Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies

Figures & data

Table 1 PICOS Criteria for Study Selection

Criteria	Inclusion Criteria
Population(s)	Persons aged ≥12 years with asthma
Interventions/comparators	Licensed treatments and/or complementary and alternative medicine
Outcomes	Medication initiation, implementation, and discontinuation
Study design	Qualitative research (prospective and retrospective studies, cross-sectional and longitudinal studies, systematic literature reviews, and clinical trials)
Other	English language, any geographical region

Abbreviation: PICOS, population, intervention, comparison, outcome, and study design.

Figure 1 Summary of study selection for analysis.

Table 2 Representative Statements from Patients Highlighting Key Drivers Affecting Medication Adherence in Asthma

Theme	Quote
Doubts about the accuracy of asthma diagnosis	“Not every GP has pulmonary function test equipment and (even when he possesses the equipment) can make accurate diagnoses”^Citation33 “ … maybe even people in general sometimes have trouble breathing … I don’t know what’s normal”^Citation32
Daily life is unaffected by asthma	“I don’t use it at all … right after I come from the doctor’s, I take it for 2 to 3 days and then I just forget. It is not that I don’t want to take it, it is that I forget to take it … if I had more symptoms, then I would take it”^Citation25 “I think it [diabetes] makes me lose sight of my asthma until something, you know, until I can’t breathe or it’s hot out or something”^Citation28 “Don’t need to take any medication until the pollen season comes. Maybe when it’s really cold”^Citation38
Patient-physician communication	“When I go to my appointment, they try to rush, get you in there, rush you out, get you some stuff, take this, do this”^Citation29 “We never actually sat down and made a plan”^Citation29
Suboptimal knowledge of reliever and maintenance medications	“I was like supposed to take so many puffs a day, and I over use it”^Citation18
Suboptimal inhaler technique	“Have you taken or inhaled the full dose, or not? You never know”^Citation34
Perceived concerns about side effects	“I had to take steroids, which has made me gain weight, which has sort of kept me from exercising”^Citation40 “ … when I take my medicine, sometimes I still get sick. When I don’t take my medicine, I don’t get sick. I really don’t see where it comes in handy, but I guess if the doctor says I need it, I need it”^Citation25
Stigma of inhaler use	“I hate feeling like I’m different. I have a problem when it comes to that and I hold off on my medicine. As you get older, you care what people think more. So I try to hold [asthma medication] off and be cool”^Citation29
Perceived medication affordability	“My physician told me to take my medication in the mornings and in the evenings, but I take it every two days because that’s a lot of money”^Citation34

Abbreviation: GP, general practitioner.

Figure 2 Drivers of medication adherence in asthma derived from qualitative literature.

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