by EBSCO Medical Review Board

Asthma narrows the airways and makes it difficult for people to breathe. When taken regularly, inhaled corticosteroids can prevent asthma symptoms and attacks. However, some people forget to take their medication as prescribed, don't understand why it is important, or don't like the side effects. Missing doses of can lead to asthma flare-ups.

Researchers wanted to assess the efficacy and safety of interventions intended to improve adherence to inhaled corticosteroids among people with asthma. The study, published in the Cochrane Database of Systematic Reviews, found that a variety of interventions can improve adherence.

About the study

The systematic review of 39 randomized controlled trial included over 16,000 children and adults with asthma who were using steroid inhalers. Most of the studies collected data at 6 months. Compared to the control group (usual asthma care), studies looked at strategies to improve adherence to asthma medication.

The review found:

  • A 20% increase in adherence in participants who were given education about adherence (20 studies)
  • A 19% increase in adherence in participants who used electronic trackers and reminders to take their medication (11 studies)
  • A 4% increase in adherence in participants who were given an easier way of taking their inhaler, such as fewer times a day (4 studies)

How Does this Affect You?

A systematic review combines a number of smaller trials to create a larger pool of participants. The larger the pool of participants the more reliable the outcomes are. In these studies, most of the participants knew which group they were in, which may have resulted in bias. The studies also had a high participant dropout rate, which brings the results into further question.

The review is only as reliable as the studies that are included. The 4 strategies in the studies that were included in this review were very different from one another. None of the strategies showed significant benefit when it came to clinical outcomes, such as asthma control, unscheduled doctor visits, and quality of life. In addition, most studies collected data at 6 months. This means that we cannot say whether these strategies would work in the long term beyond the 6 month data collection point.

If you are having difficulty taking your inhaled corticosteroids as prescribed, talk to your doctor about strategies to improve adherence. While one strategy may work for one person, it may not work for another. The strategies in this study are easy to implement and do not have side effects associated with them.


American Academy of Allergy, Asthma and Immunology 

American Lung Association 


Asthma in adults and adolescents. EBSCO DynaMed Plus website. Available at: . Updated October 25, 2017. Accessed November 29, 2017.

Enhancing patient adherence to asthma therapy. EBSCO DynaMed Plus website. Available at: . Updated November 2, 2017. Accessed November 29, 2017.

Normansell R, Kew KM, et al. Interventions to improve adherence to inhaled steroids for asthma. Cochrane Database Syst Rev. 2017 Apr 18;4:CD012226.

Revision Information