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Difficult asthma may be due to difficult patients

October 24, 2009 |  6:00 am

Asthma can be a tough condition to treat in certain patients. But according to a new study, the difficulty may sometimes lie with the patients, not the medication.

The study, published in the Nov. 1 issue of the American Journal of Respiratory and Critical Care Medicine, found that people don't always adhere to the prescribed dosages for inhaled and oral asthma medication, even when they say they do. Researchers from Belfast City Hospital and Queen's University Belfast in Northern Ireland analyzed data on 182 people who were referred to a clinic specializing in dealing with difficult asthma cases. None of the participants were suspected of not complying with their doctors' prescriptions, and none said they were noncompliant about their prescriptions during their first visit to the clinic.

Researchers looked at physician prescriptions for a six-month period and compared it to the patients' refill rates. They also checked blood plasma prednisolone and cortisol levels to see if the patients were complying with their doctors' orders and taking their oral medications as prescribed.

Not all were. Only 35% filled less than half of their inhaled combination therapy, and 21% filled more than what was prescribed. A little less than half filled between half and all their prescribed medication.

After examining levels of prednisolone and cortisol in the blood, researchers determined that 45% were not taking prescribed levels of their oral medications. Most admitted as much in follow-up conversations with the researchers. Women were less compliant than men, which researchers believe needs further study.

In a news release, study co-author Dr. Liam Heaney of Belfast City Hospital said, "Of these patients who were referred for assessment and treatment of difficult asthma, many are actually not taking their treatment as prescribed, which would suggest an important first course of action in assessing difficult asthma may actually be verifying the patient's adherence to his or her treatment protocol. Determining whether the patient is taking medications as prescribed is of utmost importance before moving to more aggressive and expensive treatments."

-- Jeannine Stein

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