Influence of patients' adherence to medication, patient background and physicians' compliance to the guidelines on asthma control.

This study conducted a thorough examination on the associations among several factors of asthma therapy, i.e., physicians' compliance with the guidelines, patients' adherence to medication, asthma symptom severity, asthma episodes, and patient background. Fifty outpatients treated continuously for asthma from October 2002 to October 2004 at Showa University Hospital were selected and their medical charts were surveyed. Physicians were recognized as noncompliant when their treatments included divergence from the Asthma Prevention and Management Guidelines. Patient adherence was evaluated as the ratio of the "measured (dispensed)" doses divided by the "expected (prescribed)" doses. The inhaled corticosteroids adherence and the ratio of the asthma-related emergency department visits of the patients with a family asthma medical history were significantly higher (p=0.034) and lower (p=0.043), respectively, than those without this medical history. This may indicate the necessity of education for patients with no family history of asthma. A significant correlation between the mean patients' adherence and the asthma symptom severity at the end of surveillance was found (p=0.010), suggesting the importance of patient adherence in asthma control. The asthma symptom severity in the noncompliant group at the beginning of surveillance was significantly worse (p=0.016), suggesting that physician compliance was low when the asthma symptom severity was poor. Based on the above findings, we proposed a flow-chart, which includes the confirmation processes of patients' adherence to medication and physicians' compliance to guidelines, in order to better control asthma, while also taking their family medical history into account.