Chapter 12 -Adherence to Aerosol Medication

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Chapter 12 Adherence to Aerosol Medication by Robert W. Morton, MB, ChB and Mark L. Everard, MB, ChB, DM

There are a variety of methods for recording adherence rates to inhaled medication, with differing objectivity and validity. When objective methods of measurement are used, adherence rates are suboptimal for all major chronic respiratory diseases and all patient groups. Consequences of suboptimal adherence include poor lung function and poor disease control with increased exacerbations. This results in increased healthcare utilization and associated cost. Intentional barriers to adherence are based on negative illness and healthcare perceptions, or medication beliefs. Unintentional barriers include forgetting doses and work or social time constraints. An element of suboptimal adherence is also due to poor device technique, although the extent of this effect is difficult to quantify. Educational interventions alone to increase adherence rates have had limited success, although combined interventions with a behavioral aspect have had more promising results. Objective adherence feedback and direct reminders such as text messages or alarms have been shown to increase adherence levels, although an associated improvement in disease control has been more difficult to establish.

Key Words: Monitoring, inhalers, adaptive aerosol delivery, electronic monitoring, compliance, dose counters