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Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort

Alahmadi, Fahad H; Simpson, Andrew; Gomez, Cristina; Ericsson, Magnus; Thörngren, John-Olof; Wheelock, Craig; Shaw, Dominic E; Fleming, Louise J; Roberts, Graham; Riley, John; Bates, Stewart; Sousa, Ana R; Knowles, Richard; Bansal, Aruna T; Corfield, Julie; Pandis, Ioannis; Sun, Kai; Bakke, Per S; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Horvath, Ildiko; Krug, Norbert; Montuschi, Paolo; Singer, Florian; Wagers, Scott; Adcock, Ian M; Djukanovic, Ratko; Fan Chung, Kian; Sterk, Peter J; Dahlen, Sven-Erik; Fowler, Stephen J; Study Group, U-BOPRED


Fahad H Alahmadi

Cristina Gomez

Magnus Ericsson

John-Olof Thörngren

Craig Wheelock

Dominic E Shaw

Louise J Fleming

Graham Roberts

John Riley

Stewart Bates

Ana R Sousa

Richard Knowles

Aruna T Bansal

Julie Corfield

Ioannis Pandis

Kai Sun

Per S Bakke

Massimo Caruso

Pascal Chanez

Barbro Dahlén

Ildiko Horvath

Norbert Krug

Paolo Montuschi

Florian Singer

Scott Wagers

Ian M Adcock

Ratko Djukanovic

Kian Fan Chung

Peter J Sterk

Sven-Erik Dahlen

Stephen J Fowler

U-BOPRED Study Group


Whilst estimates of sub-optimal adherence to oral corticosteroids in asthma range from 30 to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high.

Research Questions
1. What is the prevalence of suboptimal adherence detected using self-reporting and direct measures? 2. Is suboptimal adherence associated with disease activity?

Study Design and Methods
Data were included from individuals with severe asthma taking part in the U-BIOPRED study prescribed daily oral corticosteroids. Participants completed the MARS, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid-chromatography mass spectrometry.

Data from 166 participants were included in this study, mean (SD) age 54.2 (11.9) years, FEV1 65.1 (20.5) % predicted, 58% female. 37% completing the MARS reported sub-optimal adherence, and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 35% participants who had both performed; adherence detection did not match between methods in 53%. Self-reported high-adherers had better asthma control and quality of life, whereas directly-measured high-adherers had lower blood eosinophils.

Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.


Alahmadi, F. H., Simpson, A., Gomez, C., Ericsson, M., Thörngren, J., Wheelock, C., …Study Group, U. (in press). Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort. Chest,

Journal Article Type Article
Acceptance Date Feb 2, 2021
Online Publication Date Feb 19, 2021
Deposit Date Feb 3, 2021
Publicly Available Date Feb 20, 2022
Journal Chest
Print ISSN 0012-3692
Publisher Elsevier
Peer Reviewed Peer Reviewed
Keywords Asthma; Adherence; Urinary corticosteroids
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