Assessment of inhaler adherence and factors associated with non adherence among asthmatic patients at Muhimbili National Hospital

Abstract

ABSTRACT Background: Bronchial asthma is a chronic inflammatory disorder of the airways characterized by variable and frequent symptoms of airflow obstruction, bronchial hyper responsiveness, and an underlying inflammation. Asthma is characterized by repeated attacks of shortness of breath and wheezing, that vary in severity and frequency from person to person. The most effective long-term controller medicines available are inhaled corticosteroids. Despite the availability of highly effective pharmacotherapy, non adherence with this treatment is very common with rate ranging from 30% to 70%. Non adherence however is associated with poor symptom control, higher health care utilization and healthcare cost and reduction in health related quality of life. In Tanzania, prevalence of inhaler adherence as well as factors associated with non-adherence to inhaler medications is lacking. There is a need to address the burden of inhaler non-adherence and provide recommendations in order to improve the quality of asthma care at MNH and in Tanzania as whole. Objective: To assess inhaler adherence level and determine factors for non-adherence among asthmatics at Muhimbili National Hospital pulmonology clinic. Methodology: A cross-sectional hospital-based study was conducted at Muhimbili National Hospital. Structured Questionnaires were used to obtain patients’ demographic, clinical and socioeconomic factors. Medication adherence was measured using a self report standard Test of Adherence to Inhalers (TAI) questionnaire and asthma control was assessed using an Asthma Control Test (ACT). Data was analyzed using SPSS statistical software version 23. Summary statistics were reported as frequencies with percentages. Associations between categorical variables were analyzed using the chi-square test. Multivariate regression was applied to determine predictors of inhaler non-adherence. A P < 0.05 value was considered as statistically significant. Results: A total of 385 asthma patients were enrolled in the study. 179 (46.5%) were male and 206 (53.5%) were female. A large proportion of participants (60.3%) were non adherent to inhalational medications. Lack of health insurance, fear of medication side xii effects, being too busy, having alternative medication for asthma management and incorrect inhaler technique were significantly associated with non-adherence. Conclusion: The magnitude of inhaler non-adherence is very high. To improve adherence therapeutic decisions should be discussed with the patient taking into consideration their individual factors, socio-economic and health system factors. Interventions such as patients’ assessment on their inhaler technique, regular and repeated demonstrations of inhaler use may help to improve and master the inhaler. Medication cost and insurance coverage are not easy to change; however patients should be encouraged whenever possible to enroll themselves to health insurance funds so as to cut down out of the pocket medication cost. On the other hand, the government should make sure that the inhalers are available throughout the country in affordable price so that all patients can access it.