Adherence

Question 1

Learning outcomes of inhaler adherence lecture

Answer 1

• Extent and consequences of non-adherence in asthma
• Barriers to adherence
• Strategies to address barriers

Question 2

Rates of adherence in asthma

Answer 2

• Adults: ~30–70%
• Lowest in adolescents and young adults

Question 3

Consequences of poor adherence

Answer 3

• Increased symptoms
• Increased healthcare use
• Reduced quality of life/social function
• Increased asthma mortality

Question 4

COM-B model components

Answer 4

• Capability
• Opportunity
• Motivation

Question 5

Capability in asthma (COM-B)

Answer 5

• Knowledge and skills to use inhaler
• Shown how to use?
• Remember technique?
• Able to use correctly?

Question 6

Opportunity in asthma (COM-B)

Answer 6

• Physical: chance to use when needed
• Social: embarrassment, support from others

Question 7

Motivation in asthma (COM-B)

Answer 7

• Belief in benefits (short/long-term)
• Concerns about harms (short/long-term)

Question 8

Top inhaler mistakes (1–5)

Answer 8

• Wrong technique for device
• Not using spacer
• Not breathing out fully first
• Not shaking inhaler
• Not lifting chin before inhalation

Question 9

Top inhaler mistakes (6–10)

Answer 9

• Breathing too early/late
• Not waiting between puffs
• Poor lip seal
• Not holding breath after use
• Not rinsing mouth after steroid inhaler

Question 10

Necessity–Concerns Framework

Answer 10

• Patients weigh need vs concerns
• Higher adherence when perceived need > concerns

Question 11

Patient beliefs affecting adherence

Answer 11

• Understanding of condition
• Perceived need for medicine
• Concerns about side effects

Question 12

Strategies to improve adherence (communication)

Answer 12

• Involve patient in decisions
• Explain benefits and risks
• Address concerns

Question 13

Strategies to improve adherence (practical)

Answer 13

• Demonstrate technique
• Simplify regimen
• Address barriers in consultation

Question 14

Structured consultations to optimise medicines

Answer 14

• New Medicines Service (NMS)
• Structured Medication Review (SMR)
• Supports long-term conditions incl. asthma/COPD

Question 15

NICE adherence guidance

Answer 15

• Ask beliefs and understanding
• Ask about concerns
• Review medicines regularly

Question 16

Key principle about inhalers

Answer 16

• Must be used correctly to gain benefit
• Non-adherence common but modifiable

Question 17

Effect of structured consultations

Answer 17

• Improve understanding
• Improve inhaler technique
• Improve adherence

Question 18

MCQ concept: which belief profile gives best adherence?

Answer 18

• Few concerns + high perceived need for inhaler