Associations between medication and disease beliefs and use of inhaled corticosteroids among inner city adults with persistent asthma☆

Abstract 

Rationale

This study examined underlying beliefs that may explain suboptimal adherence with inhaled corticosteroid (ICS) among inner city adults with moderate and severe asthma.

Methods

A prospective cohort of consecutive adults hospitalized at a large New York City hospital over 1 year were interviewed at baseline and 6 months to assess medication and disease beliefs and self-reported ICS adherence.

Results

Overall, 204/218 patients (Pts) consented and 97% and 84% completed baseline and 6 month interviews(28% in Spanish). Mean age was 49.9 years, 78% female, 62% Hispanic, 28% African-American, and 5% White. Twenty-three percent had previous intubations and 88% prior steroids. Before hospitalization, 66% were on ICS. Of these, 73% used them regularly when symptomatic vs. 58% when asymptomatic (p<.02). At 6 months, ICS prescriptions increased to 76% (p<.04), though use when symptomatic (77%) and asymptomatic (64%) was unchanged. Eighty-five percent said it was very important to use ICS when symptomatic compared to 65% important to use when asymptomatic (p<.05). Fifty-seven percent worried about side effects and 45% worried about addiction to ICS. Beliefs about importance of using ICS when symptomatic correlated most strongly with ICS use when symptomatic (r=.82; p<.0001) and beliefs about the importance of using ICS when asymptomatic correlated most strongly with ICS when asymptomatic (r=.88; p<.0001). Concerns about side effects and addiction were not significantly correlated with adherence. Beliefs about having asthma even when they did not have symptoms correlated with adherence (r=.28; p<.001), but beliefs about underlying lung inflammation were not

Conclusions

Efforts to improve asthma outcomes should concentrate on addressing suboptimal medication and disease beliefs.

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