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P91 A review of severe asthma patients’ adherence to preventer inhalers after 12 months of mepolizumab

In 2018, the Severe Asthma team at Wythenshawe Hospital assessed adherence to preventer inhalers in long-tern omalizumab patients and found that 50.6% of patients were non-adherent (1). In response, service improvements focussed on patient education and closer monitoring of adherence were implemented. All patients initiating on biologic therapies now have an education session with the Severe Asthma Pharmacist where the importance of adherence is highlighted. The Severe Asthma nurses reiterate this at each visit and adherence is reassessed after 12 months on biologics. To assess the impact of these service improvements we reviewed the adherence of 50 patients who had received 12 months of mepolizumab. In line with the North West Severe Asthma Network criteria for biologic approval, a patient was classified as adherent if they had collected over 80% (10/12) of prescriptions for their preventer inhaler, from their GP. In addition, ACQ-7 scores, forced exhaled nitric oxide (FENO) and forced expiratory volume (FEV1) at baseline and 12 months in the adherent vs non-adherent groups were compared. 10% (5/50) of patients had collected less than 80% of their preventer inhaler prescriptions in the last 12 months. In the non-adherent group ACQ-7 scores had risen at 12 months, indicating poorer asthma control. FENO increased in both groups. FEV1 had fallen in the adherent group. In conclusion, the results indicate that the service improvements we have implemented have led to improved collection of prescriptions for preventer inhalers. Non-adherent patients demonstrated a decrease in asthma control through a rise in their ACQ-7 scores. However, the median ACQ-7 and FENO score are better in the non-adherent group compared to the adherent group. These results compare to those seen in the omalizumab adherence review. This raises the question of whether non-adherence is related to patients’ illness perception and a belief that they are better controlled and therefore do not require their preventer inhalers. In these patients the perceptions and practicalities approach (PAPA®) can be used to make targeted interventions to improve adherence. Reference Allen DJ, et al. Non-adherence with inhaled preventer therapy in severe asthmatic patients on long term Omalizumab. ERJ 2018;54:1.Abstract P91 Table 1 Median values at baseline and 12 month in adherent and non-adherent groups Adherent group Non-adherent group Baseline FEV1 (litres) 2.66 (IQR 1.33) 2.4 (IQR 1.52) Current FEV1 (litres) 1.75 (IQR 1.14) 2.41 (IQR 1.66) Baseline ACQ-7 4 (IQR 2.15) 2 (IQR 2.84) Current ACQ-7 3.57 (IQR 1.93) 2.8 (IQR 3.08) Baseline FENO (ppb) 22 (IQR 31) 16 (IQR 15) Current FENO (ppb) 31 (IQR 28.5) 22 (IQR36)