Dr William "Andy" Nish on Increasing Medication Adherence for Asthma Therapies

Using the argument that regularly taking medication is a great way to earn parents' trust is a great tactic to encourage children and teenagers to remain adherent to their asthma therapies, said William "Andy" Nish, MD, an allergist and immunologist in Georgia.

William "Andy" Nish, MD, is a medical director and allergist and immunologist at Northeast Georgia Physicians Group in Gainesville, Georgia.


If patients do have issues with medication adherence, for any reason, what are some strategies that clinicians and their staff can use to try to help them?

Nish: Well, first, it's important that we, as physicians, explain to them how important this is to do because sometimes they don't really get that it's an important thing. So, up to 25% of people with asthma don't really experience it, they're having trouble with their breathing. And so, sometimes I will use the analogy of [people with diabetes], they don't realize how much trouble they're having until they check their glucose. Or somebody with high blood pressure doesn't realize how high their blood pressure is until they check their blood pressure. And so, we'll do their breathing tests, and they're really not good, and so, I'll say, "Hey, you know, I'm glad you feel well and yeah, if we do the test that measures how your breathing is doing, it tells us well, things really aren't so good and you're in danger of short-term being in the [emergency department] or being in a hospital." People still die from asthma in this country, 3500 people every year still die from asthma in the United States.

And so, we can't just take it lightly. It's not something that is just a nuisance, it's something that can be deadly. And then I tell them that long-term they're at risk of what's called remodelling, where your lungs have changes that are not fixable. And so, if you don't take care of yourself, currently, you're in danger for short term problems and also long term problems. So, I try to explain to them there's a reason we're doing this. And it's important. It's not just because I'm telling you to do it, it's for your health, and then try to make it easy. Certainly, some of the medicine we used to have were 4 times a day. Well, 4 times a day is like almost impossible. Two times a day shouldn't be that hard but then, fortunately, we have now once-a-day medicines like Breo [fluticasone furoate and vilanterol], Trelegy [fluticasone furoate, umeclidinium, and vilanterol], Arnuity [fluticasone furoate], and Alvesco [ciclesonide]. So, if you can't take it once-a-day, I don't know how much easier to make it. You can do things like set an alarm on your phone to take the medicine, put the medicine by your toothbrush, or deodorant, or something that you hopefully use regularly. Put it on the dinner table, put a calendar up and put an X on the calendar once you take the medicine.

Particularly kids and particularly teenagers are just the worst about taking the medicine. They don't want to be different. They don't want to have to do something their friends don't do. They don't want to do something that marks them as somehow different or odd. And it's not a priority for them. So, I tell teenagers, I say, "Look, you can earn your parents trust by taking the medicine." I say, "If you don't take your medicine while you're sitting there right in front of your parents and they can sit there and see what you're doing, how do they know you're going to do what you're supposed to be doing when you're out there with your friends? So, you can earn their trust by doing what you're supposed to do when you're right there in front of them and then maybe they'll trust you more to do what you're supposed to do when you're out there in the world."

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