PURPOSE: Low dose inhaled corticosteroids (ICS) are the first line treatment for mild asthma in Canada. However, non compliance may reduce asthma control and lower patient satisfaction. To describe in a “real-world” setting the percentage of mild asthmatics being at least 6 years old whose symptoms are uncontrolled with low-dose ICS and to assess the association between treatment compliance, asthma symptom control and patient satisfaction.
METHODS: The survey was administered at the baseline visit of a prospective cohort study in patients with mild asthma treated with low dose ICS. Non compliance was defined as either i) reported less than 80% use of ICS on average, or ii) a positive response for ≥ 1 of 4 validated compliance questions. Asthma control definition was according to the Canadian Asthma guidelines (i.e. asthma symptoms less than 4 times/wk; awakening less than one night/wk). Dissatisfaction with treatment was defined as being “very dissatisfied” or “dissatisfied” from a 5-point Likert scale.
RESULTS: 1817 patients completed the survey. Mean (SD) age was 31.9 (20.47) years. 779 (42.9%) were male. 1397 (76.9%) patients had uncontrolled asthma and 439 (24.2%) were unsatisfied with treatment. Non compliant patients had significantly higher dissatisfaction (N=348, 25.3%) vs. those who were compliant (N=81, 20.3%) (P=0.04). A significantly higher proportion of non compliant patients (N=1115, 80.9%) also had uncontrolled asthma when compared to patients who were compliant (N=251, 62.8%) (P<0.001). In two logistic regression models non compliance and age between 6 and 14 years were significantly (P< 0.05) and independently associated with both outcomes, specifically uncontrolled of asthma and dissatisfaction with treatment (P<0.05). Longer duration of asthma was also an independent risk factor for uncontrolled asthma (P=0.001).
CONCLUSION: Non compliance is a risk factor related to uncontrolled asthma and patient dissatisfaction in mild asthmatics prescribed low dose ICS.
CLINICAL IMPLICATIONS: The prospective cohort study will enable us to assess if substituting montelukast, an oral therapy for the ICS, will enable these uncontrolled mild asthmatics patients to attain asthma control and patient satisfaction.
DISCLOSURE: Caroline Koch, None.