A tool for recognizing asthma nonadherence during disease management: A prospective cohort study

BACKGROUND: The adherence of asthma patients remains an urgent issue that needs to be addressed, and there is still a lack of tools for the rapid identification of nonadherence. METHODS: A number of factors associated with increased risk of nonadherence were compared with adherence assessed using the Medication Adherence Report Scale for Asthma (MARS-A). Among them was the tool for recognizing asthma nonadherence (TRAN), which is the ratio between the patient’s perceived overall health measured using a 0–100 visual analog scale and their asthma control test score. The development set used data from a multicenter, prospective cohort study in asthma. The TRAN was then validated in a further test set of asthma patients. RESULTS: Data from 518 participants who completed 3-month follow-up formed the development set. TRAN was the best predictor of nonadherence as defined by MARS-A (odds ratio = 9.14; 95% confidence interval [CI]: 4.16, 20.10; P < 0.01) in univariate logistic regression analysis. Its area under the curve (AUC) for identifying nonadherent patients was 0.810 (95% CI: 0.753, 0.866), at a cutoff score of 1.08, its sensitivity was 82.0%, specificity was 84.4%, positive predictive value (PPV) was 55.8%, and negative predictive value (NPV) was 95.1%. In the validation group ( n = 175), the AUC was 0.75 with PPV and NPV at 56.4% and 90.8%, respectively. CONCLUSION: The TRAN is a simple method for the initial screening of asthma patients for potential nonadherence.