As noted in previous entries on this site, adherence to medication regimens usually hovers around the 50 percent mark. This suggests that, on average, patients take their drugs half of the time, but fail to do so the remaining half. In reality, it is more complicated than this, but you get the idea. Failure to take medications as directed has long been a festering thorn in the side of health care personnel. They complain that the treatments they prescribe don’t work because patients, particularly those with chronic illness, do not take them as told. Many personnel, in fact, blame any failure of treatment on nonadherence. Patients, on the other hand, often fail to understand the need to take drugs on a daily basis, particularly when they do not have any symptoms. As many have been conditioned to only take drugs to manage acute episodes, taking medications on a regular basis flies against everything they have been taught. Needless to say, the issue of medication compliance is a long way from being resolved, a matter unlikely to occur under the best of circumstance. Charles and colleagues set about to see whether an audiovisual reminder would improve adherence with patients prescribed inhaled corticosteroids to control their asthma. They studied 110 adult or adolescent subjects with asthma who were randomized to receive 24 weeks of inhaled corticosteroids, one actuation twice daily via a metered dose inhaler with or without an audiovisual reminder function. All the inhalers had electronic adherence monitors that could record adherence, defined as the proportion of medication taken as prescribed over the final 12 weeks of the study. Adherence was also assessed as the proportion of subjects who took more than 50%, 80%, or 90% , respectively, of prescribed medication. The results indicated that the proportion of medication taken in the last 12 weeks was greater in the group given the audiovisual reminder compared with the control group. The proportion of patients taking more than 50%, 80%, or 90%, respectively, was also greater when patients had the audiovisual reminder.

COMMENTS: The audiovisual reminder function improved adherence to inhaled corticosteroid therapy in adult asthma. This appears to be an approach that may work with larger groups of patients given inhaled corticosteroids to control their asthma. However, a couple of questions are raised by the study. First, how expensive is the inhaler device used in the study? Unless it was inexpensive, which it likely isn’t, then the reality of introducing it with a large population of asthma patients is slim. Second, is there any evidence that the inhaler would be used for a prolonged period of time? That issue was not addressed in this study, as the aim was mainly to test the inhaler device. However, as inhaled steroids are prescribed for as long as needed for asthma patients, there is no evidence that patients would continue to use the inhaler over time. The likelihood of this occurring, however, can only be found in future research with the inhaler used in this study.

T. Charles et al. An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma. Journal of Allergy & Clinical Immunology, 2007; 119: 811-816.