COMPLIANCE IN ASTHMA

Compliance in antiasthmatic, especially antiinflammatory therapy is ge nerally critical. Despite the knowledge on hundreds of documented comp liance correlates, the understanding of the process character of treat ment motivation and compliance requires further clarification. Within the context of the patient's coping with asthma, the paper outlines pr ototypical feedback loops leading to stable versus insufficient compli ance patterns during the course of the chronic disease. Compliance dif ficulties may be part of the following vicious circle: a high severity of disease in the individual implies a broad array of somatic and psy chosocial stressors which may intensify experiences of threat and help lessness, especially in the case of insufficient coping resources. Cop ing behavior then tends to be occupied by emotion regulation instead o f problem solving which results in continuous deficits in asthma manag ement. The lack of self-efficacy experiences further reduces treatment motivation and adherence behavior which, in turn, increases the risk of additional exacerbations and, therefore, the severity of asthma in the patient. The worsened prognosis finally enlarges the patient's str ess level which again may impede succeesful coping and adequate compli ance. As a counterpart, a positive circle of ongoing compliance stabil ization is outlined as well.