Assessment of adherence to inhalers in asthmatics

Background: Asthma is a chronic disorder which affects the quality of life and causes significant morbidity when uncontrolled. Good control of asthma has now become possible with the advent of preventive inhalers and well-established guidelines. But despite all this, a significant number of patients all over the world still has uncontrolled asthma. Suboptimal asthma control is largely due to poor adherence to inhalers and incorrect inhaler techniques. There are very few studies conducted in India to assess the adherence to inhalers using a validated and easily reproducible questionnaire which simultaneously assess adherence as well as psychometric factors associated with non-adherence. Materials and Methods: In this cross-sectional observational single centre study conducted in a tertiary centre in Kerala, India we have assessed the level of adherence to inhalers among 111 patients attending Pulmonology outpatient department between November 2019 to January 2020 using a well-validated Test of adherence to inhalers (TAI) questionnaire. Results: The result showed that good adherence to inhaler was seen only in 28.8%of patients, intermediate adherence in 27% and poor adherence in 45%. Overall, 67% of subjects were women, majority of subjects were older than 20yrs. of age and most of them had education of at least tenth standard and all were literate. Conclusion: Adherence to inhalers is low among asthmatics. There was a significant relation between TAI score and asthma control test score (ACT). The pattern of adherence was mostly erratic and ignorant types and good inhaler technique were seen in only 22.5%