Therapieadhärenz bei Asthma bronchiale

Zusammenfassung

Das Asthma bronchiale ist eine chronische Erkrankung, die ab dem Schwergrad 2 eine Dauertherapie erfordert. Entscheidend für einen guten Therapieerfolg ist neben der richtigen Medikamentenauswahl und der leitliniengerechten Therapie die korrekte Patientenmitarbeit, die im Mittel allerdings nur ca. 50 % beträgt. Typischer Weise ist die Mitarbeit der Patienten mit Asthma bronchiale bei der Bedarfsmediation (reliever) besser als bei der Dauertherapie (controller). Eine schlechte Mitarbeit ist meist mit einer Untertherapie und in der Folge mit einer schlechten Behandlung assoziiert. Höheres Patientenalter, Frauen, höherer Ausbildungsstandard und sozio-öknomischer Status, Krankheitsverständnis und Kenntnisse über das Asthma sowie die Therapieprinzipien, geringere Medikamentenmenge (inkl. inhalativer Kombinationspräparate) und ein gutes Patienten-Arzt-Verhältnis sind die wichtigsten die Patientenmitarbeit positiv beeinflussenden Faktoren. Es gibt keinen goldenen Standard zur sicheren Quantifizierung der Patientenmitarbeit. Meistens wurden in Compliance-/Adherence-Studien die Einlösung von Rezepten oder mit elektronischem Chip-ausgerüstete Inhalationsgeräte bzw. Tablettendöschen verwendet. Die Selbstbeurteilung durch den Patienten, das Wiegen der Dosieraerosole und die Einschätzung durch den Arzt erwiesen sich dabei als besonders fehleranfällige und ungenaue Verfahren. In dieser Übersicht erfolgt eine Bestandsaufnahme der die Patientenmitarbeit positiv oder negativ beeinflussenden Faktoren und der zur Verfügung stehenden Messinstrumente.

Summary

Asthma is a chronic disease requiring regular use of controller medication (e.g. inhaled corticosteroids at step 2 of treatment guidelines) to improve symptoms and prevent exacerbations. However, inadequate patient adherence/compliance to prescribed treatment regimens is a major cause of poor clinical outcome. Adherence rates in these patients are generally about 50%. Typically, adherence with reliever medication is better than with controller medications. Poor compliance most often results in infrequent and lower than prescribed taking of medication. While older age or female gender are fixed factors, some modifiable characteristics which can achieve better adherence include formal education, higher socioeconomic status, belief that asthma is a serious illness, fewer concerns about the side effects of their medication, shortened and simple treatment regimens (including the prescription of inhaled fixed-combination devices), patient-oriented devices for inhalation therapy, and good patient-physician relationship. There is no gold standard for quantifying patient adherence. In general, direct measures of assessing patient behavior, such as direct observation or electronic inhaler monitoring, give a more accurate, valid indication than indirect methods such as patient diaries, self-reporting, weighting of inhaler devices or doctors' judgment. An understanding of the barriers that impede guideline adherence, described in this article, is necessary before programs are designed to initiate changes in the practices of the treating doctor.

Schlüsselwörter

Asthma - Patientenmanagement - Arzt-Patient-Beziehung - Applikationsform - Compliance - Adhärenz

Key words

Asthma - patient management - adherence - compliance - application form

Literatur

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