ABSTRACT
OBJECTIVES: To identify patients' beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. METHODS: We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT™), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). RESULTS: Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0 ± 4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5 ± 2.0 and 53% were adherent. Adherence was significantly associated with patients' understanding of the disease and inhaler techniques, and with patients' acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p < 0.01 for all). In multivariate analysis, three questions related to patients' acceptance of inhaler medicines remained significantly associated with poor adherence, after adjusting for potential confounders: "I am not sure inhaler type medicines work well" (p = 0.001), "Taking medicines more than once a day is inconvenient" (p = 0.002), and "Sometimes I skip my inhaler to use it over a longer period" (p < 0.001). CONCLUSIONS: Our study showed that patients' acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.
Subject(s)
Anti-Asthmatic Agents/administration & dosage , Asthma/drug therapy , Asthma/psychology , Health Knowledge, Attitudes, Practice , Medication Adherence/psychology , Adult , Age Factors , Aged , Anti-Asthmatic Agents/therapeutic use , Body Mass Index , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Nebulizers and Vaporizers , Patient Acceptance of Health Care/psychology , Quality of Life , Sex Factors , Socioeconomic FactorsABSTRACT
INTRODUCTION: Sudden cardiac death is a known complication of acromegaly. Little is known of the exact mechanism leading to sudden cardiac death in these patients. Ventricular tachyarrhythmias may be an important cause. If this is so, clinical markers of ventricular tachyarrhythmias may be more common in this group of patients. The presence of these markers allow better risk stratification among acromegalic patients. METHODS: We performed signal averaged electrocardiography and analysed 12 lead electrocardiography for QT dispersion on 17 acromegaly patients who attended the UKM endocrine clinic within a period of 5 months and compared them with similar age matched controls. Signal averaged electrocardiogram was performed using Marquette Mac 12/15 ECG analyser and QT intervals were measured manually from 12 lead ECG tracings. Late potential positivity was defined by the standard Breithardt criteria. QT dispersion was defined as the longest minus the shortest QT interval from all 12 lead tracings. Echocariography was done to assess left ventricular hypertrophy in patients and controls. RESULTS: Late potential positivity was found to be more common in acromegaly patients compared with controls (chi-square, p < 0.05, n = 34) and QT dispersion was also found to be significantly higher in the acromegaly group compared with control s (mean +/- SE QT dispersion respectively 121.0 +/- 8.6 ms vs 86.2 +/- 7.0 ms, t-test, p < 0.05, n = 34). Left ventricular hypertrophy was present in five acromegaly patients and two in the control group. CONCLUSION: Acromegaly patients have a higher incidence of late potential positivity and higher QT dispersion compared with age matched controls. These findings might explain the increase susceptibility of these patients to sudden cardiac deaths from ventricular tachyarrhythmias.
