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Published ahead of print on September 16, 2004, doi:10.1164/rccm.200403-409OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 12, December 2004, 1281-1285

A more recent version of this article appeared on December 15, 2004
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Submitted on March 25, 2004
Accepted on September 15, 2004

Corticosteroid Use after Hospital Discharge among High-risk Adults with Asthma

Jerry A Krishnan1*, Kristin A Riekert1, Jonathan V McCoy2, Dana Y Stewart3, Spencer Schmidt1, Arjun Chanmugam4, Peter Hill4, and Cynthia S Rand1

1 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, 2 Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA, 3 Department of Pediatrics, Wright State University, Dayton, OH, USA, 4 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA

* To whom correspondence should be addressed. E-mail: jkrishnan{at}jhmi.edu.

Despite the efficacy of corticosteroid therapy, patients hospitalized for asthma exacerbations are at high risk for re-exacerbation and death following discharge. The objective of this prospective cohort study was to evaluate adherence to inhaled and oral corticosteroids after discharge in adults hospitalized for asthma exacerbations. Inhaled and oral corticosteroids were equipped with electronic medication monitors and provided at discharge. Adherence (use/prescribed use X 100%) was measured by self-report and canister weight (inhaled corticosteroids), pill count (oral corticosteroids), and electronic medication monitors (both inhaled and oral corticosteroids) 2 weeks after discharge. Poor adherence was defined as adherence <50%. The Asthma Control Questionnaire was used to assess symptom control. Sixty patients were enrolled (age 42.2 years, 98.3% African-American, 65.0% female, 46.7% with history of near-fatal asthma). Electronically measured adherence to both corticosteroids dropped to about 50% within 7 days of discharge. Poor adherence to both corticosteroids predicted significantly worse symptom control (p=0.04). Self-report, canister weight, and pill count all had low sensitivity (29.2%, 65.0%, and 7.7%, respectively) for detecting poor adherence. We conclude that adherence to inhaled and oral corticosteroids deteriorates within days of hospital discharge but may not be recognized in a substantial proportion of patients.
Key words: Asthma, exacerbation, severe asthma, adherence, hospitalization




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