Adherence to Inhaled Corticosteroids for Asthma Suboptimal in Young Adults

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.

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.”

Reference

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