Adherence to Inhaled Corticosteroids for Asthma Suboptimal in Young Adults

Asthma inhaler
Asthma inhaler
Findings from a meta-analysis showed that adherence to inhaled corticosteroids for asthma control was a significant problem in patients with a mean age between 15 and 30 years.

Approximately one-quarter of adolescents and young adults with asthma adhere to inhaled corticosteroid (ICS) medications, with a higher adherence prevalence observed in individuals younger than 18 years of age, according to a study published in the Journal of Asthma.

A systematic review and meta-analysis were performed using studies that included patients with asthma between the mean ages of 15 and 30 years. Studies were eligible for inclusion if they reported the prevalence and/or predictors of ICS adherence. A total of 29 studies with a pooled cohort of 187,401 adolescents and young adults (mean age, 23.30 years) were included in the analysis.

To assess the prevalence of adherence in this population, the investigators performed a meta-analysis of 16 studies, since 12 of the studies reporting adherence did not provide the percentage of the sample defined as adherent and thus were not included in the meta-analysis.

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Overall, the pooled prevalence of adherence was 28% (95% CI, 20%-38%; κ = 16; I2 = 100%; P <.001). The pooled estimated prevalence of adherence was highest in studies that featured a mean age <18 years (36%; 95% CI, 36%-37%; κ = 4; I2= 0%; P =.13) compared with studies that featured a mean age of 18 to 30 years (25%; 95% CI, 16%-37%; κ = 12; I2 = 99%; P <.01). Additionally, self-reported measures of adherence were associated with higher estimates of adherence (35%; 95% CI, 28%-42%; κ = 10; I2 = 95%; P <.01) compared with pharmacy refill data (20%; 95% CI, 9%-38%; κ = 6; I2 = 95%; P <.01).

Predictors of adherence, according to a narrative review, included personality, illness perceptions, and treatment beliefs.

Limitations of this meta-analysis were the inclusion of studies conducted in predominantly high-income countries, lack of data onicsadherence predictors in young adults, and as the inclusion of mostly observational studies.

According to the researchers, these findings emphasize that a substantial proportion of patients with asthma are “not benefiting from effective asthma treatment in early adulthood, leading to a high prevalence of uncontrolled asthma.”


Murphy J, McSharry J, Hynes L, Matthews S, Van Rhoon L, Molloy GJ. Prevalence and predictors of adherence to inhaled corticosteroids in young adults (15-30 years) with asthma: a systematic review and meta-analysis [published online January 21, 2020]. J Asthma. doi:10.1080/02770903.2020.1711916