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Tuesday 29 January 2019

Inhalers and inhaled therapy

I have worked in the speciality of respiratory disease management for decades.

I have been responsible for designing services to aid the delivery of care for patients with asthma, COPD and other diseases.

I am also asthmatic and have been for decades.
I have not needed regular treatment with inhalers until last year. Now, I have to take 2 puffs of symbicort 200/ 6 twice daily.
It takes a few seconds a day, yet I have a problem remaining compliant..!
I know right?
Tablets wise, I use a dosset box and I can see when I need to take my meds, when I have forgotten them, in time to correct this.
I am extremely compliant with my tablets.
So why such a difference in adherence?

One of the key areas we have always tried to focus on is concordance and compliance with inhaled therapy.
Unlike pills, we cannot put inhalers into dosset boxes so concordance can sometimes be very poor.
Inhalation therapy is recommended at all stages of the disease and allows the delivery of active molecules directly to the target site of action, whilst minimising adverse side-effects. Inhalers therefore play a crucial role in the effective management of patients with COPD and asthma. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects.

Rate of adherence is usually reported as the percentage of the prescribed doses of the medication actually taken by the patient over a specified period. The extent of non-adherence varies widely, and in different studies it has been recorded as low as 10% and as high as 92%.
Extensive review of the literature reveal that in developed countries adherence to therapies averages 50%.
Approximately half of this non-adherence is intentional, whilst the remainder occurs because patients are either unaware that they are not taking medications as prescribed or the regimen is just too complex. Adherence rates are typically higher among patients with acute conditions, as compared against those with chronic conditions.
Studies reveal that patients with chronic illnesses take only ~50% of medications prescribed for those conditions.

So can we make this easier?

Yes and this is something I am working on to develop a new strategy around this through an innovative approach that I will disclose once it is complete... So watch this space.

Useful link

Concordance

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