A multi-disciplinary team (MDT) approach to improve adherence to inhaled corticosteroids (ICS) and severe asthma management

<bold>Background:</bold> Enhancing inhaled corticosteroid (ICS) adherence in severe asthma can be challenging. We applied an MDT algorithm to address this issue. <bold>Objectives:</bold> To evaluate the effectiveness of the MDT algorithm in detecting and enhancing ICS adherence (Figure 1). <bold>Methods:</bold> We conducted a 12-month prospective study to assess the effectiveness of this algorithm in our severe asthma service, including a pharmacist-led clinic, a connected-inhaler clinic using an electronic monitoring device (EMD) and a complex adherence clinic. Non-adherence was determined by EMD or Prescription Possession Ratio (PPR), indicating ≤75% ICS usage. <bold>Results:</bold> The pharmacist-led clinic followed 105 patients [mean age 46 years (17-78), 71% females]. Non-adherent patients per PPR was reduced from 53 (50%) at baseline to 26 (25%) at the end visit, p<0.001. PPR median increased from [75% (58,100) to 100% (80,100) at the end visit, p<0.001]. Patients with 1≥asthma exacerbations reduced from 94 at baseline to 59 at the end visit, p<0.001. The connected clinic followed 98 patients, of which 75 and 26 attended 1-month and 6-12-month visits, respectively. Non-adherent patients per EMD reduced from a baseline of 22/75 to 10/75 (p=0.01) and 7/26 to1/26 (p=0.01) at visits 1 and 6-12 months respectively. The asthma exacerbation median reduced from a baseline of [5 (1,4) to 3 (0,2) on the 12-month visit, p=0.07]. Non-adherent patients who followed complex clinic (n=11) reduced from a baseline of 7 to 3 at the end visit, p<0.05 and PPR increased from a baseline median of [66% (42,100) to 100%(100,100), p=0.01]. <bold>Conclusions:</bold> This approach is associated with enhanced ICS adherence and reduced asthma exacerbations.