Two simple recommendations for older patients with asthma – keeping medication in the bathroom and integrating its use into a daily routine – can significantly improve adherence to inhaled corticosteroids.
When patients consistently did either of those, adherence rose threefold, compared with patients who didn’t, Dr. Alex Federman and his associates wrote in the August issue of the Journal of Internal Medicine.
The findings suggest that clinicians might help improve adherence by suggesting that their patients store the medication in their bathroom cabinet, and take it, for example, when they brush their teeth every day.
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For older patients with asthma, keeping corticosteroids in the bathroom and integrating its use into a daily routine can reduce forgetful nonadherence.
"Because adherence strategies are modifiable, the findings in this study may provide clinicians and care coaches with straightforward and useful messages to help older patients improve their medication adherence," wrote Dr. Federman of Icahn School of Medicine at Mount Sinai, New York, and his coauthors (J. Intern. Med. 2014 Aug. 5 [doi:10.1007/s11606-014-2940-8]).
The team investigated adherence to inhaled corticosteroids among 358 elderly patients with asthma. They were a mean of 67 years old, with 31% older than 70 years. Most (84%) were women and many were Latino (38%). Black patients comprised 31% of the cohort and the others were non-Hispanic whites.
The majority had a low monthly income ($1,350 or less), and 25% were not fully literate in English. Many had comorbid psychological conditions, including depression (20%) and anxiety (21%).
Low health literacy was common (34%), although most (71%) did understand that they would always have asthma and that it could not be cured (81%) But half believed that they only had the disease when they were symptomatic. In a survey of medication beliefs, most did believe that the steroids were good for them and that their benefits outweighed the risks.
However, only 37% of the cohort reported good medication adherence. This proportion was significantly worse among blacks and Hispanics; those with lower incomes and lower education; those born in Puerto Rico and the Dominican Republic; and those with poor physical health, anxiety, or depression.
The authors identified six medication adherence strategies among the group: keeping the medication in a usual location (44%); integrating it into their daily routine (33%); taking it at a specific time of day (22%); taking it with other medications (13%); using it only when needed; (13%) and using other reminders (12%). Less than 2% reported using written notes as a reminder or having someone else remind them; 4% had no specific strategy.