Embarrassment Contributes to Poor Asthma Treatment Adherence, Study Finds

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Despite there being effective therapies, asthma is commonly poorly controlled. Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence to asthma medication is necessary for designing adherence interventions for patients.

Asthma is commonly poorly controlled due to nonadherence to asthma treatment. A recent study, which evaluated patients’ perceptions of their inhaled asthma treatment, found that acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is necessary for designing adherence interventions for patients.

The study involved searches of electronic databases, including The Cochrane Library, MEDLINE, EMBASE and PsycINFO, for predetermined search terms were used to find relevant studies. Two researchers then used the Rayyan web app to screen titles and abstracts and to extract data in relation to psychological components, such as beliefs and attitudes about medicines and adherence.

“Effective pharmacological therapies exist, of which inhaled corticosteroids (ICS) are the mainstay of treatment preventing asthma symptoms, exacerbations and hospitalisations. Despite the effectiveness of current asthma treatments, nonadherence to ICS remains a significant problem,” explained the authors. “Although an 80% adherence rate with ICS has been suggested as the minimum acceptable level of adherence for achieving good asthma control, reported ICS adherence rates range from 30 to 70% in the literature.”


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In total, 36 papers met the inclusion criteria of the study. The main findings of the review were categorized as:

  • Perceived need for treatment—The 12 studies that used the Beliefs about Medicines Questionnaire to measure patients’ perceived need for treatment found that patients’ beliefs about the need for treatment were associated with their adherence.
  • Concerns about treatment—58% were concerned about immediate and long-term side effects, 19% were worried about safety, and 31% were concerned about the potential addiction to the asthma medication.
  • Perceived Social Stigma—22% of the studies found that embarrassment contributed to poor adherence.

“The results indicate that adherence to asthma medication may be increased by addressing doubts about the necessity for medicines, as well as concerns about adverse effects of inhaled medication for asthma. In addition, the studies included in the review showed that patients also experience other barriers to adherence to inhaled medicines, such as social stigma and embarrassment,” the authors concluded. “These findings allow us to better understand the reasons why patients may not adhere to inhaled medication in asthma, the experiences they face, and how they may manage these experiences.”

The researchers emphasized the need for future research that focuses on further establishing the relationship between treatment perceptions and adherence behavior by exploring interventions that address perceptual barriers to adherence while considering how patients can overcome their negative perceptions.


Lycett H, Wildman E, Raebel EM, Sherlock J-P, Kenny T, Chan AHY. Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence. Respir Med. 2018;141:180-189. doi: 10.1016/j.rmed.2018.06.032.