Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients
Received 3 August 2009; received in revised form 25 September 2009; accepted 19 October 2009.
Background
Complementary and alternative medicines (CAM), such as herbal remedies, are widely used by patients with chronic diseases, such as asthma. However, it is unclear whether use of the herbal remedies is associated with decreased adherence to inhaled corticosteroids (ICSs), a key component of asthma management.
Objective
To examine the association among use of herbal remedies, adherence to prescribed ICSs, and medication and disease beliefs.
Methods
We surveyed 326 adults with persistent asthma who received care at 2 inner-city outpatient clinics. Patients were asked about CAM use (teas, herbs, and rubs) for the treatment of asthma in the prior 6 months. Medication adherence was assessed using the Medication Adherence Report Scale, a validated self-report measure. Univariate and multiple regression analyses were used to assess the relationship among herbal remedy use, adherence to ICSs, and medication and disease beliefs.
Results
Overall, 25.4% (95% confidence interval, 20%–30%) of patients reported herbal remedy use. Univariate analyses showed that herbal remedy use was associated with decreased ICS adherence and increased asthma morbidity. In multivariable analysis, herbal remedy use was associated with lower ICS adherence (odds ratio, 0.4; 95% confidence interval, 0.2–0.8) after adjusting for confounders. Herbal remedy users were also more likely to worry about the adverse effects of ICSs (P = .01).
Conclusions
The use of herbal remedies was associated with lower adherence to ICSs and worse outcomes among inner-city asthmatic patients. Medication beliefs, such as worry about ICS adverse effects, may in part mediate this relationship. Physicians should routinely ask patients with asthma about CAM use, especially those whose asthma is poorly controlled.
⁎Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
†Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York
‡Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
§Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
¶Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York
∥Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, New York
Requests for reprints should be addressed to: Angkana Roy, MD, Department of Pediatrics, Mount Sinai School of Medicine, Box 1198, One Gustave L. Levy Place, New York, NY 10029
Disclosures: Dr Li is 45% owner of Herbal Springs, LLC; Dr Leventhal has received reimbursement for travel expenses (related to presenting his research at national and international meetings) from the American Diabetes Association and the National Heart, Lung, and Blood Institute; and Dr Wisnivesky is a member of the research advisory board of EHE International and the recipient of a research grant from GlaxoSmithKline.
Funding Sources: This study was supported by a grant from the Food Allergy Initiative (Dr Li), a grant from the National Center for Complementary and Alternative Medicine (Dr Li), the National Institutes of Health (Dr Leventhal), grant K08 HS013312 from the Agency for Healthcare Research and Quality (Dr Wisnivesky), grant RO1 HS09973 from the National Institute on Aging, grant P01 AT002625-01 from the National Center for Complementary and Alternative Medicine, and Research Training Grant in Environmental Pediatrics 5T32 HD049311 from the National Institutes of Health.
ABSTRACT