Background

Uncontrolled asthma remains prevalent and inadequate adherence is thought to be a major cause of poor control and worsened outcomes (Levy et al., 2014).

Objectives

To evaluate a multidisciplinary team approach to enhance adherence by conducting an asthma adherence clinic.

Methods

We applied an adherence optimisation algorithm (Figure.1). Non-adherence patterns were identified using the Test of Adherence to Inhalers questionnaire (TIA), prescription possession ratio (PPR), fractional exhaled nitric oxide suppression testing, and liquid chromatography-based assay.

Results

A total of 56 patients followed the study protocol [mean age 45 years (17-78), 35 (62%) females]. Non-adherence (PPR<75%) was observed in 26 (46%) patients. From 48 patients (FeNO?45 ppb), 16 (33%) showed negative FeNO suppression. Non-adherence (TIA?45) was observed in 18 (32%) patients, and 13 (23%) intermediate non-adherences, of which 4 (11%), 16(43%), and 17(46%) were classed as intentional, non-intentional or mixed non-adherent patterns respectively. Of 11 (20%) on maintenance oral corticosteroids, 5 (45%) showed unsuppressed blood cortisol and detectable prednisolone. Critical errors in inhalation technique were observed in 31 (55%) with some non-adherent patients having good technique and vice versa.

Conclusions

Preliminary data demonstrate a high prevalence of non-adherence. Data on adherence optimisation will be available at the conference.