Compliance with asthma therapy - Measurement and implications

Asthma is a common disease. World-wide experience has shown an increase in prevalence and severity, although whether the natural history of the disease is changing is unknown. International practice guidelines are presented for a step-wise treatment approach, emphasising the chronic nature of the inflammatory component of the disease. Compliance is a major issue. Physicians need to understand the problem and be actively involved in improving compliance. Merely creating a treatment plan is insufficient, and a broad understanding of the problems in healing with a chronic disease is required. Methods to assess compliance have been developed. Biochemical measurements of biological fluids are familiar to most physicians. Significant limitations are found with their usefulness, including drug interactions, biological variability and practicality. Electronic monitoring of inhaler usage and pulmonary function can help evaluate compliance and effectiveness of treatment. An ideal way to monitor treatment has yet to be developed. Improving compliance has 3 important components: education, skills training and behaviour modification. Programmes for education about the illness, methods to control it and skills training needed for effective use of inhalers and peak flow meters have been developed. Behavioural changes are difficult to achieve and require a multifaceted approach. A self-management programme promotes patient involvement and a sense of control. Effective physicians are acquainted with their patients' health beliefs and life circumstances. Promotion of compliance is a dynamic process that requires the physician to think in a patient-centred approach. Practical suggestions are made to identify areas where compliance is a problem and how to deal with it. Outcomes management will be assessed as reduced mortality and morbidity, and an improved quality of life.