Methods: 420 adult asthma patients prescribed daily inhaled corticosteroids (ICS) were enrolled in a study to develop a brief patient-reported adherence tool, the Adult Asthma Adherence Questionnaire (AAAQ). Participants completed a mailed survey including a subset of 22 items from the AsthmaPACT, a 92-item survey that identifies multiple factors related to asthma patient self-reported non-adherence (SRNA) (JACI 2011;127:A564). Each item was scored using a 6-point Likert-type scale indicating degree of agreement. Factor analysis was performed to identify underlying constructs. Relationships of individual item scores to SRNA (difference between doses per day prescribed and doses actually taken) (t test) and number of ICS canisters dispensed in the prior year (r correlation) were evaluated.
Results: : Five factors emerged (need, adherence, side effects, cost, asthma impact), four of which included questions that significantly (p<0.01) related to SRNA and/or ICS. NEED:"I do not need the ICS" (SRNA and ICS); "I do not understand why I am taking ICS" (SRNA); "My MD starts strong medicine too soon" (ICS); "I do not need preventative treatment" (SRNA and ICS); "I prefer not to take regular medicines" (SRNA); ADHERENCE: "I follow my medication plan" (SRNA and ICS);I follow medication instructions for an attack (NSRA and ICS); "I forget at least one dose per day" (SRNA and ICS; "I avoid known allergens and irritants" (SRNA); SIDE EFFECTS: "My ICS causes side effects" (NSRA); COST: "My ICS costs too much" (ICS); I can't afford my ICS (ICS).
Conclusions: This research identified a preliminary set of items related to SRNA and ICS adherence that may form the basis of a tool to identify patients at risk for non-adherence and possible reasons for their non-adherence. The AAAQ may also be useful for targeting intervention strategies.