Primary adherence to controller medications for asthma is poor

Ann Am Thorac Soc. 2015 Feb;12(2):161-6. doi: 10.1513/AnnalsATS.201410-459OC.


Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.

Objective: To compare adherence to the major controller medication regimens for asthma.

Methods: This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).

Measurements and main results: Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting β-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.

Conclusions: Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.

Keywords: adherence; asthma; inhaled corticosteroids; leukotriene antagonists; medications.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Adrenergic beta-Agonists / therapeutic use*
  • Adult
  • Aged
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Black or African American / statistics & numerical data
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Leukotriene Antagonists / therapeutic use*
  • Logistic Models
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Young Adult


  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists
  • Anti-Asthmatic Agents
  • Leukotriene Antagonists