Disease Management & Health Outcomes

, Volume 15, Issue 6, pp 355–376 | Cite as

Patient and Physician Factors Contributing to Poor Outcomes in Patients with Asthma and COPD

  • Adrian Gillissen
  • Hubertus Wirtz
  • Uwe Juergens
Review Article


Poor adherence with medical regimens by patients with asthma and chronic obstructive pulmonary disease (COPD) is a major problem facing medical practitioners, with patients typically taking approximately half the prescribed doses of self-administered medications. Poor adherence with medication regimens results in inadequate disease control and is assumed to be associated with poor long-term outcomes and high medical and social costs. Efforts to assist patients with treatment adherence are thought to improve the benefits of prescribed medications; however, even the most effective interventions do not necessarily lead to significant improvements in adherence and treatment outcomes.

Simple interventions (such as re-calling patients who miss appointments, making every effort to keep patients in care, and simplifying treatment regimens) and complex strategies (including combinations of more thorough patient instructions and counseling, reminders, close follow-up, supervised self-monitoring, family therapy, crisis intervention, and telephone follow-up) may improve adherence and treatment outcomes for both short- and long-term treatments. All these measures are highly dependent on a good physician-patient relationship, and the willingness and ability of caregivers to closely follow guidelines and recommendations.

The diversity and complexity of interventions, and uncertainty about their effects, make it difficult to assess which interventions are effective and which are not. The literature regarding interventions remains surprisingly limited. There is little evidence to show that medication adherence can be improved consistently, or that interventions will inevitably lead to improvements in treatment outcomes, especially considering the resources usually available in outpatient settings. Most studies assessing successful complex interventions have not assessed the effect on clinical endpoints. Studies in COPD are sparse compared with those in asthma, leaving room for further research efforts. As all self-administered treatments are affected by low adherence, and as the number of efficacious, self-administered treatments continues to grow, detailed knowledge about this complex issue may help to ensure better management in patients with obstructive pulmonary diseases.



No sources of funding were used to assist in the preparation of this review. Dr Gillissen has previously acted as a consultant for GlaxoSmithKline, AstraZeneca, and Merck Frost; has received honoraria from AstraZeneca, Asche Chiesi, Merck Frost, and GlaxoSmithKline; and has received grants from AstraZeneca and Merck Frost. Dr Wirtz has acted as a consultant for Altana Pharma and has received honoraria from Altana Pharma, AstraZeneca, GlaxoSmithKline, Merck Sharp & Dohme, and Norvartis; and Dr Juergens has received honoraria from Merck Sharp & Dohme and GlaxoSmithKline.

Author’s website: http://www.rkk-leipzig.de


  1. 1.
    Rabe KF, Schmidt DT. Pharmacological treatment of asthma today. Eur Respir J Suppl 2001; 34: 34s–40sPubMedCrossRefGoogle Scholar
  2. 2.
    Beardon PHG, McGilchrist MM, McKendrick AD, et al. Primary non-compliance with prescribed medication in primary care. BMJ 1993; 307: 846–8PubMedCrossRefGoogle Scholar
  3. 3.
    Cochrane GM. Therapeutic compliance in asthma: its magnitude and implications. Eur Respir J 1992; 5: 122–4PubMedGoogle Scholar
  4. 4.
    Coutts JAP, Gibson NA, Paton JY. Measuring compliance with inhaled medication in asthma. Arch Dis Child 1992; 67(3): 332–3PubMedCrossRefGoogle Scholar
  5. 5.
    Haynes RB, Taylor DW, Sacket DL. Compliance in health care. Baltimore (MD): Johns Hopkins University Press, 1979Google Scholar
  6. 6.
    Cramer JA, Bradley-Kennedy C, Scalera A. Treatment persistence and compliance with medications for chronic obstructive pulmonary disease. Can Respir J 2007; 14: 25–9PubMedGoogle Scholar
  7. 7.
    Tamura G, Ohta K. Adherence to treatment by patients with asthma or COPD: comparison between inhaled drugs and transdermal patch. Respir Med 2007; 101(9): 1895–902PubMedCrossRefGoogle Scholar
  8. 8.
    Roghmann MC, Sexton M. Adherence to asthma guidelines in general practices. J Asthma 1999; 36: 381–7PubMedCrossRefGoogle Scholar
  9. 9.
    Soriano JB, Rabe KF, Vermeire PA. Predictors of poor asthma control in European adults. J Asthma 2003; 40: 803–13PubMedCrossRefGoogle Scholar
  10. 10.
    National Institutes of Health. Global strategy for asthma management and prevention: NHLBI/WHO workshop report. Bethesda (MD): US Department of Health and Human Services, 2006Google Scholar
  11. 11.
    Gillissen A. Managing asthma in the real world. Int J Clin Pract 2004; 58: 592–603PubMedCrossRefGoogle Scholar
  12. 12.
    Suissa S, Ernst P, Benayoun S, et al. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000; 343: 332–6PubMedCrossRefGoogle Scholar
  13. 13.
    Weiner P, Weiner M, Azgad Y. Long term clinical comparison of single versus twice daily administration of inhaled budesonide in moderate asthma. Thorax 1995; 50: 1270–3PubMedCrossRefGoogle Scholar
  14. 14.
    Suissa S, Hemmelgarn B, Biais L, et al. Bronchodilators and acute cardiac death. Am J Respir Crit Care Med 1996; 154: 1598–602PubMedGoogle Scholar
  15. 15.
    Spitzer WO, Suissa S, Ernst P, et al. The use of β-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326: 501–6PubMedCrossRefGoogle Scholar
  16. 16.
    Nelson HS, Weiss ST, Bleeker ER, et al. The salmeterol mulicenter asthma research trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006; 129: 15–26PubMedCrossRefGoogle Scholar
  17. 17.
    Maneechotesuwan K, Essilfie-Quaye S, Kharitonov SA, et al. Loss of control of asthma following inhaled corticosteroid withdrawal is associated with increased sputum interleukin-8 and neutrophils. Chest 2007; 132: 98–105PubMedCrossRefGoogle Scholar
  18. 18.
    Calverley PMA, Anderson JA, Celli BR, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–89PubMedCrossRefGoogle Scholar
  19. 19.
    Vestbo J, Pauwels RA, Anderson JA, et al. Early onset of effect of salmeterol and fluticasone Propionate in chronic obstructive pulmonary disease. Thorax 2005; 60: 301–4PubMedCrossRefGoogle Scholar
  20. 20.
    Calverley PMA, Olsson H. Budesonide/formoterol in a single inhaler sustains improvements in lung function over 12 months compared with monocomponents and placebo in patients with COPD [abstract]. Am J Respir Crit Care Med 2003; 167: A319CrossRefGoogle Scholar
  21. 21.
    Jones PW, Willits LR, Burge PS, et al. Disease severity and the effect of fluticasone propionate on chronic obstructive pulmonary disease exacerbations. Eur Respir J 2003; 21: 68–73PubMedCrossRefGoogle Scholar
  22. 22.
    Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981; I: 681–6Google Scholar
  23. 23.
    Elliott RA, Barber N, Horne R. Cost-effectiveness of adherence-enhancing interventions: a quality assessment of the evidence. Ann Pharmacother 2005; 39: 508–15PubMedCrossRefGoogle Scholar
  24. 24.
    Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348: 383–6PubMedCrossRefGoogle Scholar
  25. 25.
    GOLD Executive Committee. Global initiative for chronic obstructive lung disease [online]. Available from URL: http://www.goldcopd.com [Accessed 2007 1 Nov]
  26. 26.
    Wenzel SE. Asthma: defining of the persistent adult phenotypes. Lancet 2006; 368: 804–13PubMedCrossRefGoogle Scholar
  27. 27.
    Lemanske RF, Busse WW. Asthma. JAMA 1997; 278: 1855–73PubMedCrossRefGoogle Scholar
  28. 28.
    Lange P, Scharling H, Ulrik CS, et al. Inhaled corticosteroids and decline of lung function in community residents with asthma. Thorax 2006; 61: 100–4PubMedCrossRefGoogle Scholar
  29. 29.
    Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339: 1194–200PubMedCrossRefGoogle Scholar
  30. 30.
    Busse WW, Brazinsky S, Jacobson K, et al. Efficacy response of inhaled beclomethasone dipropionate in asthma is proportional to dose and is improved by formulation with a new propellant. J Allergy Clin Immunol 1999; 104: 1215–22PubMedCrossRefGoogle Scholar
  31. 31.
    Busse WW. Inflammation in asthma: the cornerstone of the disease and target of therapy. J Allergy Clin Immunol 1998; 102: S17–22PubMedCrossRefGoogle Scholar
  32. 32.
    Hackett TL, Knight DA. The role of epithelial injury and repair in the origins of asthma. Curr Opin Allerg Clin Immunol 2007; 7: 63–8CrossRefGoogle Scholar
  33. 33.
    Larj MJ, Bleeker ER. Therapeutic responses in asthma and COPD: corticosteroids. Chest 2004; 126: 138S–49SPubMedCrossRefGoogle Scholar
  34. 34.
    Bateman ED, Bousquet J, Keech ML, et al. The correlation between asthma control and health status: the GOAL study. Eur Respir J 2007; 29: 56–63PubMedCrossRefGoogle Scholar
  35. 35.
    Bateman ED, Jacques L, Goldfrad C, et al. Asthma control can be maintained when fluticasone propionate/salmeterol in a single inhaler is stepped down. J Allergy Clin Immunol 2006; 117: 563–70PubMedCrossRefGoogle Scholar
  36. 36.
    Mannino DM, Watt G, Hole D, et al. The natural history of chronic obstructive pulmonary disease. Eur Respir J 2006; 27: 627–43PubMedCrossRefGoogle Scholar
  37. 37.
    Anthonisen NR. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. Am Rev Respir Dis 1989; 140: 95–9CrossRefGoogle Scholar
  38. 38.
    Fletcher C, Peto R. The natural history of chronic airway obstruction. BMJ 1977; 1: 1645–8PubMedCrossRefGoogle Scholar
  39. 39.
    Teramoto S. COPD pathogenesis from the viewpoint of risk factors. Intern Med 2007; 46: 77–9PubMedCrossRefGoogle Scholar
  40. 40.
    Siafakas NM, Tzortzaki EG. Few smokers develop COPD: why? Respir Med 2002; 96: 615–24PubMedCrossRefGoogle Scholar
  41. 41.
    Sandford AJ, Silverman EK. Chronic obstructive pulmonary disease: 1. Susceptibility factors for COPD the genotype-environment interaction. Thorax 2002 Aug; 57(8): 736–41PubMedCrossRefGoogle Scholar
  42. 42.
    Stoller JK, Aboussouan LS. Alpha-1-antitrypsin deficiency. Lancet 2005; 365(9478): 2225–36PubMedCrossRefGoogle Scholar
  43. 43.
    Mannino DM. COPD epidemiology, prevalence, morbidity and mortality, and disease heterogenity. Chest 2002; 121: 121–126SCrossRefGoogle Scholar
  44. 44.
    Gross NJ. Outcome measurements in COPD: are we schizophrenic? Chest 2003; 123: 1325–7PubMedCrossRefGoogle Scholar
  45. 45.
    Belman MJ, Brooks LR, Ross DJ, et al. Variability of breathlessness measurement in patients with chronic obstructive pulmonary disease. Chest 1991; 99(3): 566–71PubMedCrossRefGoogle Scholar
  46. 46.
    Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54(7): 581–6PubMedCrossRefGoogle Scholar
  47. 47.
    American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–7Google Scholar
  48. 48.
    Wise RA, Brown CD. Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test. COPD 2005; 2(1): 125–9PubMedCrossRefGoogle Scholar
  49. 49.
    Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 2002; 19: 398–404PubMedCrossRefGoogle Scholar
  50. 50.
    Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993; 118: 622–9PubMedGoogle Scholar
  51. 51.
    Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773–8PubMedCrossRefGoogle Scholar
  52. 52.
    Calverley PMA. Minimal clinically important difference: exacerbations of COPD. COPD 2005; 2: 143–8PubMedCrossRefGoogle Scholar
  53. 53.
    Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. Ann Intern Med 1980; 93: 391–8Google Scholar
  54. 54.
    National Emphysema Treatment Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003; 348: 2059–73CrossRefGoogle Scholar
  55. 55.
    Sin DD, Tu JV. Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164: 580–4PubMedGoogle Scholar
  56. 56.
    Sin DD, Man SFP. Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter? Eur Respir J 2003; 21: 260–6PubMedCrossRefGoogle Scholar
  57. 57.
    Gillissen A, Buhl R, Kardos P, et al. Inhalable corticosteroids in long-term COPD treatment: opinions of an expert panel [in German]. Pneumologie 2000; 54: 256–62PubMedCrossRefGoogle Scholar
  58. 58.
    Suissa S. Effectiveness of inhaled corticosteroids in chronic obstructive pulmonary disease: immortal time bias in observational studies. Am J Respir Crit Care Med 2003; 168: 49–53PubMedCrossRefGoogle Scholar
  59. 59.
    Suissa S. Statistical treatment of exacerbations in therapeutic trials of COPD. Am J Respir Crit Care Med 2006; 173(8): 842–6PubMedCrossRefGoogle Scholar
  60. 60.
    Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005–12PubMedCrossRefGoogle Scholar
  61. 61.
    Anthonisen NR, Connett JE, Enright PL, et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9PubMedCrossRefGoogle Scholar
  62. 62.
    Hunter MH, King DE. COPD: management of acute exacerbations and chronic stable disease. Am Fam Physician 2001; 64: 603–12PubMedGoogle Scholar
  63. 63.
    Scanlon PD, Connett JE, Waller LA, et al. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease: the Lung Health Study. Am J Respir Crit Care Med 2000; 161: 381–90PubMedGoogle Scholar
  64. 64.
    American Lung Association. Chronic obstructive pulmonary disease (COPD): fact sheet [online]. Available from URL: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35020 [Accessed 2007 Jan 1]
  65. 65.
    Burge PS, Calverley PMA, Jones PW, et al. Randomised, placebo-controlled study of fluticasone Propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320: 1297–303PubMedCrossRefGoogle Scholar
  66. 66.
    Soriano JB, Kiri VA, Pride NB, et al. Inhaled corticosteroids with/without longacting β-agonists reduce the risk of rehospitalization and death in COPD patients. Am J Respir Med 2003; 2: 67–74PubMedCrossRefGoogle Scholar
  67. 67.
    Calverley PMA, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003; 22: 912–9PubMedCrossRefGoogle Scholar
  68. 68.
    Burge PS, Calverley PMA, Jones PW, et al. Randomised, double blind, placebo controlled study of fluticasone Propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320: 1297–303PubMedCrossRefGoogle Scholar
  69. 69.
    Aaron SD, Vandernheen KL, Fergusson D, et al. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease. Ann Intern Med 2007; 146: 545–55PubMedGoogle Scholar
  70. 70.
    Stempel DA, Stoloff SW, Carranza Rosenzweig JR, et al. Adherence to asthma Controller medication regimes. Respir Med 2005; 99: 1263–7PubMedCrossRefGoogle Scholar
  71. 71.
    Williams LK, Pladevall M, Xi H, et al. Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol 2004; 114: 1288–93PubMedCrossRefGoogle Scholar
  72. 72.
    Buston KM, Wood SF. Non-compliance amongst adolescents with asthma: listening to what they tell us about self-management. Fam Pract 2000; 17: 134–8PubMedCrossRefGoogle Scholar
  73. 73.
    Rand CS, Nides M, Cowles MK, et al. Long-term metered-dose inhaler adherence in a clinical trial: the Lung Health Study Research Group. Am J Respir Crit Care Med 1995; 152: 580–8PubMedGoogle Scholar
  74. 74.
    Dolce JJ, Chrisp C, Manzella B, et al. Medication adherence patterns in chronic obstructive pulmonary disease. Chest 1991; 99: 837–41PubMedCrossRefGoogle Scholar
  75. 75.
    Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol 2002; 110: 58–64PubMedCrossRefGoogle Scholar
  76. 76.
    Fish JE, Lung CL. Adherence to asthma therapy. Ann Allergy Asthma Immunol 2001; 86: 24–30PubMedCrossRefGoogle Scholar
  77. 77.
    Hernandez DV, Schmaling KB. Understanding and resolving adherence problems. Clin Rev Allergy Immunol 2004; 27: 65–73PubMedCrossRefGoogle Scholar
  78. 78.
    Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Respir Crit Care Med 1994; 149: S69–76PubMedGoogle Scholar
  79. 79.
    Cochrane GM, Home R, Chanez P. Compliance in asthma. Resp Med 1999; 93: 763–9CrossRefGoogle Scholar
  80. 80.
    Rau JL. Determinants of patient adherence to an aerosol regimen. Resp Care 2005; 50: 1346–56Google Scholar
  81. 81.
    Lagerlov P, Leseth A, Matheson I. The doctor-patient relationship and the management of asthma. Soc Sci Med 2000; 47: 85–91CrossRefGoogle Scholar
  82. 82.
    Bender B, Wamboldt FS, O’Connor SL, et al. Measurement of children’s asthma medication adherence by self report, mother report, canister weight, and Doser CT. Ann Allergy Asthma Immunol 2000; 85: 416–21PubMedCrossRefGoogle Scholar
  83. 83.
    Hyland ME, Kenyon CAP, Allen RC, et al. Diary keeping in asthma: comparison of the written and electronic methods. BMJ 1993; 306: 487–9PubMedCrossRefGoogle Scholar
  84. 84.
    Rand CS, Wise RA, Nides M, et al. Metered-dose inhaler adherence in a clinical trial. Am Rev Respir Dis 1992; 146: 1559–64PubMedGoogle Scholar
  85. 85.
    Levine RJ. Monitoring for adherence: ethical considerations. Am J Respir Crit Care Med 1994; 149: 287–8PubMedGoogle Scholar
  86. 86.
    Braunstein GL, Trinquet G, Harper AE. Compliance with nedocromil sodium and a nedocromil sodium/salbutamol. Eur Respir J 1996; 9: 893–8PubMedCrossRefGoogle Scholar
  87. 87.
    van Schayck CP, van Der Heijden FM, van Den Boom G, et al. Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project. Thorax 2000; 55: 562–5PubMedCrossRefGoogle Scholar
  88. 88.
    Siersted HC, Boldsen J, Hansen HS, et al. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ 1998; 316: 651–5PubMedCrossRefGoogle Scholar
  89. 89.
    Wahlström R, Lagerlov P, Stalsby Lundborg C, et al. Variations in general practitioners’ views of asthma management in four European countries. Soc Sci Med 2001; 53: 507–18PubMedCrossRefGoogle Scholar
  90. 90.
    Lagerlov P, Veninga CC, Muskova M, et al. Asthma management in five European countries: doctors’ knowledge, attitudes and prescribing behaviour. Drug Education Project (DEP). Eur Respir J 2000; 15: 25–9PubMedGoogle Scholar
  91. 91.
    Kahn LS, Fox CH, Olawaiye A, et al. Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice. J Natl Med Assoc 2007; 99: 377–83PubMedGoogle Scholar
  92. 92.
    Marklund B, Tunsäter A, Bengtsson C. How often is the diagnosis bronchial asthma correct? Fam Pract 1999; 16: 112–6PubMedCrossRefGoogle Scholar
  93. 93.
    Adams RJ, Wilson DH, Appleton S, et al. Underdiagnosed asthma in South Australia. Thorax 2003; 58: 846–50PubMedCrossRefGoogle Scholar
  94. 94.
    Doshi DR, Weinberger MM. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol 2006; 96: 794–9PubMedCrossRefGoogle Scholar
  95. 95.
    Dahlström U. Frequent non-cardiac comorbidities in patients with chronic heart failure. Eur J Heart Fail 2005; 7: 309–16PubMedCrossRefGoogle Scholar
  96. 96.
    Decramer M, Selroos O. Asthma and COPD: differences and similarities. With special reference to the usefulness of budesonide/formoterol in a single inhaler (Symbicort) in both diseases. Int J Clin Pract 2005; 59: 385–98PubMedCrossRefGoogle Scholar
  97. 97.
    Bellia V, Battaglia S, Catando F, et al. Aging and disability affect misdiagnosis of COPD in elderly asthmatics: the SARA study. Chest 2003; 123: 1066–72PubMedCrossRefGoogle Scholar
  98. 98.
    Pinnock H, Johnson A, Young P, et al. Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district. Respir Med 1999; 93: 397–401PubMedCrossRefGoogle Scholar
  99. 99.
    Taylor DM, Auble TE, Calhoun WJ, et al. Current outpatient management of asthma shows poor compliance with International Consensus Guidelines. Chest 1999; 116: 1638–45PubMedCrossRefGoogle Scholar
  100. 100.
    Bousquet J, Knani J, Henry C, et al. Undertreatment in a nonselected population of adult patients with asthma. J Allergy Clin Immunol 1996; 98: 514–21PubMedCrossRefGoogle Scholar
  101. 101.
    Cydulka RK, Emerman CL, Schreiber D, et al. Acute asthma among pregnant women presenting to the emergency department. Am J Respir Crit Care Med 1999; 160: 887–92PubMedGoogle Scholar
  102. 102.
    Steurer-Stey C, Fletcher M, Vetter W, et al. Patient education in asthma: a survey of physicians’ knowledge of the principles and implementation of self management in practice. Swiss Med Wkly 2006; 136: 561–5PubMedGoogle Scholar
  103. 103.
    Sarrell EM, Mandelberg A, Cohen HA, et al. Compliance of primary care doctors with asthma guidelines and related education programs: the employment factor. IMAJ 2002; 4: 403–6PubMedGoogle Scholar
  104. 104.
    Cochrane MG, Bala MV, Downs KE, et al. Inhaled corticosteroids for asthma therapy: patient compliance, devices and inhalation technique. Chest 2000; 117: 542–50PubMedCrossRefGoogle Scholar
  105. 105.
    Balsbaugh TA, Chambers CV, Diamond JJ. Asthma controller medications: what do patients want? J Asthma 1999; 36: 591–6PubMedCrossRefGoogle Scholar
  106. 106.
    James PN, Anderson JB, Prior JG, et al. Patterns of drug taking in patients with chronic airflow obstruction. Postgrad Med J 1985; 61: 7–10PubMedCrossRefGoogle Scholar
  107. 107.
    Jones C, Santanello NC, Boccuzzi SJ, et al. Adherence to prescribed treatment for asthma: evidence from pharmacy benefits data. J Asthma 2003; 40: 93–101PubMedCrossRefGoogle Scholar
  108. 108.
    Irvine L, Crombie IK, Alder EM, et al. What predicts poor collection of medication among children with asthma? A case-control study. Eur Respir J 2002; 20: 1464–9PubMedCrossRefGoogle Scholar
  109. 109.
    Mann M, Eliasson O, Patel K, et al. A comparision of the effects of bid and quid dosing on compliance with inhaled flunisolide. Chest 1992; 101: 496–9PubMedCrossRefGoogle Scholar
  110. 110.
    Mann MC, Eliasson O, Patel K, et al. An evaluation of severity-modulated compliance with q.i.d. dosing of inhaled beclomethasone. Chest 1992; 102: 1342–6PubMedCrossRefGoogle Scholar
  111. 111.
    Simmons MS, Nides MA, Rand CS, et al. Trends in compliance with bronchodilator inhaler use between follow-up visits in a clinical trial. Chest 1996; 109: 963–8PubMedCrossRefGoogle Scholar
  112. 112.
    Nides MA, Tashkin DP, Simmons MS, et al. Improving inhaler adherence in a clinical trial through the use of the nebulizer chronolog. Chest 1993; 104: 501–7PubMedCrossRefGoogle Scholar
  113. 113.
    Camargo CA, Ramachandran S, Ryskina KL, et al. Association between common asthma therapies and recurrent asthma exacerbations in children enrolled in a state Medicaid plan. Am J Health Syst Pharm 2007; 64: 1054–61PubMedCrossRefGoogle Scholar
  114. 114.
    Ng TP, Lim TK, Abisheganaden J, et al. Factors associated with acute health care use in a national adult asthma management program. Ann Allergy Asthma 2006; 97: 784–93CrossRefGoogle Scholar
  115. 115.
    Okelo SO, Wu AW, Merriman B, et al. Are physician estimates of asthma severity less accurate in black than in white patients? J Gen Intern 2007; 22: 976–81CrossRefGoogle Scholar
  116. 116.
    Cochrane GM. Compliance and outcomes in patients with asthma. Drugs 1996; 52: 12–9PubMedCrossRefGoogle Scholar
  117. 117.
    Milgrom H, Bender B. Nonadherence with the asthma regime. Pediatr Asthma Allergy Immunol 1997; 11: 3–8CrossRefGoogle Scholar
  118. 118.
    Clark NM, Partridge MR. Strengthening asthma education to enhance disease control. Chest 2002; 121: 1661–9PubMedCrossRefGoogle Scholar
  119. 119.
    Halm EA, Mora P, Leventhal H. No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest 2006; 129: 573–80PubMedCrossRefGoogle Scholar
  120. 120.
    Halimi L, Vachier I, Varrin M, et al. Interference of psychological factors in difficult-to-control asthma. Respir Med 2007; 101: 154–61PubMedCrossRefGoogle Scholar
  121. 121.
    Conn KM, Halterman JS, Fisher SG, et al. Parental beliefs about medications and medication adherence among urban children with asthma. Ambul Pediatr 2005; 5: 306–10PubMedCrossRefGoogle Scholar
  122. 122.
    Chambers CV, Markson L, Diamond JJ, et al. Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices. Respir Med 1999; 93: 88–94PubMedCrossRefGoogle Scholar
  123. 123.
    Nolte H, Nepper-Christensen S, Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respir Med 2006; 100: 354–62PubMedCrossRefGoogle Scholar
  124. 124.
    Chai SM, Tan KL, Wong JL, et al. Asthma knowledge among adult asthmatic outpatients in a tertiary care hospital. Asian Pac J Allergy Immunol 2005; 22: 81–9Google Scholar
  125. 125.
    Kolbe J, Vamos M, James F, et al. Assessment of practical knowledge of self-management of acute asthma. Chest 1996; 109: 86–90PubMedCrossRefGoogle Scholar
  126. 126.
    Ulrik CS, Backer V, Soer-Petersen U, et al. The patient’s perspective: adherence or non-adherence to asthma controller therapy? J Asthma 2006; 43: 701–4PubMedCrossRefGoogle Scholar
  127. 127.
    Prabhakaran L, Lim G, Abisheganaden J, et al. Impact of an asthma education programme on patients’ knowledge, inhaler technique and compliance to treatment. Singapore Med J 2006; 47: 225–31PubMedGoogle Scholar
  128. 128.
    Canonica GW, Baena-Cagnani CE, Blaiss MS, et al. Unmet needs in asthma: Global Asthma Physician and Patient (GAPP) survey. Global adult findings. Allergy 2007; 62: 668–74PubMedCrossRefGoogle Scholar
  129. 129.
    Moffat M, Cleland J, Molen Tvd, et al. Sup-optimal patient and physician communication in primary care consultations: its relation to severe and difficult asthma. Prim Care Respir J 2006; 15: 159–65PubMedCrossRefGoogle Scholar
  130. 130.
    Vincent SD, Toelle BG, Aroni RA, et al. Exasperations of asthma: a qualitative study of patient language about worsening asthma. Med J Aust 2006; 184: 451–4PubMedGoogle Scholar
  131. 131.
    Adams RJ, Appleton S, Wilson DH, et al. Participatory decision making, asthma action plans, and use of asthma medications: a population survey. J Asthma 2005; 42: 673–8PubMedCrossRefGoogle Scholar
  132. 132.
    Corsico AG, Cazzoletti L, de Marco R, et al. Factors affecting adherence to asthma treatment in an international cohort of young and middle-aged adults. Respir Med 2007; 101: 1363–7PubMedCrossRefGoogle Scholar
  133. 133.
    Janson C, de Marco R, Accordini S, et al. Changes in the use of anti-asthmatic medication in an international cohort. Eur Respir J 2005; 26: 1047–55PubMedCrossRefGoogle Scholar
  134. 134.
    Sun BC, Burstin HR, Brennan TA. Predictors and outcomes of frequent emergency department users. Acad Emerg Med 2003; 10: 320–8PubMedCrossRefGoogle Scholar
  135. 135.
    Valerio M, Cabana MD, White DF, et al. Understanding of asthma management Medicaid patients’ perspective. Chest 2006; 129: 594–601PubMedCrossRefGoogle Scholar
  136. 136.
    Clark NM, Gong M, Brown RW, et al. Influences on childhood asthma in lowincome communities in China and the United States. J Asthma 2005; 42: 493–7PubMedGoogle Scholar
  137. 137.
    Stingone JA, Claudio L. Disparities in the use of urgent health care services among asthmatic children. Ann Allergy Asthma Immunol 2006; 97: 244–50PubMedCrossRefGoogle Scholar
  138. 138.
    Greek AA, Kieckhefer GM, Kim H, et al. Family perceptions of the usual source of care among children with asthma by race/ethnicity, language, and income. J Asthma 2006; 43: 61–9PubMedCrossRefGoogle Scholar
  139. 139.
    Halm FA, Wisnivesky JP, Leventhal H. Quality and access to care among a cohort of inner-city adults with asthma: who gets guideline concordant care? Chest 2005; 128: 1943–50PubMedCrossRefGoogle Scholar
  140. 140.
    Dey AN, Bloom B. Summary health statistics for US children: National Health Interview Survey, 2003. Vital Health Stat 10 2005; 223: 1–78PubMedGoogle Scholar
  141. 141.
    Dormuth CR, Glynn RJ, Neumann P, et al. Impact of two sequential drug costsharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther 2006; 28: 964–78PubMedCrossRefGoogle Scholar
  142. 142.
    Garg VK, Bidani R, Rich EP, et al. Asthma patient’s knowledge, perception, and adherence to the asthma guidelines. J Asthma 2005; 42: 633–8PubMedCrossRefGoogle Scholar
  143. 143.
    Backer V, Ulrik CS, Harving H, et al. Management of asthma in adults: do the patients get what they need and want? Allergy Asthma Proc 2007; 28: 375–81PubMedCrossRefGoogle Scholar
  144. 144.
    Kolbe J, Vamos M, Fergusson W, et al. Differential influences on asthma self-management knowledge and self-management behaviour in acute severe asthma. Chest 1996; 110: 1463–8PubMedCrossRefGoogle Scholar
  145. 145.
    Sing V, Sinha HV, Gupta R. Barriers in the management of asthma and attitudes towards complementary medicine. Respir Med 2002; 96: 835–40CrossRefGoogle Scholar
  146. 146.
    Gilliland FD, Islan T, Berhane K, et al. Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med 2006; 174: 1094–100PubMedCrossRefGoogle Scholar
  147. 147.
    Gillissen A, Lecheler J. Social impact of asthma: patients opinion and physicians view [abstract]. Am J Respir Crit Care Med 2000; 161: A609Google Scholar
  148. 148.
    Gillissen A, Lecheler J. Corticophobia in adults and children with asthma: differences between patients and their physicians [abstract]. Am J Respir Crit Care Med 2000; 161: A319Google Scholar
  149. 149.
    Gillissen A, Lecheler J. Corticophobia in asthma [in German]. Med Klinik 2003; 98: 309–14Google Scholar
  150. 150.
    Boulet L-P. Perception of the role and potential side effects of inhaled corticosteroids among asthmatic patients. Chest 1998; 113: 587–92PubMedCrossRefGoogle Scholar
  151. 151.
    Home R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47: 555–67CrossRefGoogle Scholar
  152. 152.
    Grunsven van PM, Schayck van CP, Kollenburg van HJ, et al. The role of ‘fear of corticosteroids’ in nonparticipation in early intervention with inhaled corticosteroids in asthma and COPD in general practice. Eur Respir J 1998; 11: 1178–81PubMedCrossRefGoogle Scholar
  153. 153.
    Irwin RS, Richardson D. Side effects with inhaled corticosteroids: the physician’s perception. Chest 2006; 130: 41–53CrossRefGoogle Scholar
  154. 154.
    Powell H, Gibson PG. Inhaled corticosteroid doses in asthma: an evidence-based approach. Med J Aust 2003; 178: 223–5PubMedGoogle Scholar
  155. 155.
    Penza-Clyve SM, Mansell C, McQuaid EL. Why don’t children take their asthma medications? A qualitative analysis of children’s perspectives on adherence. J Asthma 2004; 41: 189–97PubMedCrossRefGoogle Scholar
  156. 156.
    Callery P, Milnes L, Verduyn C, et al. Qualitative study of young people’s and parents’ beliefs about childhood asthma. Br J Gen Pract 2003; 53: 185–90PubMedGoogle Scholar
  157. 157.
    Bender BG, Bender SF. Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires. Immunol Allergy Clin North Am 2005; 25: 107–30PubMedCrossRefGoogle Scholar
  158. 158.
    Bender B, Milgrom H, Rand C, et al. Psychological factors associated with medication nonadherence in asthmatic children. J Asthma 1998; 35: 347–53PubMedCrossRefGoogle Scholar
  159. 159.
    Creer TL, Levstek D. Medication compliance and asthma: overlooking the trees because of the forest. J Asthma 1996; 33: 203–11PubMedCrossRefGoogle Scholar
  160. 160.
    Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J 2002; 19: 246–51PubMedCrossRefGoogle Scholar
  161. 161.
    Walia M, Paul L, Satyavani A, et al. Assessment of inhalation technique and determinants of incorrect performance among children with asthma. Pediatr Pulmonol 2006; 41: 1082–7PubMedCrossRefGoogle Scholar
  162. 162.
    Beerendonk van I, Mesters I, Mudde AN, et al. Assessment of the inhalation technique in outpatients with asthma or chronic obstructive pulmonary disease using a metered-dose inhaler or dry powder device. J Asthma 1998; 35: 273–9PubMedCrossRefGoogle Scholar
  163. 163.
    Hesselink AE, Penninx BW, Wijnhoven HA, et al. Determinants of an incorrect inhalation technique in patients with asthma or COPD. Scand J Prim Health Care 2001; 19: 255–60PubMedCrossRefGoogle Scholar
  164. 164.
    Campos A, Diaz MA, Munoz MP, et al. Assessment of the inhalation technique in asthmatic patients: a comparative study of three aerosol devices. Allergol Immunopathol (Madr) 1998; 26: 47–51Google Scholar
  165. 165.
    Molimard M, Raherison C, Lignot S, et al. Assessment of handling of inhaler devices in real life: an observational study in 3 811 patients in primary care. J Aerosol Med 2003; 16: 249–54PubMedCrossRefGoogle Scholar
  166. 166.
    Smith A, Krishnan JA, Bilderback A, et al. Depressive symptoms and adherence to asthma therapy after hospital discharge. Chest 2006; 130: 1034–8PubMedCrossRefGoogle Scholar
  167. 167.
    Nelson EC, Stason WB, Neutra RR. Identification of the noncompliant hypertensive patient. Prev Med 1980; 9: 504–17PubMedCrossRefGoogle Scholar
  168. 168.
    Bosley CM, Fosbury JA, Cochrane GM. The psychological factors associated with poor compliance with treatment in asthma. Eur Respir J 1995; 8: 899–904PubMedGoogle Scholar
  169. 169.
    Waxman HM, McCreary G, Weinrit RM, et al. A comparison of somatic complaints among depressed and non-depressed older persons. Gerontologist 1985; 25: 501–7PubMedCrossRefGoogle Scholar
  170. 170.
    Bender BG. Risk-taking, depression, adherence, and symptom control in adolescents and young adults with asthma. Am J Respir Crit Care Med 2006; 173(9): 953–7PubMedCrossRefGoogle Scholar
  171. 171.
    Fritz G, Rubenstein S, Lewiston N. Psychological factors in fatal childhood asthma. Am J Orthopsychiatry 1987; 57: 253–7PubMedCrossRefGoogle Scholar
  172. 172.
    Kravis L. An analysis of fifteen childhood asthma fatalities. J Allergy Clin Immunol 1987; 80: 467–72PubMedCrossRefGoogle Scholar
  173. 173.
    Strunk R, Mrazek DA, Wofson Fuhrmann G, et al. Physiological and psychological characteristics associated with deaths from asthma in childhood. JAMA 1985; 254: 1193–8PubMedCrossRefGoogle Scholar
  174. 174.
    Laurin C, Lavoie KL, Bacon SL, et al. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest 2007; 132: 148–55PubMedCrossRefGoogle Scholar
  175. 175.
    Hynninen KM, Breitve MH, Wibourg AB, et al. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res 2005; 59: 429–43PubMedCrossRefGoogle Scholar
  176. 176.
    Bosley CM, Corden ZM, Rees PJ, et al. Psychological factors associated with use of home nebulized therapy for COPD. Eur Respir J 1996; 9: 2346–50PubMedCrossRefGoogle Scholar
  177. 177.
    Hublet A, Bacquer De D, Boyce W, et al. Smoking in young people with asthma. J Public Health (Oxf) 2007; 29(4): 343–9CrossRefGoogle Scholar
  178. 178.
    Mo F, Robinson C, Choi B, et al. Analysis of prevalence, triggers, risk factors and the related socio-economic effects of childhood asthma in the Student Lung Health Survey. J Adolesc Health 2003; 15: 349–58Google Scholar
  179. 179.
    Gillissen A, Lecheler J. Bronchial asthma: a comparison of the doctor’s assessment and the patient’s opinion [in German]. Dtsch Med Wschr 2004; 129(10): 484–9PubMedCrossRefGoogle Scholar
  180. 180.
    Wagena EJ, Knipschild PG, Huibers MJ, et al. Efficacy of bupropion and nortriptyline for smoking cessation among people at risk for or with chronic obstructive pulmonary disease. Arch Intern Med 2005; 165: 2286–92PubMedCrossRefGoogle Scholar
  181. 181.
    Silverman REB, Woodruff P, Clark S, et al. Cigarette smoking among asthmatic adults presenting to 64 emergency departments. Chest 2003; 123: 349–58CrossRefGoogle Scholar
  182. 182.
    Levine M, Iliescu ME, Margellos-Anast H, et al. The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations. Chest 2005; 128: 1951–7PubMedCrossRefGoogle Scholar
  183. 183.
    Partridge MR, Hill SR. Enhancing care for people with asthma: the role of communication, education, training and self-management. Eur Respir J 2000; 16: 333–48PubMedCrossRefGoogle Scholar
  184. 184.
    Bender BG. Overcoming barriers to nonadherence in asthma treatment. J Allergy Clin Immunol 2002; 109: S554–9PubMedCrossRefGoogle Scholar
  185. 185.
    Jones KG, Bell J, Fehrenbach C, et al. Understanding patient perceptions of asthma: results of the Asthma Control and Expectations (ACE) survey. Int J Clin Pract 2002; 56: 89–93PubMedGoogle Scholar
  186. 186.
    Price D, Ryan D. The AIR study: asthma in real life. Asthma J 1999; 4: 74–8Google Scholar
  187. 187.
    Clark NM, Gong M, Schork MA, et al. Impact of education for physicians on patient outcomes. Pediatrics 1998; 101: 831–6PubMedCrossRefGoogle Scholar
  188. 188.
    Cabana MD, Rand CS, Wu AW, et al. Why don’t patients follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282: 1458–65PubMedCrossRefGoogle Scholar
  189. 189.
    Cabana MD, Slish KK, Evans D, et al. Impact of physician asthma care education on patient outcomes. Pediatrics 2006; 117: 2149–57PubMedCrossRefGoogle Scholar
  190. 190.
    Davis RS, Bukstein DA, Luskin AT, et al. Changing physician prescribing patterns through problem-based learning: an interactive, teleconference case-based education program and review of problem-based learning. Ann Allergy Asthma Immunol 2004; 93: 237–42PubMedCrossRefGoogle Scholar
  191. 191.
    Ting S. Multi-colored simplified asthma guideline reminder: why pragmatic asthma tools are needed in real-world practice. Clin Rev Allergy Immunol 2004; 27: 133–45PubMedCrossRefGoogle Scholar
  192. 192.
    Carlton BG, Lucas DO, Ellis EF, et al. The status of asthma control and asthma prescribing practices in the United States: results of a large prospective asthma control survey of primary care practices. J Asthma 2005; 42: 529–35PubMedGoogle Scholar
  193. 193.
    Coleman CI, Reddy P, Laster-Bradley NM, et al. Effect of practitioner education on adherence to asthma treatment guidelines. Ann Pharmacother 2003; 37: 956–61PubMedCrossRefGoogle Scholar
  194. 194.
    Andersen M, Kragstrup J, Sondergaard J. How conducting a clinical trial affects physician’s guideline adherence and drug preferences. JAMA 2006; 295: 2759–64PubMedCrossRefGoogle Scholar
  195. 195.
    Eisen SA, Miller DK, Woodward RS, et al. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med 1990; 150: 1881–4PubMedCrossRefGoogle Scholar
  196. 196.
    Stoloff SW, Stempel DA, Meyer J, et al. Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies. J Allergy Clin Immunol 2004; 113: 245–51PubMedCrossRefGoogle Scholar
  197. 197.
    Kelloway JS, Wyatt RA, Adlis SA. Comparison of patients’ compliance with prescribed oral and inhaled asthma medications. Arch Int Med 1994; 154: 1349–52CrossRefGoogle Scholar
  198. 198.
    Bosley CM, Parry OT, Cochrane GM. Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance? Eur Respir J 1994; 7: 504–9PubMedCrossRefGoogle Scholar
  199. 199.
    Sherman J, Hutson A, Baumstein S, et al. Telephoning the patient’s pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions. J Pediatr 2000; 136: 532–6PubMedCrossRefGoogle Scholar
  200. 200.
    Carter EB, Ananthakrishnan M. Adherence to montelukast versus inhaled corticosteroids in children with asthma. Pediatr Pulmonol 2003; 36: 301–4PubMedCrossRefGoogle Scholar
  201. 201.
    Sherman J, Patel P, Hutson A, et al. Adherence to oral montelukast and inhaled fluticasone in children with persistent asthma. Pharmacotherapy 2001; 21: 1464–7PubMedCrossRefGoogle Scholar
  202. 202.
    Tremblay M, Gervais A, Lacroix C, et al. Physicians taking action against smoking: an intervention program to optimize smoking cessation counselling by Montreal general practitioners. CMAJ 2001; 165: 601–7PubMedGoogle Scholar
  203. 203.
    Kripalani S, Yao X, Haynes B. Interventions to enhance medication adherence in chronic medical conditions. Arch Int Med 2007; 167: 540–50CrossRefGoogle Scholar
  204. 204.
    Sudre P, Jacquemet S, Uldry C, et al. Objectives, methods and content of patient education programmes for adults with asthma: systematic review of studies published between 1979 and 1998. Thorax 1999; 54: 681–7PubMedCrossRefGoogle Scholar
  205. 205.
    Haynes RB, McDonald H, Garg AX. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002; (2): CD000011Google Scholar
  206. 206.
    Cote J, Bowie DM, Robichaud P, et al. Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation. Am J Respir Crit Care Med 2001; 163: 1415–9PubMedGoogle Scholar
  207. 207.
    Gallefoss F, Bakke PS. How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication? Am J Respir Crit Care Med 1999; 160: 2000–5PubMedGoogle Scholar
  208. 208.
    Smeele IJ, Grol RP, Schayck van CP, et al. Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease? Quality Health Care 1999; 8: 92–8CrossRefGoogle Scholar
  209. 209.
    Morice AH, Wrench C. The role of the asthma nurse in treatment compliance and self-management following hospital admission. Respir Med 2001; 95: 851–6PubMedCrossRefGoogle Scholar
  210. 210.
    Levy ML, Robb M, Allen J, et al. A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. Respir Med 2000; 94: 900–8PubMedCrossRefGoogle Scholar
  211. 211.
    Schaffer SD, Tian L. Promoting adherence: effects of theory-based asthma education. Clin Nurs Res 2004; 13: 69–89PubMedCrossRefGoogle Scholar
  212. 212.
    Es van SM, Nagelkerke AF, Colland VT, et al. An intervention programme using the ASE-model aimed at enhancing adherence in adolescents with asthma. Patient Educ Couns 2001; 44: 193–203PubMedCrossRefGoogle Scholar
  213. 213.
    Ruoff G. Effects of flow sheet implementation on physician performance in the management of asthmatic patients. Farn Med 2002; 34: 514–7Google Scholar
  214. 214.
    Bender B, Milgrom H, Apter A. Adherence intervention research: what have we learned and what do we do next? J Allergy Clin Immunol 2003; 112: 489–94PubMedCrossRefGoogle Scholar
  215. 215.
    Apter AJ, Boston RC, George M, et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: it’s not just black and white. J Allergy Clin Immunol 2003; 111: 1219–26PubMedCrossRefGoogle Scholar
  216. 216.
    Gebert N, Hummeling R, Konning J, et al. Efficacy of a self-management program for childhood asthma: a prospective controlled study. Patient Educ Couns 1998; 35: 213–20PubMedCrossRefGoogle Scholar
  217. 217.
    Bailey WC, Richards Jr JM, Brooks CM, et al. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med 1990; 150: 1664–8PubMedCrossRefGoogle Scholar
  218. 218.
    Ignacio-Garcia J-M, Pinto-Tenorio M, Chocrón-Giraldez MJ, et al. Benefits of 3 yrs of an asthma education programme coupled with regular reinforcement. Eur Respir J 2002; 20: 1095–101PubMedCrossRefGoogle Scholar
  219. 219.
    Cote J, Cartier A, Robichaud P, et al. Influence on asthma morbidity of asthma education programs based on self-management plans following treatment optimization. Am J Respir Crit Care Med 1997; 155: 1509–14PubMedGoogle Scholar
  220. 220.
    Farber HJ, Oliveria L. Trial of asthma education program in an inner-city pediatric emergency department. Pediatr Asthma Allergy Immunol 2004; 17: 107–15CrossRefGoogle Scholar
  221. 221.
    Klein JJ, Van der Palen J, Uil SM, et al. Benefit from the inclusion of self-treatment guidelines to a self-management programme for adults with asthma. Eur Respir J 2001; 17: 386–94PubMedCrossRefGoogle Scholar
  222. 222.
    Weinberger M, Murray MD, Marrero DG, et al. Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA 2002; 288: 1594–602PubMedCrossRefGoogle Scholar
  223. 223.
    Song WS, Mullon J, Regan NA, et al. Instruction of hospitalized patients by respiratory therapist on metered-dose inhaler use leads to decrease in patient errors. Respir Care 2005; 50: 1040–5PubMedGoogle Scholar
  224. 224.
    Van der Palen J, Klein JJ, Kerkhoff AH, et al. Inhalation technique of 166 adult asthmatics prior to and following a self-management program. J Asthma 1999; 36: 441–7PubMedCrossRefGoogle Scholar
  225. 225.
    Thompson J, Irvine T, Grathwohl K, et al. Misuse of metered-dose inhalers in hospitalized patients. Chest 1994; 105: 715–7PubMedCrossRefGoogle Scholar
  226. 226.
    Dolovich M. New propellant-free technologies under investigation. J Aerosol Med 1999; 12: S9–17PubMedCrossRefGoogle Scholar
  227. 227.
    Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines. American Chest Physicians/American College of Asthma. Chest 2005; 127: 335–71PubMedCrossRefGoogle Scholar
  228. 228.
    Milgrom H, Bender B, Ackerson LM, et al. Noncompliance and treatment failure in children with asthma. J Allergy Clin Immunol 1996; 98: 1051–7PubMedCrossRefGoogle Scholar
  229. 229.
    Palen van der J, Klein JJ, Herwaarden van CLA, et al. Multiple inhalers confuse asthma patients. Eur Respir J 1999; 14: 1037Google Scholar
  230. 230.
    Stempel DA, Riedel AA, Carranza Rosenzweig JR. Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma. Curr Med Res Opin 2006; 22: 463–70PubMedCrossRefGoogle Scholar
  231. 231.
    Calverley PMA, Pauwels RA, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 2003; 361: 449–56PubMedCrossRefGoogle Scholar
  232. 232.
    Calverley PMA, Pauwels RA, Vestbo J, et al. Salmeterol/fluticasone propionate combination for one year provides greater clinical benefit than its individual components in COPD [abstract]. Am J Respir Crit Care Med 2002; 165: A226Google Scholar
  233. 233.
    Aubier M, Wettenger R, Gans SJM. Efficacy of HFA-beclomethasone dipropionate extra-fine aerosol (800 μg day) versus HFA-fluticasone Propionate (1000 μg day) in patients with asthma. Respir Med 2001; 95: 212–20PubMedCrossRefGoogle Scholar
  234. 234.
    Aubier M, Pieters WR, Schlosser NJ, et al. Salmeterol/fluticasone propionate (50/500 microg) in combination in a Diskus inhaler (Seretide) is effective and safe in the treatment of steroid-dependent asthma. Respir Med 1999; 93: 876–84PubMedCrossRefGoogle Scholar
  235. 235.
    Dal Negro RW, Pomari C, Tognella S, et al. Salmeterol and fluticasone 50μg/250μg bid in combination provides a better long-term control than salmeterol 50μg bid alone and placebo in COPD patients already treated with theophylline. Pulm Pharmacol Ther 2003; 16: 241–6CrossRefGoogle Scholar
  236. 236.
    Papi A, Canonica GW, Maestrelli P, et al. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N Engl J Med 2007; 356: 2040–52PubMedCrossRefGoogle Scholar
  237. 237.
    Papi A, Paggiaro P, Nicolini G, et al. Beclomethasone/formoterol versus budesonide/formoterol combination therapy in asthma. Eur Respir J 2007; 29: 682–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Adrian Gillissen
    • 1
  • Hubertus Wirtz
    • 2
  • Uwe Juergens
    • 3
  1. 1.St. George Medical CenterRobert-Koch-HospitalLeipzigGermany
  2. 2.Department of Pulmonary MedicineUniversity HospitalLeipzigGermany
  3. 3.University Hospital BonnBonnGermany

Personalised recommendations