Good adherence to treatment for severe asthma was reported by 35% of patients, either via self-report or direct measurements, but the agreement between the 2 methods was poor, according to the results of a recent study published in the journal CHEST.

Researchers enrolled patients with severe asthma in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes) study who were prescribed daily oral corticosteroids to measure adherence via 2 methods: urine analysis and the Medication Adherence Report Scale (MARS) questionnaire. Adherence rates between the 2 methods were compared to determine differences between self-reporting and direct measurements, and whether suboptimal adherence is associated with disease activity.

Among the 166 participants included in the study, the average age was 54.2 years and 58% were women. When adherence to oral corticosteroids were analyzed, 37% reported suboptimal adherence in the MARS survey, while 43% had suboptimal adherence in the urine analysis. Good adherence by both methods was detected in 35% of participants. However, adherence detection did not match between methods in 53%. Patients who self-reported high adherence had better asthma control and quality of life, whereas patients who were directly measured had lower blood eosinophil counts.

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“Low adherence is a common problem in severe asthma, whether measured directly or self-reported,” the study authors wrote. “We report poor agreement between the two methods suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Alahmadi FH, Simpson AJ, Gomez C, et al; on behalf of the U-BIOPRED Study Group. Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort. CHEST. February 18, 2021. doi:10.1016/j.chest.2021.02.023