Adherence — What's the Fuss?

What is Adherence?

Kate is a middle-aged woman with asthma. She developed the disease in her adult life. Pretty often, Kate forgets to take her treatment medication of inhaled corticosteroids. Instead, she has begun to use a reliever inhaler for instant relief when her symptoms get worse. Kate is feeling somewhat tired and has an occasional cough, but has gotten used to the symptoms. But after she experiences an asthma exacerbation and the reliever doesn’t help, she is taken to the hospital for acute treatment. 

If Kate had taken her medication as prescribed, the emergency trip to the hospital might well have been avoided. This Kate example, albeit fictional, is a pretty typical one. In chronoic respiratory conditions,  low commitment to medical treatment — poor adherence — is the greatest challenge in treating the illnesses effectively. 

Estimates regarding adherence rates vary, but they have been found to be as low as 22% in asthma patients, which is a staggeringly small percentage. And even at their best (63%), they  leave room for improvement. The percentages of COPD patients adhering to treatment have been found to be similar, ranging from 22% to 78%.

The Challenges of Committing to Treatment 

So, why is it so difficult to commit to treatment? According to GINA (Global Initiative for Asthma), the reasons are three-fold. First, unintentional factors influence adherence, such as forgetfulness or misunderstandings. Second, there are intentional factors: treatment is seen as unnecessary or there is a fear of stigmatisation, for example. 

In asthma and COPD treatment, the third group — medication or regimen factors — also plays an important role. Difficulties using an inhaler, or administering the medicine incorrectly, is a particular challenge. Some need to use several inhalers, sometimes many times a day, which can feel burdensome. 

Added to that is the finding that in chronic conditions, commitment to ongoing medication tends to falter. Lung health also deteriorates slowly. If you neglect to take your daily medication, you don’t experience its repercussions right away, and often get used to symptoms creeping in. But by relying on reliever medication for immediate relief, you are not treating the basic condition. 

Big Healthcare and Societal Costs

There is good reason to tackle poor adherence. According to studies, higher adherence is related to several positive health outcomes. It increases quality of life and productivity, improves disease control and reduces mortality. In COPD, optimal treatment slows the progression of the disease.

Poor asthma and COPD treatment adherence places a considerable financial burden on healthcare and the workplace. Asthma is the leading cause of school absences, emergency visits and hospitalisations in Europe. Lost working days and other activity make up for more than half (62.5%) of the total costs caused by asthma. The annual costs of healthcare and lost productivity due to COPD are estimated at €48.4 billion and those due to asthma at €33.9 billion within the EU alone.

Much of these costs could be deterred by better adherence. In asthmatics, 24% of exacerbations and the majority (60%) of asthma-related hospitalizations could be attributed to poor adherence. 

Follow-up Made Easy

How should we tackle poor adherence then? And how could remote monitoring improve the situation? Let’s bring up our Kate example once more. At the hospital, Kate agrees to a new treatment plan with her nurse and pulmonologist. She is given a KAMU home-use spirometer and a KAMU Asthma application for follow-up, and is instructed in their use.

At home, Kate sets daily reminders for her medication intake and spirometer tests. The results are quick to log in the app. She also saves her personal triggers in the app: cats and pollen. Besides this, she starts to plan her days smartly, following air quality forecasts shown in the app.

Kate’s improvement is monitored based on the data she has agreed to share with her doctor and nurse. The visualised charts demonstrate which factors impact her lung health. To Kate, the data is particularly clarifying, because it shows her how much her condition improves when she sticks to treatment. To the doctor, the data also helps determine whether there is a need to readdress Kate’s treatment plan. After some weeks, Kate’s cough is gone and she is less tired. And by following her own measurement results, she can react fast and up her dosage, as she has been instructed. 

Self-monitoring Empowers the Patient

The key to good adherence is sticking to treatment even when you are feeling good. Fortunately, there are solutions that support good adherence. Studies have consistently shown that patients who actively monitor their own conditions have better outcomes than those who don’t. The KAMU service is based on self-monitoring, made as easy as possible. It can also improve patients’ communication with healthcare professionals, and provides solid data to inform decisions. 

Self-monitoring is about empowering the patient to take the treatment of their illness in their own hands — it’s about being a subject, instead of an object of care. With KAMU, patients become their own experts in their disease management. In this way, they are more motivated to maintain the good results and feel their best.