Abstract
Background Understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.
Methods We reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.
Results Of 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.
Conclusions Belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Busby has nothing to disclose.
Conflict of interest: Dr. MATTHEWS has nothing to disclose.
Conflict of interest: Dr. Chaudhuri reports grants, personal fees and non-financial support from AstraZeneca, personal fees from Glaxo Smithkline, personal fees and non-financial support from Chiesi, personal fees from Novartis, non-financial support from Napp Pharmaceuticals, outside the submitted work.
Conflict of interest: Dr. Pavord reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Aerocrine, personal fees from Almirall, personal fees from Novartis, personal fees from GlaxoSmithKline, personal fees from Genentech, personal fees from Regeneron, from Teva, from Chiesi, from Sanofi, from Circassia, from Knopp, grants from NIHR, outside the submitted work.
Conflict of interest: Dr. Hardman has nothing to disclose.
Conflict of interest: Dr. Arron reports In addition, Dr. Arron has a patent Diagnosis and treatments relating to Th2 inhibition (US 9,684,000 B2) issued, and a patent Diagnosis and treatments relating to Th2 inhibition (US 9,995,755 B2) issued and JRA is an employee of Genentech, Inc. and owns stocks/options in the Roche group.
Conflict of interest: Dr. Bradding reports grants from Genentech, other from Roche, other from Boehringer-Ingelheim, outside the submitted work.
Conflict of interest: Dr. Brightling reports grants and personal fees from GSK, grants and personal fees from AZ, grants and personal fees from Sanofi, grants and personal fees from Novartis, grants and personal fees from Chiesi, grants and personal fees from Genentech, grants and personal fees from Gossamer, grants and personal fees from Mologic, grants and personal fees from 4DPharma, outside the submitted work.
Conflict of interest: Dr. Choy reports and DFC is an employee of Genentech, Inc. and owns stocks/options in the Roche group.
Conflict of interest: Dr. Cowan has nothing to disclose.
Conflict of interest: Dr Djukanovic reports receiving fees for lectures at symposia organised by Novartis, AstraZeneca and TEVA, consultation for TEVA and Novartis as member of advisory boards, and participation in a scientific discussion about asthma organised by GlaxoSmithKline. He is a co-founder and current consultant, and has shares in Synairgen, a University of Southampton spin out company.
Conflict of interest: Dr. Hanratty has nothing to disclose.
Conflict of interest: Dr. Harrison reports grants, personal fees and non-financial support from AstraZeneca, grants and personal fees from GSK, personal fees from Vectura, personal fees from Synairgen, personal fees from Chiesi, outside the submitted work.
Conflict of interest: Dr. Holweg reports other from Genentech Inc., A member of the Roche Group, outside the submitted work.
Conflict of interest: Dr. Howarth reports employment by GSK.
Conflict of interest: Dr. Fowler reports personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GSK, personal fees from Novartis, personal fees from Teva, outside the submitted work.
Conflict of interest: Dr. Lordan has nothing to disclose.
Conflict of interest: Dr. Mansur reports personal fees, non-financial support and other from GSK, AZ, Novartis, Sanofi, Teva, others, outside the submitted work.
Conflict of interest: Dr. Menzies-Gow reports grants and personal fees from Astra Zeneca, personal fees from Novartis, personal fees from Glaxo SmithKline, personal fees and non-financial support from Teva, personal fees from Sanofi, personal fees from Vectura, personal fees and non-financial support from Boehringer Ingelheim, outside the submitted work.
Conflict of interest: Dr Niven has received lecture fees, advisory board activity and been supported to attend international meetings/conferences in the last 5 years by the following companies: AstraZeneca, Boehringer, Boston Scientific, Chiesi, Napp, Novartis, Teva.None of these have any relevance to the manuscript.Dr Niven own's no shares or stocks and is not personally or in any family way connected to any of the pharma companies.
Conflict of interest: Dr. Robinson has nothing to disclose.
Conflict of interest: Dr. Walker has nothing to disclose.
Conflict of interest: Dr. Woodcock reports personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Chiesi, other from Reacta Biotech, other from Axalbion, other from Medicines Evaluation Unit, outside the submitted work.
Conflict of interest: Dr. Heaney reports other from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceutical, personal fees from Novartis, Hoffman la Roche/Genentech Inc, Sanofi, Glaxo Smith Kline, Astra Zeneca, Teva, Theravance, Circassia, grants from Medimmune, Novartis UK, Roche/Genentech Inc, and Glaxo Smith Kline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, Medimmune, Glaxo Smith Kline, Aerocrine and Vitalograph, outside the submitted work.
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- Received March 15, 2021.
- Accepted August 24, 2021.
- Copyright ©The authors 2021.
This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.
