Brooks Taylor L, Leventhal Howard, Wolf Michael S, O'Conor Rachel, Morillo Jose, Martynenko Melissa, Wisnivesky Juan P, Federman Alex D
New York University, New York, NY, USA.
J Gen Intern Med. 2014 Nov;29(11):1506-12. doi: 10.1007/s11606-014-2940-8. Epub 2014 Aug 5.
Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.
To identify medication use strategies associated with good ICS adherence in older adults.
English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.
Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater.
The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03-9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62-8.77, p = 0.002).
Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.
老年哮喘患者对吸入性糖皮质激素（ICS）的依从性较低。虽然先前的研究已经确定了与老年哮喘患者ICS依从性相关的人口统计学和认知因素，但对于老年人实现日常用药所采用的策略知之甚少。确定这些策略可以为临床医生在向患者提供关于ICS依从性的咨询时提供有用的建议。
确定与老年患者良好的ICS依从性相关的用药策略。
从纽约市和伊利诺伊州芝加哥市的初级保健和肺病科招募了年龄在60岁及以上、患有中度或重度哮喘的讲英语和西班牙语的成年人。排除患有慢性阻塞性肺疾病、其他慢性肺部疾病或吸烟史超过10包年的患者。
使用药物依从性评定量表（MARS）评估药物依从性。通过开放式提问评估用药策略。“良好依从性”定义为MARS平均得分4.5或更高。
ICS的良好依从率为37%。我们确定了六类用药依从性策略：将药物放在常用位置（44.2%）、将用药与日常生活相结合（32.6%）、在特定时间服药（21.7%）、与其他药物一起服用（13.4%）、仅在需要时使用药物（13.4%）以及使用其他提醒方式（11.9%）。将ICS药物放在浴室的人（调整后的优势比[AOR] 3.05，95%置信区间1.03 - 9.02，p = 0.04）或把用药纳入日常生活的人（AOR 3.77，95%置信区间：1.62 - 8.77，p = 0.002）的良好依从率更高。
将ICS药物放在浴室并将其纳入日常生活是与良好的ICS依从性相关的策略。关注依从性的临床医生应考虑向老年哮喘患者推荐这些策略，不过还需要进一步研究以确定此类建议是否会改善依从行为。
