Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma

John Busby, John G. Matthews, Rekha Chaudhuri, Ian D. Pavord, Timothy C. Hardman, Joseph R. Arron, Peter Bradding, Christopher E. Brightling, David F. Choy, Douglas C. Cowan, Ratko Djukanovic, Catherine E. Hanratty, Tim W. Harrison, Cecile T. Holweg, Peter H. Howarth, Stephen J. Fowler, James L. Lordan, Adel H. Mansur, Andrew Menzies-gow, Robert M. NivenDouglas S. Robinson, Samantha M. Walker, Ashley Woodcock, Liam G. Heaney

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Abstract

Background Understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.

Methods We reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.

Results Of 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.

Conclusions Belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.
Original languageEnglish
Article number2100768
Pages (from-to)1-37
Number of pages37
JournalEuropean Respiratory Journal
Early online date24 Sep 2021
DOIs
Publication statusE-pub ahead of print - 24 Sep 2021

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