Optimizing Asthma Adherence: Inhaler Technique, Cost, and Team-Based Care

This episode, "Optimizing Asthma Adherence: Inhaler Technique, Cost, and Team-Based Care," has the panel dissecting why patients fall off therapy and what a coordinated care team can do about it.

Dr. Chupp explains that adherence begins with a strong doctor-patient relationship. The physician must take time to explain why adherence matters. That includes the harms of systemic steroids and exacerbations, lost work, and reduced quality of life.

Many patients assume lifelong breathlessness is simply how they must live. He believes a thoughtful explanation, something too rarely done, can change how patients feel about their medication. Sometimes that conversation alone is enough.

He also stresses inhaler technique, which requires trained nursing staff and physician reinforcement. Biologics offer further opportunities through autoinjection and ultra-long-acting agents that last 6 months. Favorable half-life and dosing characteristics can build adherence into the treatment itself. In his practice, pharmacists meet with patients virtually to check on biologic use and flag adherence concerns.

Dr. Wechsler adds that medications cannot work as shown in clinical trials if patients do not take them. Overall adherence is poor. Contributing factors include cost, forgetfulness, and a lack of understanding about why medications are needed or how often.

Dr. Mosnaim describes a frustrating cycle. She prescribes an inhaler on the patient's formulary, but the electronic record does not show the actual copay. She has written step-by-step protocols for every inhaler device on the market and trained her staff to teach each one.

Then the patient reaches the pharmacy and finds the copay unaffordable. If motivated, they call back, and she prescribes an alternative they were never taught to use. Poor technique means the drug may never reach the lungs.

She also sees widespread fear of inhaled steroids. Even when told that low doses are safe, and that about 90% of benefit comes at low doses of fluticasone propionate, patients hesitate. Some stop when they feel fine. Others report adherence they have not maintained, simply to please their physician.

In "Biologic Dosing Frequency and Real-World Persistence in Severe Asthma," Dr. Wechsler compares how often today's therapies must be given, while Dr. Mosnaim reviews what real-world data show about longer dosing intervals.