Using prednisolone and cortisol assays to assess adherence in oral corticosteroid dependant asthma: An analysis of test-retest repeatability.
Pulm Pharmacol Ther
; 64: 101951, 2020 10.
Article
em En
| MEDLINE
| ID: mdl-33045343
ABSTRACT
BACKGROUND AND OBJECTIVE:
Non-adherence is an important issue within severe asthma. Prednisolone and cortisol assays have been proposed as an inexpensive, objective measure of adherence for oral corticosteroid (OCS)-dependent asthmatics, however, little is known about the reliability of these tests.METHODS:
41 severe OCS-dependent asthmatics had their prednisolone and cortisol measured during six study visits over a three month time period. Subjects were classed as non-adherent/variably-adherent if they had undetectable prednisolone and/or cortisol >100 nmol/L. Intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability of prednisolone and cortisol, and Gwets AC1 kappa was used to assess the reliability of the adherence classification. Mean change in blood eosinophils for adherent and variably/non-adherent visits were calculated and linear regression with cluster-robust standard errors was used to test for differences.RESULTS:
30 subjects were included in the analysis. Reliability was poor for prednisolone (ICC 0.43; 95% CI 0.27, 0.59), and moderate for cortisol (ICC 0.60; 95% CI 0.44, 0.74). Using the combined rule, subjects were classified as adherent during 141 (88%) visits, with 21 subjects (70%) adherent during all study visits. The adherence classification had almost perfect reliability (Kappa 0.84; 95% CI 0.74, 0.95). Blood eosinophils were decreased by 47 cells/µl (95% CI 11, 84) during adherent visits but increased by 65 cells/µl (95% CI 4, 134; Pdifference = 0.03) during variably/non-adherent visits.CONCLUSIONS:
Assessing adherence to maintenance OCS using a simple rule based on prednisolone and cortisol assays is highly reliable and correlated with blood eosinophil changes. Clinicians should have confidence in the results of this rule.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Asma
/
Hidrocortisona
Limite:
Humans
Idioma:
En
Revista:
Pulm Pharmacol Ther
Assunto da revista:
FARMACOLOGIA
Ano de publicação:
2020
Tipo de documento:
Article