RT Journal Article SR Electronic T1 Medication adherence and risk of severe exacerbations in asthma- A systematic review JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP P722 VO 42 IS Suppl 57 A1 Marjolein Engelkes A1 Hettie Janssens A1 Johan de Jongste A1 Miriam Sturkenboom A1 Katia Verhamme YR 2013 UL http://erj.ersjournals.com/content/42/Suppl_57/P722.abstract AB Asthma is a chronic inflammatory disease with a high prevalence worldwide. Asthma therapy includes drugs for asthma control and for quick relief. Especially for controller therapy, adherence is crucial to reduce the risk of exacerbations.Objective: To systematically review the association between adherence to asthma controller therapy and risk of severe exacerbations in children and adults.Methods: Systematic literature search of the PUBMED, EMBASE and Web of Knowledge databases from inception until 2013. Studies were included if there were empirical data about adherence, exacerbations and their association. Quality was assessed using a modified version of the Newcastle Ottawa Scale.Results: The search yielded 2956 unique publications. 33 articles met the inclusion criteria and underwent data extraction and quality scoring. 24 studies used objective measures and 9 used subjective measures to assess adherence. Included studies were published between 1993-2013. Sample sizes ranged from 24 to 97,743 individuals. High levels of heterogeneity across studies in adherence and exacerbation measurements, designs and strategies for evaluating the association, precluded a formal meta-analysis. Although effect measures varied widely and were inconsistent, in high quality studies better adherence tended to be associated with fewer exacerbations.Conclusions: Based on current literature, it is difficult to make strong statements on adherence to asthma therapy and risk of exacerbations. New, well designed prospective studies, using standardized definitions for adherence and treatment outcomes are needed. This is essential to disentangle their association, and to ultimately increase patient adherence.