Background and Importance Comorbidities are often associated with severe asthma including those patients treated with biologics. That often contributes to poorly controlled asthma¹, which could be related to deficient adherence to inhalers.

Aim and Objectives To evaluate proportion of non-adherence to inhalers in patients with severe asthma (SA) treated with biologics according to their comorbidity and to compare two methods to assess non-adherence.

Material and Methods Cross-sectional retrospective observational study of patients with SA recruited from the SA unit of a tertiary hospital in Madrid from June to December 2020. We registered demographic data, comorbidities and concomitant therapy for asthma. Non-adherence was defined as pharmacy refill data (PRD) <80% to the primary inhaler² and/or Test of Adherence to Inhalers questionnaire (TAI) result s<50³. Concordance was assessed by determining the Cohen’s kappa statistic. Primary variable: Proportion of patients classified as not having therapeutic adherence measured by both of the following methods: PRD <80% in the previous 6 months, and TAI questionnaire: a value <50. Comorbidities considered: rhinoconjunctivitis, nasal polyposis, anxiety and depression, gastroesophageal reflux, bronchiectasis, aspirin-exacerbated respiratory disease (AERD) and allergic bronchopulmonary aspergillosis.

Results 53 patients were evaluated. Median age was 61 years (IQR 51.8-67) and 33 (61%) were women. 41(77%) had comorbidity: 25(61%), rhinoconjunctivitis, 16 (38%) nasal polyposis, 15 (36%) anxiety and depression, 7 (17%) gastroesophageal reflux, 6 (15%) bronchiectasis, 5 (12%) AERD and 1(2%) allergic bronchopulmonary aspergillosis. The highest non-adherence was detected in patients with rhinoconjunctivitis by the two methods: 50% and 55% according to TAI and PRD, respectively (k=0.022 95% CI -0.256–0.3). Agreement of both methods was low in all comorbidities; nasal polyposis: 42% vs 23% (k=-0.049 95% CI -0.421–0.519); anxiety and depression: 25% vs 32%( k=0 95% CI -0.317–0.317); gastroesophageal reflux: 8% vs 10% (k=0.364 95% CI -0.21-0.938) and AERD 17% vs 10% (k=-0.154 95% CI-0.659–0.967).

Conclusion and Relevance Our results highlight a high prevalence of non-adherence to inhalers in patients with SA and other comorbidities treated with biologics. Therefore, hospital pharmacists should focus on this patient´s adherence to inhalers, especially those with rhinoconjunctivitis, when providing pharmaceutical care to SA treated with biologics in practice.

References and/or Acknowledgements 1. J Precis Respir Med, 2019;2:5–9.

2. Assessing adherence by combining the test of adherence to inhalers with pharmacy refill records. J Investig Allergol Clin Immunol 2021;31:58–64.

3. Test of Adherence to Inhalers. Arch Bronconeumol 2017;53:360–1.

Conflict of Interest No conflict of interest