The study authors found that there are many barriers to adherence, some of which can be addressed through improved doctor-patient communication.

Below, Apter and George share their study findings as well as strategies for maintaining a drug schedule.

What were you hoping to learn from this study?
Apter: Understanding why patients don't take their medicines is a very complicated issue. As providers, we only see one aspect of the patient: when the patient comes to clinic. We don't know about all the things in their life that impact whether they take their medicines.

George: We have these great medications that people don't seem to have accepted. Before we design interventional studies to try and improve compliance, we wanted to conduct these focus groups to get a better understanding of the attitudinal beliefs that may influence patients' decision-making.

What were some of the reasons people weren't taking their medicine consistently?
George: Many of the patients skipped their medicines when they came home late because they believed it was safer to omit a dose than to take a dose late. And yet, if you were to ask any asthma provider, we would say it would be much wiser to take that dose than to skip a dose.

There were also some specific fears of the side effects of the medications that weren't true, such as the belief that the medication could cause organ damage, cancer and infertility or sterility.

One of the barriers that was specific to this population was the belief that the patient's assessment of their disease control was superior to that of their provider.

Apter: Insurance coverage was another barrier. Some patients get 28 days worth of medicine through their insurance because that's considered a month's worth. They can't get those extra two days refilled until the new month, so they run out. That causes patients to not take their medication one day so that they have it when they really need it.

What are the consequences of not maintaining an asthma regimen?
George: The risk of undertreating asthma is, at best, suboptimal control and, at worst, death. Suboptimal control could include more acute asthma attacks and the risk of developing permanent damage to the lungs. It could also include more acute care needs — such as unplanned doctor visits or intensive care admissions — absenteeism from work or school, poor exercise tolerance, poor quality of life and nocturnal awakenings.

What strategies did patients find helpful?
George: Asthma educators and clinicians have been told by the experts that patients should just leave their medication at home and take it when they get up in the morning and go to bed at night. The patients in this study told us that they felt that the provider should encourage them to carry their medicines with them because they have chaotic lifestyles. Another theme was to offer fewer medicines that can be taken less frequently.

Apter: Different people had different solutions. For example, one woman thought of taking her medicine when her children took theirs. A man who went to work early in the morning put his medicine in the car and would take it on the way to work.

What did patients say about their relationship with their doctors?
Apter: Our patients liked their physicians, who came from one practice. But many of them described experiences in the past where they didn't feel that a physician listened to them. They felt the physician or the provider wasn't empathetic or didn't provide them the time and the individualized attention that they needed.

How can caregivers or family members help a patient stay on schedule?
Apter: If the patient's family has the time, coming with the patient to appointments is always helpful because they can support the patient. If that is not possible, a phone conversation with doctor, while the patient listens, could be helpful.

George: Some patients said, "My family members don't trust these medicines and don't trust the doctors." But many of the patients also felt that the family members were actually tougher on them. They didn't want their family members to know that they hadn't been taking their medicine. If family members came to the doctor with the patient, they'd have a better understanding of the burden of the disease and the complexity of the regimen. Family members might then learn to be more understanding of lapses in therapy and still provide some motivation for the patient to stay on the straight and narrow.