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Opinions/Hypotheses |

What Does It Mean When a Patient Says, “My Asthma Medication Is Not Working?”*

Bruce K. Rubin, MEngr, MD, FCCP
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*From the Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to: Bruce K. Rubin, MD, FCCP, Professor and Vice-Chair, Department of Pediatrics, Professor of Biomedical Engineering, Physiology, and Pharmacology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1081; e-mail: brubin@wfubmc.edu



Chest. 2004;126(3):972-981. doi:10.1378/chest.126.3.972
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Published guidelines for the care of patients with asthma state that adherence to medical therapy is important for good clinical outcome. In case-control studies, asthma morbidity1 and mortality23 have been strongly associated with nonadherence to therapy. Despite the acknowledgment that understanding the appropriate use of medications and adherence to medication therapy are among the most important factors for effective asthma therapy, little guidance is given that can help the caregiver understand why a patient will not take medications as directed or would misuse prescribed medications. Without such an understanding, the problem may be compounded by an inappropriate caregiver response. In the office of a busy practice, it is often easier to respond to the patient who tells you that their medications are not working by simply writing a prescription for a different medication or for additional medications. In many cases, the problem is not the medication at all, and by changing prescriptions the problems can be compounded as patients are often reticent to come back to their physicians with a second or third observation that the newly prescribed medication is not working either.4

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