Asthma is common chronic disease characterized by episodic respiratory symptoms. While there are effective therapies, inadequate symptom control remains an important problem, particularly for low-income adults living in the inner-city. As in other chronic diseases, adequate self-management skills are necessary to reduce the burden from asthma. However, non-adherence to effective therapy has been repeatedly identified in patients with inadequate symptom control. Strategies focused on improving knowledge alone have not had consistent clinical benefits in patients with asthma, strongly suggesting that education alone does not modify patients? patterns of care. Patients? attitudes and beliefs about asthma and asthma care can also affect behavior. In particular, patients? self-efficacy and attitudes/beliefs regarding their ability to effectively deal with asthma symptoms may be critical for appropriate levels of adherence to effective therapy. However, recent evidence suggests that asthma self-efficacy and attitudes/beliefs about asthma control may be inadequate in high-risk inner-city adults. Objective adherence monitoring and patient feedback can identify specific adherence difficulties and reinforce effective patterns of medication use, and may thus improve self-efficacy and attitudes/beliefs about asthma control. Based on this construct, we hypothesize that objective medication monitoring with patient feedback will improve adherence to inhaled corticosteroids (ICS), the most widely used mediation for asthma control. The primary objective of this proposal is to combined asthma education with objective adherence monitoring and patient feedback as a novel integrated approach to improve adherence to ICS in inner-city adults with poor asthma control. To this end, we propose two related studies in this population: a) a prospective cohort study to objectively describe baseline patterns of adherence to ICS (Specific Aim 1), and b) a randomized intervention trial to assess the effectiveness of this novel integrated approach to improve adherence to ICS (Specific Aim 2). This body of mentored patient-oriented research will provide Dr. Krishnan new knowledge, skills, and collaborative relationships necessary to successfully apply for funding as an independent investigator during the fourth year of this award.
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