%) were age > 61 years. Participants’ self-rating of severity showed 30&% were mild, 36% moderate and 34% severe. The majority had no exacerbations in the last 12 months (60%), 28% had 1-2 and 12% >2 exacerbations per year. Nearly half were non adherent (46%). The figure shows the relationship between self-rated severity, adherence and exacerbations. Adherence was higher in more severe participants- only 12% of severe participants were non-adherent. Interestingly of the mild participants 16% had at least one and 3% at least three exacerbations.DiscussionAdherence is unrelated to outcome in patients self-rating as mild asthma, but adherence increases with perceived severity and exacerbations. Some patients self-rate as mild despite experiencing exacerbations which shows the need to record objective measures of control and manage adherence for all patients, as their self-perception of control can be inaccurate [1,2]. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The project was funded by an unrestricted medical education grant from Teva. References and Clinical Trial Registry Information Katsaounou P, Odemyr M, Spranger O, Hyland ME, Kroegel C, Conde LG, Gore R, Menzella F, Ribas CD, Morais-Almeida M, Gasser M. Still Fighting for Breath: a patient survey of the challenges and impact of severe asthma. ERJ open research. 2018 Oct 1;4(4).Hyland ME. Asthma treatment needs: a comparison of patients' and health care professionals' perceptions. Clinical therapeutics. 2004 Dec 1;26(12):2141-52.