Allergy Asthma Immunol Res.  2013 Nov;5(6):357-364. 10.4168/aair.2013.5.6.357.

Lost to Follow-Up in Asthmatics Does Not Mean Treatment Failure: Causes and Clinical Outcomes of Non-Adherence To Outpatient Treatment In Adult Asthma

• Kang MG
• Kim JY
• Jung JW
• Song WJ
• Cho SH
• Min KU
• Kang HR

• KMID: 2260278
• DOI: http://doi.org/10.4168/aair.2013.5.6.357

Abstract

PURPOSE
Long-term asthma management is recommended to asthmatics; however, many patients do not adhere to follow-up treatment. It is unclear why many asthmatics do not adhere to follow-up treatment and long-term clinical course after discontinuation of asthma management. This study investigates the factors associated with loss to follow-up and observes the clinical course in asthmatics who discontinued asthma treatment.
METHODS
A retrospective investigation was conducted after reviewing medical records of adult patients who were newly diagnosed with asthma at a university hospital in Seoul, South Korea from January 2005 to March 2007. We compared baseline demographics and the clinical and laboratory profiles of patients to see if they successfully adhered to the treatment at an outpatient clinic for at least 3 years. The clinical course and asthma control status were surveyed by telephone for patients who were lost to follow-up within 3 years.
RESULTS
A total of 351 (73.9%) out of 475 patients were lost to follow-up within 3 years of asthma diagnosis. Patients lost to follow-up were younger and had clinical features of less severe asthma at time of diagnosis (higher FEV1 and PC20, and lower grade treatments) compared to patients who adhered to the follow-up for longer than 3 years (all P<0.05). Among the 198 responders to the telephone survey, 124 responders (62.6%) answered that they eventually discontinued asthma medication. A significantly higher proportion of the 124 responders who discontinued asthma treatment maintained symptom improvement compared to the 74 responders who continued asthma medication (77.4% vs. 55.4%, P=0.003).
CONCLUSIONS
Almost three quarters of newly diagnosed asthmatics discontinued asthma medication within 3 years despite a medical recommendation. There are considerable numbers of asthmatics who can maintain long-term asthma control status without medication.

Keyword

Asthma; medication adherence; lost to follow-up; surveys; telephone; questionnaires

MeSH Terms

Adult
Ambulatory Care Facilities
Asthma
Demography
Follow-Up Studies
Humans
Lost to Follow-Up
Medical Records
Medication Adherence
Outpatients
Republic of Korea
Retrospective Studies
Telephone
Surveys and Questionnaires

Figure

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  Fig. 1 Schematic diagram of the study design according to adherence and treatment continuity.

• 

  Fig. 2 Kaplan-Meier survival analysis of adherence and Cox-regression according to clinical parameters. (A) Adherence rates at the end of the 1st, 2nd, and 3rd years: 48.8%, 36.4%, and 26.1%, respectively. (B) FEV1<80%, OR=0.687, 95% CI: 0.55-0.86, P =0.001. (C) Age≥50, OR=0.709, 95% CI: 0.58-0.87, P =0.001. (D) Presence of lower respiratory symptoms (LRS), OR=0.742, 95% CI: 0.57-0.96, P =0.024.

• 

  Fig. 3 Telephone survey results for patients with lost to follow-up. (A) Cause of lost to follow-up. (B) Current control status. (C) Treatment continuity at other facilities. (D) Current asthma control status according to treatment continuity.

• 

  Fig. 4 Mean scores from the questionnaire for (A) the Asthma Control Test (ACT) and (B) cough (one of the parameters for the Korean Asthma control test [K-ACT]) in patients who were lost to follow-up but responded to the telephone survey. *P<0.001; †0.001≤P<0.01

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