Payel Gupta, MD: Improving Adherence in Patients with Severe Asthma


With so many new therapies available for patients with severe asthma, the array of treatment options has never been stronger. However, getting these patients to adhere to their prescribed asthma medications is an entirely different challenge than choosing the asthma therapy that fits the diagnosis. When it comes to severe asthma management, it's all about finding the middle ground.

Payel Gupta, MD, allergist and immunologist, ENT & Allergy Associates, national spokesperson for the American Lung Association:

Adherence is huge for us. No matter what area of medicine you practice, you want to know that your patient is taking the medication. I always tell my asthmatics this: If you're not using the treatments, then I'm just going to keep adding more. I'm just going to keep giving you more, I'm going to keep increasing the dose, and I'm going to keep trying to figure out why the treatment's not working.

It turns into a bigger problem once we start doing that, because then the patient has even more medications and then they start using one, but not the other, and it turns into a big mess.

Adherence is something that we constantly talk about in medicine, and how we can improve patient adherence. I think talking with the patients and coming up with a plan together, versus just throwing stuff at them is one of the most important things that I think helps with adherence.

Figuring out what their schedule is like, what makes them nervous. Some patients won't tell you right off the bat, "Hey, I don't want to use a pill," or "Hey, I don't want to use an inhaler," or "I don't want to use a nasal spray," because they've had negative outcomes or they've experienced some side-effects that they didn't like.

So you have to talk to them. Does this make you comfortable? Are you OK with this plan? Are there any questions that you have?

A lot of us are also talking about how often you call, or have your nurses call patients after a week and check in on them, or 2 weeks, and how quickly do you follow up with them during an actual office visit?

There's no written protocol for any of this stuff. You kind of figure it out as you go along. What works for your practice, what works for your patients and what makes you feel comfortable.

Patient compliance improves when they feel like they had an option, and when they feel like they were a part of that decision in which therapy to use.

And then obviously cost is also a huge issue, and I have patients that I'll ask, "Why aren't you taking it?" And they say, "Oh, well it costs like $150, doc, I can't afford that!"

Just let me know. We have no idea when we send the prescription what their copay is going to be. Part of my initial spiel to people is that when you get to the pharmacy, if it's super expensive, if they say it's not covered, if you're paying over 50 bucks for anything, I want to know.

Maybe there's something else that your insurance plan likes better, and it's the same as the other medication that I want to use, so we can use the other alternative. There are so many options now, and that's why it gets confusing for the doctors and the patients.

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