Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients

Background: To validate the ‘Test of Adherence to Inhalers’ (TAI), a 12-item questionnaire designed to assess the adherence to inhalers in patients with COPD or asthma. Methods: A total of 1009 patients with asthma or COPD participated in a cross-sectional multicenter study. Patients with electronic adherence ≥80% were defined as adherents. Construct validity, internal validity, and criterion validity were evaluated. Self-reported adherence was compared with the Morisky-Green questionnaire. Results: Factor analysis study demonstrated two factors, factor 1 was coincident with TAI patient domain (items 1 to 10) and factor 2 with TAI health-care professional domain (items 11 and 12). The Cronbach's alpha was 0.860 and the test-retest reliability 0.883. TAI scores correlated with electronic adherence (ρ=0.293, p=0.01). According to the best cut-off for 10 items (score 50, area under the ROC curve 0.7), 569 (62.5%) patients were classified as non-adherents. The non-adherence behavior pattern was: erratic 527 (57.9%), deliberate 375 (41.2%), and unwitting 242 (26.6%) patients. As compared to Morisky-Green test, TAI showed better psychometric properties. Conclusions: The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma and COPD

A New Therapeutic Approach Based on a Reinterpretation of Asthma Control

The concept of asthma control is fundamental because it establishes a target for treatment, but despite the diversity of definitions, a high proportion of patients fail to achieve it. In this article, we highlight the shortcomings of the current concept of control by discussing aspects such as the differences between patient- and physician-perceived control and the limitations of the tools used to assess it. We also comment on the drawbacks of the stepwise approach to achieve control recommended by guidelines: the absence of conclusive evidence on the exclusive use of as-needed budesonide/formoterol in mild asthma, the lack of consideration of the different pharmacological properties of the currently available inhaled corticosteroids (ICS) and ignoring the existence of different asthma endotypes, some of which are resistant to these drugs. Other aspects, such as adherence to medication, the use of rescue medication, the influence of the inhalation device, the particle size, the pharmacological characteristics, and the lung deposition of ICS, are also mentioned. As an alternative to the guidelines´ recommendations, we propose a more customized approach based on the identification of therapeutic goals and treatable traits