Insights into Asthma Understanding and Medication Compliance: A Study of Knowledge and Adherence among the Lebanese Population
Main Article Content
Keywords
asthma, adherence, inhaler devices, patients
Abstract
Background: The causes of the global surge in asthma cases are still unknown. It has been hypothesized that trigger factors and non-adherence to inhaler devices hinder optimal asthma treatment. The objective of this study was to evaluate adherence to the use of inhalers among Lebanese asthmatic patients and assess patient knowledge about asthma. Methods: This is a cross-sectional multicenter study conducted on adult patients with asthma recruited through community pharmacies in Lebanon. Participants filled out the questionnaire that assessed the adherence to the inhalers and evaluated their asthma knowledge. Results: Among 172 asthmatic patients with a mean age of 31.79 ± 20.92 years, 55.8% females, only 9.9% were adherent to asthma medications with a relatively low asthma knowledge (mean score of 66.74 ± 9.096). Significantly higher asthma knowledge scores were observed in married versus unmarried (p=0.027), in higher educational level compared to a lower level (p=0.039), and in individuals who sleep less than 6 hours/day compared to higher sleep hours (p=0.001). However, unmarried participants and individuals who sleep more than 6 hours/day had higher adherence to asthma medications with a p-value of 0.049) and 0.014. Regression results showed that higher educational level and individuals had significantly higher asthma knowledge scores (p=0.012), while patients who sleep more than 6 hours had lower knowledge scores (p=0.004). Conclusion: The study highlights that improper use of inhaler devices is common among enrolled participants. In addition, the study shows that the rate of non-adherence to the regimen is high and patients have a low level of knowledge about the proper use of the inhalers.
References
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School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon. Allergol Immunopathol (Madr). 2021 Jan2;49(1):40–9.
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29. Bassam M, Behbehani N, Farouk H, Alsayed M, Montestruc F, Al-Jahdali H, et al. Adherence to medication among adult asthma patients in the Middle East and North Africa: results from the ESMAA study. Respir Med. 2021 Jan;176:106244.
30. Bidwal M, Lor K, Yu J, Ip E. Evaluation of asthma medication adherence rates and strategies to improve adherence in the
underserved population at a Federally Qualified Health Center. Res Soc Adm Pharm RSAP. 2017;13(4):759–66.
31. Adherence to Asthma Control Measures Among Adults: An Assessment of Patient-Based Factors Among Patients in Mama Lucy Kibaki Hospital, Kenya [Internet]. [cited 2023 Dec 29]. Available from: https://wwjmrd.com/archive/2020/12/1461/
adherence-to-asthma-control-measures-among-adults-an-assessment-of-patient-based-factors-among-patients-in-mamalucy-kibaki-hospital-kenya
32. Determinants of non-adherence to inhaled steroids in adult asthmatic patients on follow up in referral hospital, Ethiopia: crosssectional study | Asthma Research and Practice | Full Text [Internet]. [cited 2023 Dec 29]. Available from: https://asthmarp.biomedcentral.com/articles/10.1186/s40733-019-0053-1
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34. Bahous J, Soriano JB. [Asthma control in Lebanon the asthma insights and reality in Lebanon]. J Med Liban. 2010 Dec;58(4):204– 9.
35. Khadadah M, Mahboub B, Al-Busaidi NH, Sliman N, Soriano JB, Bahous J. Asthma insights and reality in the Gulf and the near East. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2009 Aug;13(8):1015–22.
36. Benkheder A, Bouacha H, Nafti S, Taright S, El Ftouh M, Yassine N, et al. Control of asthma in the Maghreb: results of the AIRMAG study. Respir Med. 2009 Dec;103 Suppl 2:S12-20.
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38. Heluf H, Assefa N, Dessie Y, Tamiru D, Goshu AT, Fekadu G. Adherence to anti-asthma medications among adult asthmatic
patients in Eastern Ethiopia: A multi-center cross-sectional study. PLOS ONE. 2022 Dec 8;17(12):e0277796.
39. Luyster FS, Shi X, Baniak LM, Morris JL, Chasens ER. Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2020Sep;125(3):319–24.
40. Hu Z, Tian Y, Zeng F, Song X. The Association Between Sleep Duration, Asthma-Related Episodes/Attacks and Emergency Department Visits. Nat Sci Sleep. 2020 Apr 29;12:253–62.
41. Al-Harbi S, Al-Harbi AS, Al-Khorayyef A, Al-Qwaiee M, Al-Shamarani A, Al-Aslani W, et al. Awareness regarding childhood asthma in Saudi Arabia. Ann Thorac Med. 2016;11(1):60–5.
42. Panagiotou M, Koulouris NG, Rovina N. Physical Activity: A Missing Link in Asthma Care. J Clin Med. 2020 Mar 5;9(3):706.
2. Nguyen TS, Nguyen TLH, Pham TTV, Cao TBT, Nguyen VK, Hua S, et al. Effectiveness of a short training program for community
pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study. Respir Med. 2018;144:50– 60.
3. Prasad R, Kushwaha RAS, Verma S, Kumar S, Verma A, Prakash V, et al. A study to know the knowledge, attitude, and practices
of patients of bronchial asthma. Int J Med Public Health. 2013;3(3):159.
4. Ahmed R, Robinson R, Mortimer K. The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the
Middle East, and North Africa. Malawi Med J. 2017 Jun;29(2):203–11.
5. Waked M, Salameh P. Asthma, allergic rhinitis and eczema in 5-12-year-old school children across Lebanon. Public Health.
2008 Sep;122(9):965–73.
6. Tsiligianni I, Kocks JWH. Daytime symptoms of chronic obstructive pulmonary disease: a systematic review. NPJ Prim Care
Respir Med. 2020 Feb 21;30(1):6.
7. Anderson S, Atkins P, Bäckman P, Cipolla D, Clark A, Daviskas E, et al. Inhaled Medicines: Past, Present, and Future. Pharmacol Rev. 2022 Jan;74(1):48–118.
8. “Global strategy for asthma management and prevention: GINA executive summary.” E.D. Bateman, S.S. Hurd, P.J. Barnes, J.
Bousquet, J.M. Drazen, J.M. FitzGerald, P. Gibson, K. Ohta, P. O’Byrne, S.E. Pedersen, E. Pizzichini, S.D. Sullivan, S.E. Wenzel and H.J. Zar. Eur Respir J 2008; 31: 143-178. Eur Respir J. 2018 Feb;51(2):0751387.
9. C B, J K, Km B. Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly. Respir Med. 2015 Jul 20;109(10):1363–8.
10. Kovačević M, Ćulafić M, Jovanović M, Vučićević K, Kovačević SV, Miljković B. Impact of community pharmacists’ interventions on asthma self-management care. Res Soc Adm Pharm RSAP. 2018;14(6):603–11.
11. Leiria Pinto P, Cordeiro M, Pinto R. Adolescents and school asthma knowledge and attitudes. Allergol Immunopathol (Madr). 1999;27(5):245–53.
12. Evans C, Fidler A, Baker D, Wagner M, Fedele D. Sleep and asthma management in youth with poorly-controlled asthma and their caregivers: a qualitative approach. J Asthma Off J Assoc Care Asthma. 2022 Jun;59(6):1131–8.
13. Blaakman SW, Cohen A, Fagnano M, Halterman JS. Asthma medication adherence among urban teens: a qualitative analysis of barriers, facilitators and experiences with school-based care. J Asthma Off J Assoc Care Asthma. 2014 Jun;51(5):522–9.
14. Papi A, Blasi F, Canonica GW, Morandi L, Richeldi L, Rossi A. Treatment strategies for asthma: reshaping the concept of asthma management. Allergy Asthma Clin Immunol Off J Can Soc Allergy Clin Immunol. 2020 Aug 15;16:75.
15. Malaeb D, Hallit S, Sacre H, Malaeb B, Hallit R, Salameh P. Diet and asthma in Lebanese schoolchildren: A cross-sectional study. Pediatr Pulmonol. 2019;54(6):688–97.
16. Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study. J Epidemiol Glob Health. 2017 Sep 1;7(3):147–54.
17. Hallit S, Raherison C, Waked M, Salameh P. Association between Caregiver Exposure to Toxics during Pregnancy and Childhoodonset Asthma: A Case-control Study. 2017;16(6):14.
18. Malaeb D, Hallit S, Sacre H, Rahme C, Malaeb B, Hallit R, et al. Preconception Exposure to Over-The-Counter Medications and
Antibiotics and The Risk of Childhood Asthma in Lebanon: A Cross-Sectional Study. Allergol Immunopathol (Madr). 2020 Sep 21;
19. Hallit S, Raherison C, Malaeb D, Hallit R, Waked M, Kheir N, et al. Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children. Pediatr Neonatol. 2019 Apr;60(2):156–65.
20. Hallit S, Raherison C, Waked M, Salameh P. Validation of asthma control questionnaire and risk factors affecting uncontrolled
asthma among the Lebanese children’s population. Respir Med. 2017 Jan;122:51–7.
21. Akiki Z, Saadeh D, Farah R, Hallit S, Sacre H, Hosseini H, et al. Asthma prevalence and associated factors among lebanese
adults: the first national survey. BMC Pulm Med. 2021 Dec;21(1):162.
22. Hallit S, Sacre H, Kheir N, Hallit R, Waked M, Salameh P. Prevalence of asthma, its correlates, and validation of the Pre-
School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon. Allergol Immunopathol (Madr). 2021 Jan2;49(1):40–9.
23. Malaeb D, Hallit S, Sacre H, Hallit R, Salameh P. Factors associated with wheezing among Lebanese children: Results of a crosssectional study. Allergol Immunopathol (Madr). 2020 Nov;48(6):523–9.
24. Kharaba Z, Feghali E, El Husseini F, Sacre H, Abou Selwan C, Saadeh S, et al. An Assessment of Quality of Life in Patients With
Asthma Through Physical, Emotional, Social, and Occupational Aspects. A Cross-Sectional Study. Front Public Health. 2022 Sep 1;10:883784.
25. Plaza V, Fernández-Rodríguez C, Melero C, Cosío BG, Entrenas LM, de Llano LP, et al. Validation of the ‘Test of the Adherence
to Inhalers’ (TAI) for Asthma and COPD Patients. J Aerosol Med Pulm Drug Deliv. 2016 Apr 1;29(2):142–52.
26. Rodríguez Martínez C, Sossa MP. [Validation of an asthma knowledge questionnaire for use in parents or guardians of children
with asthma]. Arch Bronconeumol. 2005 Aug;41(8):419–24.
27. World Asthma Day 2023 - Global Initiative for Asthma - GINA [Internet]. [cited 2023 Nov 13]. Available from: https://ginasthma.org/world-asthma-day-2023/
28. Amin S, Soliman M, McIvor A, Cave A, Cabrera C. Understanding Patient Perspectives on Medication Adherence in Asthma: A
Targeted Review of Qualitative Studies. Patient Prefer Adherence. 2020 Mar;Volume 14:541–51.
29. Bassam M, Behbehani N, Farouk H, Alsayed M, Montestruc F, Al-Jahdali H, et al. Adherence to medication among adult asthma patients in the Middle East and North Africa: results from the ESMAA study. Respir Med. 2021 Jan;176:106244.
30. Bidwal M, Lor K, Yu J, Ip E. Evaluation of asthma medication adherence rates and strategies to improve adherence in the
underserved population at a Federally Qualified Health Center. Res Soc Adm Pharm RSAP. 2017;13(4):759–66.
31. Adherence to Asthma Control Measures Among Adults: An Assessment of Patient-Based Factors Among Patients in Mama Lucy Kibaki Hospital, Kenya [Internet]. [cited 2023 Dec 29]. Available from: https://wwjmrd.com/archive/2020/12/1461/
adherence-to-asthma-control-measures-among-adults-an-assessment-of-patient-based-factors-among-patients-in-mamalucy-kibaki-hospital-kenya
32. Determinants of non-adherence to inhaled steroids in adult asthmatic patients on follow up in referral hospital, Ethiopia: crosssectional study | Asthma Research and Practice | Full Text [Internet]. [cited 2023 Dec 29]. Available from: https://asthmarp.biomedcentral.com/articles/10.1186/s40733-019-0053-1
33. Tarraf H, Al-Jahdali H, Al Qaseer AH, Gjurovic A, Haouichat H, Khassawneh B, et al. Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study. Respir Med. 2018 May;138:64–73.
34. Bahous J, Soriano JB. [Asthma control in Lebanon the asthma insights and reality in Lebanon]. J Med Liban. 2010 Dec;58(4):204– 9.
35. Khadadah M, Mahboub B, Al-Busaidi NH, Sliman N, Soriano JB, Bahous J. Asthma insights and reality in the Gulf and the near East. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2009 Aug;13(8):1015–22.
36. Benkheder A, Bouacha H, Nafti S, Taright S, El Ftouh M, Yassine N, et al. Control of asthma in the Maghreb: results of the AIRMAG study. Respir Med. 2009 Dec;103 Suppl 2:S12-20.
37. Turktas H, Mungan D, Uysal MA, Oguzulgen K, Turkish Asthma Control Survey Study Group. Determinants of asthma control in tertiary level in Turkey: a cross-sectional multicenter survey. J Asthma Off J Assoc Care Asthma. 2010 Jun;47(5):557–62.
38. Heluf H, Assefa N, Dessie Y, Tamiru D, Goshu AT, Fekadu G. Adherence to anti-asthma medications among adult asthmatic
patients in Eastern Ethiopia: A multi-center cross-sectional study. PLOS ONE. 2022 Dec 8;17(12):e0277796.
39. Luyster FS, Shi X, Baniak LM, Morris JL, Chasens ER. Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2020Sep;125(3):319–24.
40. Hu Z, Tian Y, Zeng F, Song X. The Association Between Sleep Duration, Asthma-Related Episodes/Attacks and Emergency Department Visits. Nat Sci Sleep. 2020 Apr 29;12:253–62.
41. Al-Harbi S, Al-Harbi AS, Al-Khorayyef A, Al-Qwaiee M, Al-Shamarani A, Al-Aslani W, et al. Awareness regarding childhood asthma in Saudi Arabia. Ann Thorac Med. 2016;11(1):60–5.
42. Panagiotou M, Koulouris NG, Rovina N. Physical Activity: A Missing Link in Asthma Care. J Clin Med. 2020 Mar 5;9(3):706.
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Insights into Asthma Understanding and Medication Compliance: A Study of Knowledge and Adherence among the Lebanese Population. Pharm Pract (Granada) [Internet]. 2025 Jun. 13 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3161
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How to Cite
1.
Insights into Asthma Understanding and Medication Compliance: A Study of Knowledge and Adherence among the Lebanese Population. Pharm Pract (Granada) [Internet]. 2025 Jun. 13 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3161