Impact of biologic therapy on ICS/LABA adherence in severe asthma: assessment of inhaler therapy adherence remains imperative.
L Bult, S van Deelen, M S van Daalen et al.
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In 30 seconds
This prospective, single-centre randomised-trial sub-study assessed electronically recorded ICS/LABA use and inhalation technique over six months in 14 patients with severe asthma starting biologic therapy. Median weekly adherence was 100% [43-100%] at baseline (week 2) and 73% [40-100%] at follow-up (week 27), a difference that was not statistically significant (p = 0.153). Seven patients had adherence below 80% at follow-up, compared with four at baseline. Reduced medication use, rather than poorer inhalation technique, mainly accounted for declining adherence.
Key findings
- Median weekly adherence was 100% [43-100%] at baseline and 73% [40-100%] at follow-up (p = 0.153).
- Adherence below 80% was observed in four patients at baseline and seven at follow-up.
- Six patients had an adherence decrease of ≥10%; reduced medication use was the main contributor.
- At follow-up, adherence correlated positively with ACQ (Spearman's ρ = 0.698, p = 0.006).
Why it matters
Starting biologic therapy does not ensure sustained use of background inhaled treatment. In this small study, adherence tended to decline, chiefly because patients used medication less often rather than because inhalation technique worsened. Electronic monitoring may help identify this pattern and support assessment of asthma control alongside biologic treatment.
What to keep in mind
The sub-study included only 14 patients at a single centre, and the baseline-to-follow-up adherence difference was not statistically significant.