Patient and regimen-related factors that influence compliance with asthma therapy

Patient adherence can be considered as the interface between effective therapy and effective disease management. However, despite the vast improvement in asthma therapy over the past 25 yrs there has not been a corresponding reduction in asthma morbidity, which may be partly the result of clinicians paying insufficient attention to patient compliance. Both patients and healthcare professionals may have incorrect perceptions of compliance in relation to actual compliance. Most patients tend to overestimate compliance when they self-report. Some clinical trial patients 'dump' their medications in an attempt to please their clinicians and meet social expectations. Healthcare professionals, therefore, need to be aware of the variety of issues that may influence compliance for all patients. The reasons for noncompliance are many and varied, and include erratic compliance, unwitting noncompliance, and intentional or 'intelligent' noncompliance. Different patient populations, such as the elderly, paediatric patients, or those in a low socioeconomic group may have particular risk factors for noncompliance. Factors such as regimen complexity, administration route and patient beliefs about therapy can influence patient compliance. Promotion of compliance will require improved doctor-patient communication, education, tailoring of therapy, and possible novel strategies such as compliance monitoring and feedback.