Factors Influencing Adherence in Outpatients Using Beclomethasone Dipropionate Inhaler for Bronchial Asthma
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We investigated the factors influencing non-adherence in patients using beclomethasone dipropionate(BDP)to evaluate the relationship between asthma control and adherence.Forty-seven adult asthmatic outpatients continuously using a BDP inhaler for 10-12 months in 1999 at Niigata University Hospital were recruited as subjects for this study.BDP adherence was defined as the ratio of"measured dose"/"expected dose".Asthma control was estimated from peak expiratory flow(PEF).Median adherence was 0.73(interquartile range(25%-75%),0.49-0.90)(0.74±0.32 ; means±SD),and good adherence (1.25>adherence≥0.7)was 46.8%.Poor adherence(<0.7)was noted in 46.8% of the patients.We found that higher doses of BDP in the inhaler,lower age at time of onset age of asthma,and longer duration of asthma were associated with poor adherence.Data for individual patients were plotted as PEF vs.adherence relationship and divided into four zones as follows :(A)higher adherence with poor control,(B)lower adherence with poor control,(C)higher adherence with good control,and(D)lower adherence with good control.Medication for the A and D zones was assumed to be inappropriate,and in need of improvement.We considered that asthma control in the B zone could be improved by patient education and appropriate pharmaceutical care.In the present study,we assessed the adherence of outpatients using a steroid inhaler(BDP)for the first time in Japan and developed a method to evaluate the adequacy of asthma treatment based on adherence zone vs.%PEF relationship.
- 日本医療薬学会の論文
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