Factors influencing patient decisions about the use of asthma controller medication Bruce G. Bender, PhD*†; Aidan Long, MD‡; Bhash Parasuraman, PhD§; and Zung Vu Tran, PhD¶ Background: Patient nonadherence with asthma controller medication is pervasive and impedes successful adoption of national treatment guidelines. Objective: To survey adult patients with asthma about the factors influencing their decisions about when to use their asthma controller medications. Methods: Two hundred adults with asthma were randomly selected from a national database and were surveyed by telephone about medication use, barriers to adherence, and treatment preferences. Results: Adherence to daily controller medication in the group was generally well below the prescribed level despite the fact that many had relatively severe asthma and inadequately controlled symptoms. Thirty percent of the respondents indicated that they had been instructed by their physician to use their controller medication intermittently as guided by their symptoms. Most respondents expressed a desire to be more in control of their treatment and for that treatment to be more immediately effective and long-lasting but did not perceive inadequate information to be a barrier to adherence. Conclusion: These insights into patient perception and motivation suggest the importance of developing treatment plans that allow patients some degree of control over medication use. Ann Allergy Asthma Immunol. 2007;98:322–328. INTRODUCTION Adults with asthma are frequently nonadherent with control- ler medication. In a 2-year pharmacy database survey of 2,511 patients with asthma, patients on average filled less than half of the amount of controller medication necessary for daily treatment. 1 Poor adherence leads to poor asthma con- trol. 2–4 In a cohort of 405 adults with asthma from a large health maintenance organization, overall adherence to in- haled corticosteroids (ICSs) was approximately 50%. Lower adherence to ICSs was associated with increasing numbers of oral corticosteroid prescriptions filled, emergency department visits, and asthma-related hospitalizations. 2 Underuse of ICSs and the consequent poor asthma control are pervasive prob- lems in all patient groups, even after serious asthma exacer- bations. Patients who visited the emergency department for exacerbation of asthma increased medication adherence only temporarily before quickly returning to baseline rates. 3 Sim- ilarly, fewer than half of corticosteroid prescriptions were filled after children were hospitalized for asthma. 4 Strategies to improve medication adherence have largely been unsuccessful. Patient education, a component of suc- cessful asthma management that is emphasized in the Na- tional Heart, Lung, and Blood Institute’s Guidelines for the Diagnosis and Management of Asthma, 5 often results in little behavior change. The presumption that providing patients with information about their asthma will necessarily improve their adherence is not supported by research evidence. Knowledge about asthma and its treatment does not correlate well with adherence or treatment outcomes. 6 Numerous edu- cational and behavioral interventions have been designed to improve adherence and treatment outcomes, but few have been successful in changing patient behavior when tested in randomized trials. 7,8 Development of successful strategies to more effectively engage patients in asthma self-management requires better understanding of patients’ perspectives on their asthma and medications. Qualitative research exploring the personal be- liefs of patients is essential to identify the reasons, despite enormous collective efforts, asthma health care providers, educators, and behavioral scientists have not had a significant impact on the nonadherence challenge associated with asthma therapy. The present study was conducted to inquire directly of patients about how regularly they use their asthma con- troller medications, why they may be nonadherent, and what changes in their treatment management might result in in- creased adherence. MATERIALS AND METHODS Participants in the survey were recruited from a national database maintained by Jay Reckner and Associates of 6,200 households that had indicated willingness to participate in * Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado. † Department of Psychiatry, University of Colorado at Denver and Health Sciences Center, Denver, Colorado. ‡ Massachusetts General Hospital, Harvard Medical School, Boston, Mas- sachusetts. § Health Economics and Outcomes Research, AstraZeneca, Wilmington, Delaware. ¶ Department of Preventive Medicine and Biometrics, University of Colo- rado at Denver and Health Sciences Center, Denver, Colorado. This research was supported by AstraZeneca LP. Received for publication September 26, 2006. Received in revised form November 6, 2006. Accepted for publication December 23, 2006. 322 ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY