Medication use, adherence and asthma control in ambulatory patients attending the chest clinic of a tertiary facility in southwestern Nigeria

Background: Asthma is a chronic illness with rising prevalence and socio-economic burden in resourcepoor countries. Better understanding of its management and periodic assessment of therapy adherence and asthma control is therefore essential.

Objectives: To evaluate treatment recommendations, medication adherence and asthma control among cohort of ambulatory asthmatic patients.

Methods: A cross-sectional questionnaire-guided interview among asthma patients attending chest clinic of University College Hospital, Ibadan, southwestern Nigeria, between March and May 2015, and a review of patients' medical records for asthma-specific clinical parameters. Socio-demographic information, allergen and anti-asthmatic therapies were explored. Morisky Adherence Predictor Scale and Royal College of Physicians Three Questions were used to evaluate adherence and asthma control, respectively. Data were summarised using descriptive statistics. Chi-square and Mann-Whitney U test were used for categorical and ranked variables, respectively at p<0.05.

Results: Majority, 59 (67.8%) were using fixed-dose combination of inhaled corticosteroids and long-acting β2 agonist plus add-on inhaled short-acting bronchodilator. Twenty-four percent were adjudged adherent. Intentional non-adherence was most common, 55 (64.0%). Forgetfulness (40; 46.0%) was the most common unintentional non-adherence. Forty (46.0%) had good asthma control compared to 86(98.9%) who perceived their asthma to be well-controlled. Summarily, dust (55; 54.4%) was the most commonly cited allergen.

Conclusions: Medication adherence and asthma control among studied population were suboptimal. Frequent use of add-on inhaled short-acting bronchodilator with controller medication partly suggest continuing experience of in-between acute exacerbations by patients. Thus, a need for caregivers to  consistently ensure therapy adherence at every patient-provider encounter, so as to guarantee improved asthma control.