PRS83 - PATIENT PERSPECTIVE ON MEDICATION ADHERENCE IN ASTHMA: A SYSTEMATIC REVIEW OF THE LITERATURE

To conduct a targeted systematic review of the qualitative evidence underlying patients’ perspective on medication adherence with specific regard to short-acting β2-agonists (SABA) overreliance and inhaled corticosteroids (ICS) underuse in asthma patients. Peer-reviewed and published English language articles with observational and clinical trial data assessing adherence to licensed asthma medications (1 January 2012‒26 February 2018, inclusive) were identified using Medline and Embase. Results included articles with a population aged ≥12 years and qualitative data describing medication adherence (initiation/implementation/discontinuation). Of 254 citations identified, 43 were duplicates while 197 were ineligible. Examination of reference lists of the 14 eligible articles identified 3 additional eligible articles. Similarly, 4 additional articles were identified from reference lists of recent systematic reviews. Thus, 21 articles underwent full-text review and table abstractions. Seven major patient-centred drivers of SABA overreliance and ICS underuse were identified: treatment of asthma as an “as-needed” condition; consideration of asthma as a low-priority disease due to its episodic nature; doubts about diagnostic accuracy and lack of diagnostic consensus between physicians and specialists; poor patient-physician relationship due to a lack of written asthma action plans, a clear diagnosis, formal or objective assessment of disease severity, a patient-centred treatment approach and insufficient explanation of asthma management; suboptimal understanding of controller versus rescue medications; suboptimal inhaler techniques; and fear of short- and long-term side effects. Patients with asthma expressed a desire to be involved in selecting therapy options. Patient perception regarding asthma medications is related to symptoms and disease status, suboptimal knowledge of medication, poor doctor-patient relationship, and fear of side effects leading to SABA overreliance and ICS underuse. Patients with newly diagnosed asthma or known suboptimal medication understanding should receive targeted education and adherence interventions. Adherence interventions should also be directed toward changing provider behaviors and communication to promote optimal adherence.