Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients
ABSTRACT Complementary and alternative medicines (CAM), such as herbal remedies, are widely used by patients with chronic diseases, such as asthma. However, it is unclear whether use of the herbal remedies is associated with decreased adherence to inhaled corticosteroids (ICSs), a key component of asthma management.
To examine the association among use of herbal remedies, adherence to prescribed ICSs, and medication and disease beliefs.
We surveyed 326 adults with persistent asthma who received care at 2 inner-city outpatient clinics. Patients were asked about CAM use (teas, herbs, and rubs) for the treatment of asthma in the prior 6 months. Medication adherence was assessed using the Medication Adherence Report Scale, a validated self-report measure. Univariate and multiple regression analyses were used to assess the relationship among herbal remedy use, adherence to ICSs, and medication and disease beliefs.
Overall, 25.4% (95% confidence interval, 20%-30%) of patients reported herbal remedy use. Univariate analyses showed that herbal remedy use was associated with decreased ICS adherence and increased asthma morbidity. In multivariable analysis, herbal remedy use was associated with lower ICS adherence (odds ratio, 0.4; 95% confidence interval, 0.2-0.8) after adjusting for confounders. Herbal remedy users were also more likely to worry about the adverse effects of ICSs (P = .01).
The use of herbal remedies was associated with lower adherence to ICSs and worse outcomes among inner-city asthmatic patients. Medication beliefs, such as worry about ICS adverse effects, may in part mediate this relationship. Physicians should routinely ask patients with asthma about CAM use, especially those whose asthma is poorly controlled.
Full-textDOI: · Available from: Howard Leventhal, Jan 13, 2014
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ABSTRACT: Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults.Journal of Allergy and Clinical Immunology 09/2014; DOI:10.1016/j.jaci.2014.07.044 · 11.25 Impact Factor
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ABSTRACT: Purpose Herbal drug use for cardiovascular disease is frequent and growing rapidly. The aim of this study is to investigate the effect of herbal medicine use on medication adherence of cardiology patients. Methods All patients admitted to the outpatient cardiology clinics, who had been prescribed at least one cardiovascular drug before, were asked to complete a questionnaire. Participants were asked if they have used any herbals during the past 12 months with an expectation of beneficial effect on health. Medication adherence was measured by using Morisky Scale. High adherence was defined as a Morisky score <2 and a score ≥2 was accepted as low adherence in our study. Results Totally 390 patients, (54.9% males and 45.1% females, mean age 58.9) participated in our study. 29.7% of them had consumed herbals in past 12 months. The median Morisky score was significantly higher in herbal users than nonusers (p < 0.001). Rate of low adherence, according to the Morisky Scale, was also higher in herbal users (61.2% vs. 29.9%, p < 0.001). Number of herbals used was moderately correlated with Morisky score (ρ=0.313, p < 0.001). In stepwise multivariate logistic regression analyse, herbal use was significantly associated with low medication adherence (OR:3.76, 95% CI 2.36-6.09, p < 0.001). Conclusion Herbal use was found to be independently associated with low medication adherence in our study population. Further studies are needed to elucidate the effect of herbal medicine use on medication adherence of cardiology patients.Complementary Therapies in Medicine 08/2014; 22(4). DOI:10.1016/j.ctim.2014.05.013 · 2.22 Impact Factor
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ABSTRACT: Objectives To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy.DesignObservational cohort study.SettingPrimary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in New York, New York, and Chicago, Illinois.ParticipantsAdults with moderate or severe persistent asthma aged 60 and older (N = 433).MeasurementsOutcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults.ResultsThe mean age was 67, and 36% of participants had marginal or low health literacy. Adherence was low (38%) overall and worse in individuals with low health literacy (22%) than in those with adequate literacy (47%, P < .001) and after adjusting for demographic factors and health status (odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.31–0.73). Similarly, inhaler technique was poor; only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse in those with low health literacy (MDI technique: OR = 0.57, 95% CI = 0.38–0.85; DPI technique: OR = 0.42, 95% CI = 0.25–0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy.Conclusion Adherence to medications and inhaler technique are poor in older adults with asthma and worse in those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique and use low-literacy communication strategies to support self-management in older adults with asthma.Journal of the American Geriatrics Society 04/2014; 62(5). DOI:10.1111/jgs.12797 · 4.22 Impact Factor