Purpose of the Study
Misunderstanding of the role of asthma medication and fear of untoward side effects may reduce compliance to therapy. The objective of this study was to survey asthmatic patients to determine their perception of the role and potential side effects of inhaled corticosteroids (ICS) and what effect these perceptions had on compliance.
A national telephone survey was conducted on 603 asthmatic patients over 16 years of age.
Interviews were conducted from mid-to-late September 1995, in Canada. A pretested questionnaire was developed and continuous monitoring of each interviewer in the study was performed. The questionnaire included questions about various aspects of corticosteroid therapy, particularly relating to perceived modes of action and side effects of those agents. A profile was assessed in regards to years diagnosed with asthma, medication usage and dosing, a physician managing the asthma, severity of disease, and frequency of emergency room (ER) visits.
Thirty-nine percent had used regular or intermittent inhaled corticosteroids in the past 12 months. A large proportion of asthmatic patients did not understand the role of their medications and had misconceptions and fears in regard to ICS, therefore reducing their willingness to use them. Forty-three percent believed that ICS opened airways and relieved constriction and only 22% mentioned that they reduced inflammation or swelling of airways. Fifty-three percent of patients were very or somewhat concerned about using ICS with 59% expressing fear of side effects. Thirty-nine percent knew that side effects were minor if used as prescribed. The most common fears were in regard to body image, bone density, and reduction in efficacy over time. Two thirds of patients had not discussed their concerns with their physicians. Thirty-one percent indicated they were not aware that ICS existed for asthma treatment. Finally, a large number of the patients were not adequately controlled according to recent asthma consensus guidelines.
These observations stress the importance for those involved in asthma care to question their patients about their understanding of the role of asthma medications along with fears, misconceptions, what is considered adequate asthma control, and to provide adequate education.
This is a nice survey of a large population in regard to fears and misconceptions of ICS in the treatment of asthma. Adherence to maintenance therapy is vital in control of asthma, but if patients are not appropriately educated, compliance is likely to be a greater problem. As physicians, we must take time to inform our parents of the importance of adequate control of disease and discuss issues of maintenance medications, including their mode of action, proper usage, and potential side effects. With proper education and counseling, hopefully compliance will be optimized to reduce the negative consequences of the disease.