A recent article in JACI-In Practice says that not taking medicines for chronic disease as directed accounts for some 125,000 deaths in the US. This involves some 3500 asthma fatalities. “The Hidden Story of Nonadherence with Asthma Therapy: For a Few Dollars More?” (Van Boven & Chapman) attributes poor adherence to “asthma’s symptom variability, its error-prone delivery systems, and reliance on patient self-monitoring…” The authors cite several categories of nonadherence: According to the WHO, we should consider 3 broad categories of nonadherence: “(1) erratic (more commonly known as forgetfulness), (2) unwitting (eg, using reliever as preventer, poor self-management, and poor inhaler technique), and (3) intelligent nonadherence (eg, nonintake due to fear of steroids or medication dependence).” The problem is no better in countries with universal health care systems than our own.
Within that last one is the high cost of medicines. Another article in the same issue discusses this in detail. (Laba et al) A study in Australia shows that 25% of patients don’t fill their prescriptions due to cost. Per capita asthma fatalities are much higher in Australia than in the US.