Treatment Adherence of Asthma Patients in Latvia and Factors Related to Adherence

Research output: Types of ThesisDoctoral Thesis


Introduction: the problem of nonadherence to the therapy is one of the main reasons of insufficient asthma control. Evaluating the beliefs about asthma medication, cognitive and emotional perceptions may help to identify patients with poor adherence to treatment in clinical practice in order to provide additional attention in order to increase the likelihood to take their asthma medication regularly. Objective: the general objective of this study was to find out whether beliefs about asthma medication, cognitive and emotional factors are associated with asthma treatment and control in a sample of Latvian asthma patients in 2015. In addition, we wanted to assess whether the most commonly used questionnaires predicting treatment adherence can predict asthma control and treatment adherence. Methods: the study population of this cross-sectional patient survey consisted of asthma patients (n = 352) attending outpatient pulmonologist consultations in Latvia during September 2013 to December 2015. Beliefs about asthma medicine, cognitive and emotional factors related to asthma were determined in a cross-sectional survey of patients attending outpatient pulmonologist practices in Latvia. Level of asthma control were assessed using the Asthma control test (ACT), a validated five-item scale that reliably assesses asthma control over a recall period of four weeks. Beliefs about medication, cognitive and emotional factors was assessed using The validated Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ). Adherence to asthma medication was assessed using the Morisky Medication Adherence Scale (MMAS) and two different versions of the Medication Adherence Reporting Scale (MARS). Logistic regression models were used to predict poor adherence to asthma treatment. Results: patients who had a good control of asthma medication (OR 0.70; 95% CI 0.61–0.79) or were confident that their asthma medication improves illness (OR 0.84; 95% CI 0.74–0.95) had a reduced risk of poor asthma control. The more symptoms (OR 1.63; 95% CI 1.44–1.84) asthma patients perceived or the more their illness affected their life, the higher the probability of poor asthma control (OR 1.47; 95% CI 1.31–1.65). Several questions about necessity or concerns related to pharmaceutical treatment were able to predict poor adherence according to the Morisky scale. If the patient felt that without the asthma medication his life would be impossible, his risk to have poor treatment adherence was 46% reduced (OR 0.54; 95% Confidence interval (CI) 0.33–0.89). Furthermore, asthma patients who were convinced that their health depends on asthma treatment were less likely to have poor treatment adherence (OR 0.56: 95% CI 0.32–0.97). In case the patient was concerned by the need to constantly use asthma medication or sometimes concerned by long term effects of asthma medication the odds of poor treatment adherence were 1.96 (95% CI 1.19–3.24) and 2.43 (95% CI 1.45–4.08), respectively. Conclusions: medication beliefs, particularly concerns and necessity of asthma treatment were associated with poor treatment adherence when assessed with the Morisky or 5-item MARS scale. We recommend using either the MMAS or the 5-item MARS scale in Latvian asthma patients to identify patients with poor treatment adherence. Existing questionnaires assessing beliefs of medication necessity (Beliefs about Medications Questionnaire, BMQ), cognitive or emotional illness perception (Brief Illness Perception Questionnaire, IPQ) may be used to identify patients with poor asthma control, in order to help to identify problems of poor control and offering better treatment solutions. Thus, it may be worthwhile to assess routinely the concerns and necessity of asthma medication in patients within the Latvian health-care system to improve treatment adherence in that vulnerable population group to improve treatment outcomes and disease control.
Original languageEnglish
  • Briģis, Ģirts, First/Primary/Lead supervisor
Place of PublicationRiga
Publication statusPublished - 2018


  • Medicine
  • Subsection – Public Health
  • Doctoral Thesis

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 4. Doctoral Thesis


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