Liu Changwei, Tham Chee Wei, De Roza Jacqueline, Chong Bee Yen, Koh Yi Ling, Tan Ngiap Chuan
National Healthcare Group Polyclinics, Singapore.
Yong Loo Lin School of Medicine, Singapore.
Patient Prefer Adherence. 2020 Aug 4;14:1351-1359. doi: 10.2147/PPA.S266871. eCollection 2020.
While illness perceptions and medication beliefs have been shown to be associated with inhaled corticosteroid (ICS) adherence in younger adults with asthma, their impact on older adults is less understood. This study aimed to determine the prevalence of ICS adherence among older Asian adults and to assess the association between ICS adherence, illness perceptions and medication beliefs.
A questionnaire survey on older multi-ethnic Asian patients, aged ≥60 years, with physician-diagnosed asthma, was conducted in two Singapore public primary care clinics. The scores of the Medication Adherence Report Scale for asthma (MARS) were computed to determine the adherence to ICS alone or in combination with LABA. Illness perceptions and medication beliefs were assessed by the scores from the Brief-Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ), respectively. Logistic regression analyses were used to identify factors associated with ICS adherence.
Analyses of 323 participants (57% males; Chinese 73.7%, Malay 12.7%, Indian 12.4%; mean age 71.5 years) showed that 40.9% of them had good adherence to ICS (mean MARS score≥4.5). Good adherence to ICS was associated with perception of asthma as a chronic illness (OR=1.22; 95% CI=1.10-1.35; <0.001), belief of ICS as an essential medication (2.67; 1.76-4.06; <0.001) and fewer concerns about its use (0.39; 0.26-0.60; <0.001). Patients on combined ICS-LABA therapy had higher adherence (2.50; 1.41-4.44; =0.02) than those on ICS monotherapy.
Four in ten older patients with asthma were adherent to ICS. Perception of medication necessity, chronicity of illness, concerns and use of ICS-LABA medication were associated with adherence.
虽然疾病认知和用药信念已被证明与年轻哮喘患者吸入性糖皮质激素（ICS）的依从性有关，但它们对老年患者的影响尚不清楚。本研究旨在确定老年亚洲成年人中ICS依从性的患病率，并评估ICS依从性、疾病认知和用药信念之间的关联。
在新加坡两家公立基层医疗诊所对年龄≥60岁、经医生诊断为哮喘的多民族亚洲老年患者进行问卷调查。计算哮喘用药依从性报告量表（MARS）的得分，以确定单独使用ICS或与长效β2受体激动剂（LABA）联合使用时的依从性。分别通过简短疾病认知问卷（B-IPQ）和用药信念问卷（BMQ）的得分评估疾病认知和用药信念。采用逻辑回归分析确定与ICS依从性相关的因素。
对323名参与者（57%为男性；华人占73.7%，马来人占12.7%，印度人占12.4%；平均年龄71.5岁）的分析表明，其中40.9%的人对ICS有良好的依从性（平均MARS得分≥4.5）。对ICS的良好依从性与将哮喘视为慢性病的认知（比值比[OR]=1.22；95%置信区间[CI]=1.10-1.35；P<0.001）、认为ICS是必需药物的信念（2.67；1.76-4.06；P<0.001）以及对其使用的担忧较少（0.39；0.26-0.60；P<0.001）相关。接受ICS-LABA联合治疗的患者比接受ICS单药治疗的患者依从性更高（2.50；1.41-4.44；P=0.02）。
十分之四的老年哮喘患者坚持使用ICS。对药物必要性的认知、疾病的慢性、对ICS-LABA药物的担忧和使用与依从性相关。
