Optimizing adherence to inhaled therapy in asthma: Behavioral and digital strategies with insights from the Greek healthcare context

Adherence to inhaled therapy remains a persistent challenge in asthma management and continues to compromise disease control in routine clinical practice. Although data from Greece are limited, international evidence indicates that a substantial proportion of patients do not use their inhalers consistently or as prescribed. Suboptimal adherence is associated with avoidable exacerbations, loss of lung function, increased healthcare utilization, and inappropriate escalation of therapy, including early introduction of biologic agents. This narrative review examines recent evidence on behavioral, treatment-related, and healthcare-system factors influencing adherence to inhaled therapy in asthma, with particular attention to the Greek healthcare environment. Findings from clinical trials, meta-analyses, and real-world studies published between 2018 and 2025 are synthesized to identify determinants of adherence, methods of assessment, and strategies that support sustained treatment engagement. Across studies, adherence rates typically range between 30% and 60%, with major barriers including limited understanding of asthma as a chronic condition, concerns about inhaled corticosteroids, complex dosing regimens, and persistent inhaler technique errors. These challenges are often compounded by system-level constraints such as brief consultations and fragmented follow-up. Simplified treatment strategies, particularly once-daily inhaled corticosteroid/long-acting β₂-agonist regimens and single maintenance and reliever therapy approaches, are consistently associated with more regular medication use. Pharmacist-led interventions improve inhaler technique and daily adherence, while digital inhaler technologies support early identification of non-adherence, although their implementation in Greece remains limited. Improving adherence requires coordinated, patient-centered care that integrates behavioral support, appropriate inhaler selection, simplified regimens, and targeted use of digital monitoring within existing healthcare pathways.