Asthma treatment and noncompliance.

RATIONALE: Noncompliance with asthma treatments is a common cause of hospitalization. Currently, physicians in the emergency department can only diagnose noncompliance with asthma therapy by asking patients if they have taken their medication (i.e., the HONOR SYSTEM). Patients frequently "overstate" their compliance and subsequently receive unnecessary supplemental medication (p.o. corticosteroid) as well as hospitalization. However, because their noncompliant behavior goes unrecognized, these individuals are at risk for recurrent emergency care and death. It is for these reasons that drug monitoring to identify compliance status should be available in the emergency department and in specialty clinics that care for chronic asthmatics. RECOMMENDATIONS FOR ACTION: 1) Develop drug monitoring systems and make them available. There are two electronic medication-monitoring devices with microprocessor technology available for metered-dose inhalers. These devices need further improvement in design, at a lower cost. Assays have been developed for oral and injectable medications recently approved by the FDA. These assays need to become commercially available. 2) Train health care providers to improve patient compliance. As noncompliance becomes more recognized, as a result of drug monitoring, educational and behavioral programs to improve compliance with treatment will need to be developed and disseminated.