PT  - JOURNAL ARTICLE
AU  - Iida Vähätalo
AU  - Hannu Kankaanranta
AU  - Leena E. Tuomisto
AU  - Onni Niemelä
AU  - Lauri Lehtimäki
AU  - Pinja Ilmarinen
TI  - Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma
AID  - 10.1183/23120541.00715-2020
DP  - 2021 Jan 01
TA  - ERJ Open Research
PG  - 00715-2020
VI  - 7
IP  - 1
4099  - http://openres.ersjournals.com/content/7/1/00715-2020.short
4100  - http://openres.ersjournals.com/content/7/1/00715-2020.full
SO  - erjor2021 Jan 01; 7
AB  - Background In short-term studies, poor adherence to inhaled corticosteroids (ICS) has been associated with worse asthma control, but the association of long-term adherence and disease control remains unclear.Objective To assess the relationship between 12-year adherence to ICS and asthma control in patients with adult-onset asthma.Methods As part of the Seinäjoki Adult Asthma Study, 181 patients with clinically confirmed new-onset adult asthma and regular ICS medication were followed-up for 12 years. Adherence (%) to ICS was assessed individually ((µg dispensed/µg prescribed)×100) during the follow-up. Asthma control was evaluated after 12 years of treatment according to the Global Initiative for Asthma 2010 guideline.Results Asthma was controlled in 31% and not controlled (partly controlled or uncontrolled) in 69% of the patients. Patients with not-controlled asthma were more often male, older, nonatopic and used higher doses of ICS than those with controlled disease. The mean±sd 12-year adherence to ICS was 63±38% in patients with controlled asthma and 76±40% in patients with not-controlled disease (p=0.042). Among patients with not-controlled asthma, those with lower 12-year adherence (<80%) had more rapid decline in forced expiratory volume in 1 s (−47 mL·year−1) compared to patients with better adherence (≥80%) (−40 mL·year−1) (p=0.024). In contrast, this relationship was not seen in patients with controlled asthma.Conclusions In adult-onset asthma, patients with not-controlled disease showed better 12-year adherence to ICS treatment than those with controlled asthma. In not-controlled disease, adherence <80% was associated with more rapid lung function decline, underscoring the importance of early recognition of such patients in routine clinical practice.Patients with not-controlled asthma and poor adherence show increased FEV1 decline. Special emphasis should be placed on ICS adherence in subjects who do not have controlled asthma, as they seem to be at higher risk of developing fixed airway obstruction. https://bit.ly/2LOXL4f