Weinstein Andrew G
Department of Pediatrics, Thomas Jefferson Medical College, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
Ann Allergy Asthma Immunol. 2005 Feb;94(2):251-7. doi: 10.1016/S1081-1206(10)61304-X.
Poor asthma outcomes often result from patients not following physician medication recommendations (ie, nonadherence). Estimates suggest that 50% of patients with asthma do not follow physician medication recommendations.
To examine the rationale for making available objective medication adherence monitors for physicians to improve the quality of care for patients with severe persistent asthma.
Review of the literature was undertaken in the following areas related to asthma: cost, morbidity, adherence, adherence monitoring, outcomes, and guidelines.
Patients with severe asthma are at risk for nonadherence because of (1) the use of multiple medications to control symptoms, (2) coexisting disease states, (3) the occurrence of depression and anxiety, and (4) the high cost of care. Research studies have demonstrated the effectiveness of objective monitoring as part of multiple clinical strategies to improve adherence and reduce morbidity and the cost of asthma care. Without objective adherence monitoring, physicians may not accurately assess nonadherence as the cause of treatment failure. This may lead to inappropriate increases in therapy, diagnostic studies, and consultations and may leave the patient at risk for persistent symptoms, morbidity, and death.
By correctly assessing nonadherence as the cause of treatment failure in patients with not only severe asthma but mild and moderate disease as well, practicing physicians may improve the quality of care provided.
哮喘治疗效果不佳往往是由于患者未遵循医生的药物治疗建议（即不依从）。据估计，50%的哮喘患者不遵循医生的药物治疗建议。
探讨为医生提供客观的药物依从性监测仪以提高重度持续性哮喘患者治疗质量的理论依据。
对以下与哮喘相关的领域进行文献综述：成本、发病率、依从性、依从性监测、治疗效果和指南。
重度哮喘患者存在不依从的风险，原因包括：（1）使用多种药物控制症状；（2）并存疾病状态；（3）抑郁和焦虑的发生；（4）高昂的治疗费用。研究表明，作为多种临床策略的一部分，客观监测对于提高依从性、降低哮喘治疗的发病率和成本具有有效性。如果没有客观的依从性监测，医生可能无法准确评估不依从是治疗失败的原因。这可能导致不适当增加治疗、诊断检查和会诊，并可能使患者面临持续症状、发病和死亡的风险。
执业医生不仅正确评估不依从是重度哮喘患者，也是轻度和中度哮喘患者治疗失败的原因，可能会提高所提供的治疗质量。
