Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

Taylor L. Brooks, Howard Leventhal, Michael S. Wolf, Rachel O’Conor, Jose Morillo, Melissa Martynenko, Juan P. Wisnivesky, Alex D. Federman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


KEY RESULTS: The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03–9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62–8.77, p = 0.002).

MAIN MEASURES: Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. “Good adherence” was defined as a mean MARS score of 4.5 or greater.

CONCLUSIONS: Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.

BACKGROUND: Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.

OBJECTIVE: To identify medication use strategies associated with good ICS adherence in older adults.

PARTICIPANTS: English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.

Original languageEnglish (US)
Pages (from-to)1506-1512
Number of pages7
JournalJournal of general internal medicine
Issue number11
StatePublished - Nov 2014


  • asthma
  • inhaled corticosteroids
  • medication adherence

ASJC Scopus subject areas

  • Internal Medicine


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