COMPLIANCE WITH INHALED MEDICATION AND SELF-TREATMENT GUIDELINES FOLLOWING A SELF-MANAGEMENT PROGRAM IN ADULT ASTHMATICS

Two of the principal components of self-management are compliance with medication and adherence to self-treatment guidelines, The aim of thi s study was to evaluate compliance objectively, Twenty two adult asthm atics attended a self-management programme. During a 2 week run-in per iod, compliance with inhaled steroids and peak expiratory now (PEF) we re electronically-registered. For PEF this resulted in a personal best value (PBV). Subsequently, patients attended four educational group s essions, During the four weeks of follow-up, patients were instructed to measure their PEF on a fixed day of the week and when they experien ced an increase in symptoms, If PEF fell below 80% of PBV, patients ha d to double their use of inhaled steroids; if PEF fell below 60%, they had to start a short course of oral steroids, During run-in, mean com pliance was 83% and compliance per patient varied from 6 to 106%. Duri ng follow-up, on days without exacerbation, compliance with inhaled st eroids increased by 12% (95% confidence interval (95% CI) 3-21%) compa red to run-in, ranging 21-200%. On days when patients should have doub led their inhaled steroids, compliance decreased by 28% (95% CI -39 to -17), and compliance ranged 46-94%. Of the 10 patients who should hav e doubled their medication, only three did so, whilst four increased t he use of inhaled steroids but only by one or two puffs; three patient s did not alter their behaviour, In five patients (24%) PEF fell below 60% of their PBV, after which four started prednisolone (self-report) , In conclusion, even after a formal self-management programme, patien ts with asthma comply only partially to self-treatment guidelines, Mos t are willing to increase, but not double, their inhaled steroids, Thi s suggests that more emphasis is needed to reassure patients about the safety of inhaled steroids.