ASTIMLI HASTALARDA TEDAVİ UYUMSUZLUĞU SIKLIĞI VE NEDENLERİ

Öz

Amaç: Astım kontrolünün sağlanamamasının önemli nedenlerinden biri hastaların tedaviye uyumsuzluğudur. Bu çalışmada astımlı hastalarda tedavi uyumsuzluğu sıklığı ve nedenlerini araştırmak amaçlandı. Yöntem ve Gereç: Çalışmaya en az üç aydır astım tanısı olan ve düzenli kontrol edici tedavi önerilen 103 astımlı hasta alındı. Hastaların son üç ay içindeki tedavi uyumu hasta bildirimleri ve eczane kayıtları kullanılarak değerlendirildi. Hastanın alması gereken kontrol edici ilacın ≥%80’ini alması durumu ‘‘tam uyum’’, <%80’ini alması ise ‘‘tedavi uyumsuzluğu’’ olarak sınıflandı. Tedavi uyumsuzluğu olması durumunda nedenler sorgulandı. Bulgular: Hasta bildirimine dayalı tedavi uyumsuzluğu sıklığı %47.6, eczane kayıtlarına dayalı tedavi uyumsuzluğu sıklığı %48.5 saptandı. Hasta bildirimleri ve eczane kayıtları birlikte değerlendirildiğinde tedavi uyumsuzluğu sıklığı %56.3 bulundu. En sık bildirilen tedavi uyumsuzluğu nedenleri ‘‘İlacımı almayı unutuyorum’’ (%43.1), ‘‘İlaç yan etkilerinden korkuyorum’’ (%39.7), ‘‘Dü- zenli ilaç kullanmam gerektiğini düşünmüyorum’’ (%29.3) idi. Tedavi uyumsuzluğu olan hastaların %75.9’unda bilinçli uyumsuzluk, %43.1’inde düzensiz uyumsuzluk, %22.4’ünde istemsiz uyumsuzluk saptandı. Ek atopik hastalık varlığı ve GINA kriterlerine göre tam kontrol oranları, tedavi uyumu iyi olan grupta, tedavi uyumsuzluğu olan gruba göre daha yüksek bulundu. Sonuç: Astım hastalarının yarısından fazlasında kontrol edici tedaviye uyumsuzluk mevcuttur. Tedavi uyumunun, hem hastaya sorularak hem de eczane kayıtlarının incelenmesi gibi objektif bir yöntemle değerlendirilmesi, tedavi uyumsuzluğunun saptanma oranlarını arttırmaktadır.

Anahtar Kelimeler

• Astım, astım tedavisi, uyum

THE FREQUENCY AND REASONS OF TREATMENT NONADHERENCE IN PATIENTS WITH ASTHMA

Abstract

Aim: An important reason for poor asthma control is nonadherence to treatment. The aim of this study was to explore treatment nonadherence rates and reasons in patients with asthma. Material and Methods: The study included 103 patients with a diagnosis of asthma for at least three months, in whom regular controller treatment was recommended. Treatment adherence during the last three months was evaluated based on self-reports and pharmacy records. The status of receiving ≥80% of the required controller medication was classified as ‘‘complete adherence’’, while receiving <80% was classified as ‘‘ treatment nonadherence’’. In case of nonadherence the reasons were questioned. Results: The frequency of treatment nonadherence based on patients self-reports and pharmacy records was 47.6% and 48.5%, respectively. When patients self-reports and pharmacy records were evaluated together, the frequency of treatment nonadherence was 56.3%. The most frequent reasons for treatment non-adherence were ‘‘I forget to take my medication’’ (43.1%), ‘‘I am afraid of medication side effects’’ (39.7%), and ‘‘I do not think that I should use regular medication’’ (29.3%). Intelligent nonadherence was detected in 75.9%, erratic nonadherence in 43.1%, and unwitting nonadherence in 22.4% of the nonadherent patients. Presence of atopic comorbid diseases and well control according to GINA criteria were more frequent in patients with good adherence compared to patients with nonadherence. Conclusion: More than half of the patients with asthma show treatment nonadherence. Assessment of treatment adherence both by asking the patient and by an objective method like examining pharmacy records increases detection rates of treatment nonadherence.

Keywords

• Adherence, asthma, asthma treatment

Kaynakça

1. 1. Sabaté E, ed. Adherence to long-term therapies: Evidence for action. Geneva, Switzerland: World Health Organization; 2003.
2. 2. Cerveri I, Locatelli F, Zoia MC, Corsico A, Accordini S, de Marco R. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1999; 14: 288-94.
3. 3. Bender B, Milgrom H, Rand C. Nonadherence in asthmatic patients: is there a solution to the problem? Ann Allergy Asthma Immunol 1997; 79: 177-85.
4. 4. Milgrom H, Bender B, Ackerson L, Bowry P, Smith B, Rand C. Noncompliance and treatment failure in children with asthma. J Allergy Clin Immunol 1996; 98: 1051-7.
5. 5. Williams LK, Pladevall M, Xi H, Peterson EL, Joseph C, Lafata JE, Ownby DR, Johnson CC. Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol 2004; 114: 1288-93.
6. 6. Côté I, Farris K, Feeny D. Is adherence to drug treatment correlated with health-related quality of life? Qual Life Res 2003; 12: 621-33.
7. 7. Bender B, Rand C. Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol 2004; 4: 191-5.
8. 8. Global initiative for asthma. Global Strategy for asthma management and prevention, 2016. www.ginasthma.org

9. 9. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113:59-65.
10. 10. Uysal MA, Mungan D, Yorgancıoğlu A, Yıldız F, Akgun M, Gemicioglu B, Turktas H; Turkish Asthma Control Test (TACT) Study Group. The validation of the Turkish version of Asthma Control Test. Qual Life Res 2013; 22: 1773-9.
11. 11. Türk Toraks Derneği, Astım Tanı ve Tedavi Rehberi, 2014 güncellemesi. Turkish Thoracic Journal 2014;15(Suppl 1): 39-45.
12. 12. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011; 86: 304-14.
13. 13. Cooper V, Metcalf L, Versnel J, Upton J, Walker S, Horne R. Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalance: a UK-wide, cross-sectional study. NPJ Prim Care Respir Med 2015;25:15026.
14. 14. Murphy AJ, Proeschal A, Brightling CE, Wardlaw AJ, Pavord I, Bradding P, Green RH. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma. Thorax 2012; 67: 751-3.
15. 15. Capanoglu M, Dibek Misirlioglu E, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers. J Asthma 2015; 52: 838-45.
16. 16. Oğuzülgen IK, Köktürk N, Işıkdoğan Z. Astım ve kronik obstrüktif akciğer hastalarında Morisky 8-maddeli ilaca uyum anketinin (MMAS-8) Türkçe geçerliliğinin kanıtlanması çalışması. Tuberk Toraks 2014; 62: 101-7.
17. 17. Gamble J, Stevenson M, McClean E, Heaney LG. The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med 2009; 180: 817-22.
18. 18. Baiardini I, Braido F, Giardini A, Majani G, Cacciola C, Roqaku A, Scordamaqlia A, Canonica GW. Adherence to treatment: assessment of an unmet need in asthma. J Investig Allergol Clin Immunol 2006; 16: 218- 23.
19. 19. Adams S, Pill R, Jones A. Medication, chronic illness and identity: the perspective of people with asthma. Soc Sci Med 1997; 45: 189-201.
20. 20. Corsico AG, Cazzoletti L, de Marco R, Janson C, Jarvis D, Zoia MC, Bugiani M, Accordini S, Villani S, Marinoni A, Gislason D, Gulsvik A, Pin I, Vermeire P, Cerveri I. Factors affecting adherence to asthma treatment in an international cohort of young and middle-aged adults. Respir Med 2007; 101:1363-7.
21. 21. Boulet LP. Perception of the role and potential side effects of inhaled corticosteroids among asthmatic patients. Chest 1998; 113:587-92.
22. 22. Chambers CV, Markson L, Diamond JJ, Lasch L, Berger M. Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices. Respir Med 1999; 93: 88-94.
23. 23. Lindsay JT, Heaney LG. Nonadherence in difficult asthma – facts, myths, and a time to act. Patient Prefer Adherence 2013; 19: 329-36.
24. 24. Bender BG, Pedan A, Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. J Allergy Clin Immunol 2006; 118: 899-904.
25. 25. Apter JA, Boston RC, George M, Norfleet L, Tenhave T, Coyne JC, Birck K, Reisine ST, Cucchiara AJ, Feldman HI. Modifiable barriers to adherence to inhaled steroids among adults with asthma: It’s not just black and white. J Allergy Clin Immunol 2003; 111: 1219-26.