Patients' beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia

Objectives: To identify patients' beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. Methods: We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT (TM)), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). Results: Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0 +/- 4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5 +/- 2.0 and 53% were adherent. Adherence was significantly associated with patients' understanding of the disease and inhaler techniques, and with patients' acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p<0.01 for all). In multivariate analysis, three questions related to patients' acceptance of inhaler medicines remained significantly associated with poor adherence, after adjusting for potential confounders: "I am not sure inhaler type medicines work well'' (p=0.001), "Taking medicines more than once a day is inconvenient'' (p=0.002), and `` Sometimes I skip my inhaler to use it over a longer period'' (p<0.001). Conclusions: Our study showed that patients' acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.