Adherence

If asthma symptom control is poor or exacerbations continue to occur despite adequate treatment, consider poor inhaler technique and adherence. Adherence often worsens with improvement in symptoms.

Strategies that may improve adherence include:

• using an open, nonjudgmental approach when discussing adherence
• allowing the patient to express their concerns about drugs and devices (including about adverse effects), and addressing these concerns
• improving the patient’s understanding of asthma management over time; comprehensive information given at one visit is often not well retained
• explaining the goals of treatment and aligning them with the patient’s goals
• keeping treatment simple (eg using once- or twice-daily dosing if possible, using as few devices as possible)
• identifying useful daily associations (eg mealtimes, brushing teeth) or medication reminders (eg on phones or electronic devices) to improve adherence
• enlisting support of the patient’s family and peers
• keeping in touch and using reminder letters or phone calls.