***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective - To examine the influence of inhalation device ( Autohaler versus metered dose inhaler ) and patients ' subjective opinion towards the different devices , as well as daily frequency and duration of treatment on medication compliance . Design - Prospect i ve study measuring compliance in the same patients of the Autohaler twice daily with the metered dose inhaler twice daily , as well the Autohaler twice daily with the Autohaler four times daily . Setting - Primary health care . Subjects - 34 subjects with asthma . Main outcome measures - Patients preference and compliance . Results - Patients preferred the  Autohaler . The percentage of patients with a negative opinion towards the metered dose inhaler was 38 % compared with 12 % towards the Autohaler . The median values of the compliance rate of the Autohaler with twice and four times daily frequency were 90.8 % ( 25 - 75th percentile 61.6 - 98.0 % ) and 78.5 % ( 25 - 75th percentile 49.0%-91.2 % ) , respectively ( p < 0.001 ) . The duration of treatment period had a significant negative influence on compliance when four times daily dosage frequency was prescribed ( p = 0.05 ) . Conclusion - In conclusion , the devices ( metered dose inhaler and Autohaler ) and the patients ' opinion about the devices did not significantly contribute to the compliance rates . Compliance towards the medication treatment , however , is negatively influenced by a high daily frequency BACKGROUND Asthma medication adherence is related to better asthma outcomes , but identification of suboptimal patient adherence behavior is not st and ardized in clinical setting s. OBJECTIVE [ corrected ] The purpose of this study was to develop a practical question naire that reflects nonadherence risk and identifies potential adherence barriers . METHODS A question naire that included 20 potential adherence questions was completed by 420 adult patients with asthma who filled a prescription for an inhaled corticosteroid ( ICS ) and a short-acting beta agonist ( SABA ) in the previous 6 months . Questions without substantial floor or ceiling effects that were significantly related to self-reported low adherence or previous ICS canister dispensings were identified . Internal consistency reliability was tested by Cronbach α . Relationships of these questions to Asthma Control Test scores , future percent of days covered for ICS dispensings , and future asthma exacerbations and SABA dispensings were determined . RESULTS Five final questions were identified : following " my medication plan , " forgetting , not " needing " the medications , side effects , and cost . Low internal consistency reliability ( < 0.50 ) suggested items should not be summarized by a single score . All five questions were related to Asthma Control Test scores . Following the medication plan , forgetting , and not needing medication were significantly related to prospect i ve percent of days covered . Side effects were related to subsequent SABA and oral corticosteroid dispensings , and cost was significantly related to oral corticosteroid dispensings . CONCLUSIONS We identified five questions related to other measures of adherence and to asthma control that can be used clinical ly to identify patients at risk of nonadherence and the specific adherence barriers involved BACKGROUND Daily inhaled corticosteroid ( ICS ) use is the cornerstone of asthma management , although it is often suboptimal , especially in inner-city population s. OBJECTIVE To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time . METHODS Asthma history , medication beliefs , and ICS therapy adherence were determined in a prospect i ve , observational cohort . Medication beliefs were based on self-regulation and self-efficacy theory . Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale , a vali date d 10-item instrument , at baseline and at 1 and 3 months . Repeated- measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age , sex , race , and asthma severity . RESULTS The 261 patients were low-income minorities with high rates of asthma hospitalization , emergency department visits , intubation , and oral corticosteroid use .  Adherence with ICS therapy was stable across time , with 70 % of patients saying that they used ICS all or most of the time when asymptomatic . Most patients ( 82 % ) thought it was important to use ICS when asymptomatic , although 49 % worried about side effects and 37 % worried about becoming addicted . Although 82 % felt confident in using ICS , 7 % felt that their regimen was hard to follow . In multivariable analyses , the odds of adherence increased for those who felt that using ICS when asymptomatic was important ( odds ratio [ OR ] , 4.15 ) and for those who were confident in using ICS ( OR , 2.23 ) and decreased by worries about side effects ( OR , 0.52 ) or feeling the regimen was hard to follow ( OR , 0.48 ) . CONCLUSIONS Several positive and negative beliefs about ICS were associated with adherence . Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes Poor patient compliance with inhaled medication is known to cause morbidity and mortality in asthma . The reasons for nonadherence are not fully understood . We wondered whether psychological factors , such as patient attitudes to asthma and its treatment , anxiety , depression , and interpersonal problems , may be related to asthma self-care and compliance . In a prospect i ve study , 102 patients with asthma , aged 18 - 70 yrs , requiring treatment with regular inhaled corticosteroids and beta-agonists were recruited from a hospital out-patient clinic and four general practice s in South East London . They underwent psychological assessment using the Hospital Anxiety and Depression Scale ( HADS ) , the Inventory of  Interpersonal Problems  ( IIP ) , and a semi-structured interview focusing on patient attitudes , self-care , compliance , social support and treatment beliefs . Patients were given terbutaline and budesonide turbohalers to use twice daily over 12 weeks .  Turbohaler Inhalation Computers ( TICs )  recorded each inhalation , providing a measurement of compliance . Seventy two patients completed the study . Thirty seven took less than 70 % of the prescribed dose over the study period or omitted doses for 1 week and were defined as noncompliant . The noncompliant group had a higher mean ( SD ) score for depression ( 4.7 ( 3.3 ) ) than the compliant group ( 3.2 ( 2.5 ) ) . The sample had a high mean ( SD ) score for anxiety ( 8.3 ( 4.4 ) ) , but there was no significant difference between the compliant and noncompliant groups . Patients ' self-report and clinicians ' impressions of compliance were not good predictors of actual compliance . Using discriminant analysis , a model was obtained from the question naires and interview items , which correctly classified 74 % of the patients as compliant or non-compliant . ( ABSTRACT TRUNCATED AT 250 WORDS The aim of this study was to evaluate adherence to treatment in persistent asthma in Brazil to determine the factors associated with non-adherence and to measure the efficacy of telephone calls in enhancing adherence . In a prospect i ve , multicenter , interventional clinical trial with parallel groups , asthmatics were r and omized into an intervention group or a control group . Asthmatics included in the intervention group received an initial telephone call to record demographic information and asthma characterization . After that , biweekly telephone calls were made to promote treatment adherence . Asthmatics included in the control group received only the initial and final telephone calls . Both groups received three packages of salmeterol/fluticasone for 3 months . The main outcome measure was the percentage of participants who took the prescribed doses of the drug .  A total of 271 patients were included . The overall adherence rate was 51.9 % for the control group and 74.3 % for the intervention group . This meant a reduction of relative risk ( RRR ) of 47 % ( p < 0.001 ) . The number needed to treat ( NNT ) was 4.5 . The only variable associated with better adherence was severe persistent asthma . A low-cost easily implemented intervention , tailored to each individual , enhanced the adherence rate among Brazilian asthmatic patients Good adherence to inhaled corticosteroid ( ICS ) therapy is essential for effective asthma control . The factors affecting ICS therapy adherence vary among individuals and countries . As few data on adherence have been reported in Korea , the factors influencing such adherence , and the clinical implication s thereof , were evaluated in Korean asthma patients . A total of 185 asthma patients who had taken ICS regularly for over 1 year were r and omly selected from the recently established domestic adult asthma cohort , COREA ( Cohort for Reality and Evolution of Adult Asthma Korea ) . To obtain adherence to ICS , both prescription refill adherence and self-reported adherence over 1 year ( these are objective and subjective measurements respectively ) were assessed without any interventions that might affect patients ' adherence to ICS . Patients ' information such as age , sex , smoking history and number of medication taken , was collected . Assessment of asthma severity , pulmonary function tests , and asthma symptom score were performed to evaluate the possible clinical implication of adherence to ICS . Approximately half of the patients ( 50.9 % ) showed less than 80 % of prescription refill adherence . There was a considerable discrepancy between prescription refill adherence and self-reported adherence especially in the patients whose refill adherence was under than 50 % . Younger asthma patients showed lower adherence to ICS  than did older ( ≥ 60 years old ) patients .  Higher asthma severity was significantly associated with lower refill adherence  to ICS . However , asthma symptom scores and forced expiratory volume in 1 second ( FEV1 ) values were not directly related with refill adherence . To improve asthma control in Korea , enhancement of adherence to ICS is critical : our findings emphasize the need to use objective measurements when adherence to asthma medication is to be assessed in clinical practice 
    Output:
    
The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs , and possibly older age .