Patients’ beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia

Figures & data

Table 1. Demographic and clinical characteristics

Characteristics	All (n = 1054)
Age (years), mean (SD)	53.0 (14.4)
Gender
Female	651 (61.8)
BMI (kg/m^2), mean (SD)	24.6 (4.4)
Age of asthma onset (years), mean (SD)	39.0 (17.1)
Occupation
Office work	275 (26.1)
Physical labor	255 (24.2)
Unemployed/retired/housewife	510 (48.4)
Student	14 (1.3)
Smoking status
Never smoker	777 (73.7)
Current smoker	52 (4.9)
Former smoker	225 (21.3)
Exposed to passive smoking	368 (34.9)
Any comorbidity	842 (80.7)
Any allergic disorder	605 (59.0)
Any cardiovascular disorder	346 (33.9)
Any endocrine and metabolic disorder	220 (22.1)
Gastro-esophageal reflux disease	85 (8.9)
Chronic obstructive pulmonary disease	33 (3.2)
Laboratory tests
Post-bronchodilator FEV1 % predicted,   mean (SD), n = 256^a	78.3 (20.7)
Reversibility, n = 260^a	86 (33.1)
Positive reaction to skin prick test, n = 331^a	120 (36.3)
Use of rescue medication in the previous 4 weeks
Yes	404 (38.3)
≥2 times/week	262 (24.9)
<2 times/week	142 (13.5)
≥1 time/day	156 (14.8)
<1 time/day	248 (23.6)
No	650 (61.7)
Current maintenance treatment	1047 (99.3)
Any ICS	1044 (99.1)
ICS alone	189 (17.9)
ICS+LABA	871 (82.6)
Very poorly controlled	164 (15.6)
Total AQLQ(S) score, mean (SD)	5.28 (1.15)
Medication adherence
MMAS-8 score, mean (SD)	5.53 (2.03)
High	198 (18.9)
Medium	356 (34.1)
Low	491 (47.0)

Results are presented as n (%) unless otherwise specified.

^aNumber of patients with available laboratory findings.

Figure 1. Patients’ perceptions about asthma and its treatment

Figure 2. Impact of adherence on asthma control

Table 2. Impact of asthma control on quality of life and clinical events

	Well controlled	Not well controlled	Very poorly controlled	p value
AQLQ(S) score, mean (SD)	5.83 (0.81)	4.73 (0.80)	3.71 (0.98)	<0.001
Any asthma exacerbations^a				<0.001
Yes	175 (25.8)	93 (44.1)	102 (62.2)
No	504 (74.2)	118 (55.9)	62 (37.8)
Any hospitalization or emergency room visit^a				<0.001
Yes	57 (8.4)	45 (21.3)	62 (37.8)
No	622 (91.6)	166 (78.7)	102 (62.2)
Any lost days of work^a				<0.001
Yes	45 (6.6)	34 (16.3)	61 (37.9)
No	632 (93.4)	174 (83.7)	100 (62.1)

Results are presented as n (%) unless otherwise specified.

^aIn the past year.

Figure 3. Comparison of patients’ perceptions among high or medium adherent patients and low adherent patients

Table 3. Results of multivariate analysis for significant factors affecting adherence

Factors	RR (95% CI) of poor treatment adherence	p value	Overall p value
Question 8. I am not sure inhaler type medicines work well (vs. strongly agree)			0.001
Strongly disagree	0.65 (0.50–0.83)	0.001
Disagree	0.69 (0.54–0.87)	0.002
Uncertain	0.88(0.68–1.12)	0.289
Agree	0.81(0.62–1.04)	0.103
Question 6. Taking medicines more than once a day is inconvenient (vs. strongly agree)			0.002
Strongly disagree	0.80 (0.60–1.06)	0.125
Disagree	0.86 (0.69–1.08)	0.205
Uncertain	1.09 (0.85–1.39)	0.499
Agree	1.16 (0.94–1.43)	0.162
Question 1. Sometimes I skip my inhaler to use it over a longer period (vs. strongly agree)			<0.001
Strongly disagree	0.50 (0.40–0.63)	<0.001
Disagree	0.51 (0.40–0.64)	<0.001
Uncertain	0.83 (0.60–1.15)	0.268
Agree	0.98 (0.77–1.24)	0.862
Age (year)	0.99 (0.98–1.00)		0.030
Occupation (vs. office work)			0.005
Physical labor	0.87 (0.74–1.03)	0.114
Unemployed/retired/housewife	0.74 (0.62–0.88)	0.001
Student	1.09 (0.78–1.52)	0.623
Exposure to passive smoking (yes vs. no)	1.17 (1.02–1.34)		0.029
Age of asthma onset (year) (vs. <40)			0.068
40–59	1.24 (1.03–1.51)	0.025
≥60	1.15 (0.81–1.63)	0.449
Exercise-induced asthma (yes vs. no)	1.15 (1.00–1.33)		0.059
Duration of maintenance treatment with inhaler (years)	0.99 (0.97–1.00)		0.097
No. of scheduled clinic visit in the past 12 months	0.98 (0.96–1.00)		0.049
Any controller medications prescribed in the past 12 months (yes vs. no)	0.69 (0.49–0.98)		0.036
Oral β2 agonist (yes vs. no)	0.66 (0.47–0.92)		0.013
Allergic rhinitis (yes vs. no)	1.17 (1.01–1.36)		0.033
Chronic obstructive pulmonary disease (yes vs. no)	0.73 (0.50–1.05)		0.092
Country			<0.001

Ethics committees and ethics committee approval numbers

Country	Hospital name	EC name	Date of EC approval	EC approval no.
China	Xinqiao Hospital, Third Military Medical University, People's Liberation Army of China	Ethics Committee of Xinqiao Hospital, Third Military Medical University, People's Liberation Army of China	1 Nov 2011	2011015
	Daping Hospital, Third Military Medical University, People's Liberation Army of China	Ethics Committee of Daping Hospital, Third Military Medical University, People's Liberation Army of China	25 Nov 2011	2011034
	West China Hospital, Sichuan University	Ethics Committee of West China Hospital, Sichuan University	30 Nov 2011	2011111
Korea	Seoul National University Medical Centre	Seoul National University Hospital Institutional Review Board	15 Sep 2011	H-1109-006-376
	Asan Medical Centre	Asan Medical Centre Institutional Review Board	28 Oct 2011	2011-0739
	Ewha Womans University Mokdong Hospital	Ewha Womans University Institutional Review Board	07 Sep 2011	ECT 11-49-06
	Hallym University Medical Centre, Kangdong Sacred Heart Hospital	Hallym University Sacred Heart Hospital Institutional Review Board	08 Nov 2011	11-103
	Dankook University Hospital	Dankook University Hospital Institutional Review Board	19 Oct 2011	1110-102
Malaysia	Institute of Respiratory Medicine	Medical Research & Ethics Committee (MREC)	20 Mar 2012	NMRR-11-696-10159
	University of Malaya	University of Malaya Medical Centre Ethics Committee		976.46
	UMMC	Medical Ethics Committee (MEC)	23 Nov 2011	MEC Ref no. 890.30
	Hospital Penang	Medical Research & Ethics Committee (MREC)	20 Mar 2012	NMRR-11-696-10159
	Hospital Tuanky Ja’afar	Medical Research & Ethics Committee (MREC)	20 Mar 2012	NMRR-11-696-10159
Taiwan	St. Mary’s Hospital, Lotung	St. Mary’s Hospital Institutional Review Board	28 Dec 2011	SMHIRB No.: 100019
	Cathay General Hospital	Institutional Review Board of the Cathay General Hospital	4 Jan 2012	CGH-CS100104
	Taichung Veterans General Hospital	Institutional Review Board of the Taichung Veterans General Hospital	22 Dec 2011	SE11272
Thailand	King Chulalongkorn Memorial Hospital	Institutional Review Board Faculty of Medicine, Chulalongkorn University	19 Jan 2012	503/54
	Maharaj Nakorn Chiang Mai Hospital	Research Ethics Committee 3. Faculty of Medicine, Chiang Mai University	04 Jan 2012	003/2012
	Srinagrind Hospital	Khon Kaen University Ethics Committee for Human Research, Panel 1	11 Jan 2012	IRB00001189
Vietnam	National Lung Hospital	Ethic Committee in Biomedical Research of National Lung Hospital	5 Jan 2012	45/HDDD-BVPTW
	Pham Ngoc Thach Hospital	Science, Technology, and Ethic Committee of Pham Ngoc Thach Hospital	5 Apr 2012	298/PNT