Improving adherence to asthma medication: What are the most clinically and cost-effective strategies to improve medicine adherence in adults with asthma who are non-adherent to prescribed medicines?

Zuha Akhtar; Kanita Farooq; Ishpreet Singh; Maria Babu

Abstract:

Title:

What are the most clinically and cost-effective strategies to improve medication adherence in adults with asthma who are non-adherent to prescribed medicines?

Background:

Optimal asthma control depends on both pharmacological intervention and self-management, including adherence to treatment, symptom monitoring, correct inhaler use, and managing triggers. Consistent adherence reduces disease burden, hospitalizations, and mortality, while improving quality of life. Poor adherence to treatment strategies and prescribed medication remains a major concern across all age groups. Additionally, asthma imposes a significant economic burden, costing the NHS GBP 300 billion annually, largely from preventable events. Improving adherence is therefore a clinical and economic priority to ensure sustainable and accessible treatment. Strategies include behavioural support and patient education.

Method:

This systematic review was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was registered on PROSPERO. Multiple databases were searched using pre-determined terms. Eligible studies included randomized controlled trials and observational studies (case control, cohort, and cross-sectional) that investigated interventions aiming to improve adherence to prescribed asthma medications in adults. Two independent reviewers screened and extracted data. Outcomes reported include asthma control, hospitalizations, exacerbation frequency, and cost-effectiveness.

Results:

Eight included studies tested interventions to improve asthma outcomes and medication adherence, including personalised asthma action plans (PAAPs), digital and educational tools, and specialist follow-up after exacerbations. PAAP improved knowledge and satisfaction (p<0.05), but not adherence or lung function. Mobile apps and reminder tools showed modest benefit but no significant impact on clinical outcomes. Specialist follow-ups after exacerbations improved adherence (p<0.001). Additionally, when comparing individualised outcomes to caregiver-assisted approaches, the former showed better asthma control at 3 and 6 months (p<0.01).

Conclusion:

Interventions showed mixed effects, and adherence remained low overall. Further research is needed to study interventions that show promise, including individualised approaches, education, and follow-up support.