Are You Getting the Most Out of Your Asthma Treatment? Uncovering Factors Affecting Inhaler Use
"New research reveals surprising reasons why many asthma patients aren't using their inhaled corticosteroids as prescribed, and what can be done about it."
Asthma affects millions worldwide, and while there's no cure, effective management is possible. Inhaled corticosteroids (ICS) are a cornerstone of treatment for persistent asthma, helping to control airway inflammation and prevent symptoms. However, many individuals don't utilize these medications as prescribed, leading to poorer health outcomes.
A cross-sectional study conducted at Tikur Anbessa Specialized Hospital in Ethiopia sheds light on the factors contributing to ICS underutilization. The research, involving 131 persistent asthmatic patients, explored the reasons behind this concerning trend, offering valuable insights for patients and healthcare providers alike.
This article delves into the study's findings, examining the key barriers to proper ICS use and providing actionable information to help you optimize your asthma management. We'll explore the impact of income, knowledge, attitudes, and access to medication, empowering you to take control of your respiratory health.
Asthma Treatment Approaches and Implementation
Pressurised metered-dose inhalers (pMDIs) remain a cornerstone of asthma and COPD management, although their propellant gases have high global-warming potential. For mild asthma, some clinicians view reliever-only use of ICS-formoterol as a better fit for real-world inhaler use than relying on adherence to daily maintenance inhalers. The 2023 discussion also notes that, despite effective treatments, some patients remain poorly controlled because they over-rely on short-acting β2-agonists. A retrospective study described in a 2026 review examined prescription trends from 2021 to 2023 among patients with specialist-diagnosed moderate asthma in the northeastern United States.
From Bronchodilators to Inhaled Corticosteroids
A review divides asthma’s therapeutic history into periods before and after inhaled corticosteroids (ICS) arrived. Before ICS, bronchodilators such as β2-agonists and anticholinergic agents were the main drugs used for asthma therapy. Another 2025 review notes that asthma was described as early as 460 BC, while recognition of asthma as a disease and the development and implementation of therapies to control it emerged in the early 1900s. It describes the following century as bringing immunotherapy and inhaled medications.
Why Aren't People Using Their Inhalers Correctly? Unpacking the Barriers
The study revealed that a significant 68% of participants were underutilizing their ICS medications. This means they weren't using them as frequently or in the correct dosage as recommended by asthma guidelines. Several factors emerged as key contributors:
- Financial Constraints: A staggering 44% of patients cited unaffordability as the primary reason for not using their ICS medications as prescribed.
- Symptom-Based Usage: 21% of participants only used their inhalers when symptoms flared up, rather than consistently as a preventative measure.
- Concerns about Side Effects: 10% of patients expressed fear of side effects, leading them to avoid or reduce their ICS use.
- Lack of Knowledge: A significant portion of patients lacked a comprehensive understanding of asthma and the role of ICS medications in managing the condition.
- Inconsistent Availability: 7% reported that ICS medications were not consistently available in their local market.
Recent Evidence on Devices and Adherence
A 2025 study compared pressurised metered-dose inhalers (pMDIs) with dry powder inhalers (DPIs) in 156 patients newly diagnosed with mild asthma, randomly assigned to use one of the two devices. The study description says the devices’ relative effectiveness was unclear before the comparison. A systematic review and meta-analysis of asthma medication adherence in Ethiopia excluded three studies from its quantitative synthesis because they did not use a validated adherence-measurement tool. Separately, a New York public health system project aimed to increase ICS use by promoting the ICS-formoterol AIR strategy in primary care clinics.
Barriers to Inhaled Corticosteroid Use
Physicians in a study at Tikur Anbessa Specialized Hospital in Ethiopia identified unaffordability, fear of side effects and dependency, lack of local asthma-management guidelines, and unavailability of inhaled corticosteroids (ICS) as factors contributing to their underuse. The study also acknowledged a limitation in how generally its findings could be applied. These reported barriers illustrate how cost, concerns, guidance, and access can constrain ICS use in the setting studied.
Comparing Asthma Treatment Strategies
A 2022 systematic review and network meta-analysis described the comparative effectiveness of inhaler therapies for mild-to-moderate asthma as unclear and set out to assess it. A 2025 pilot randomized study compared ICS dose reduction with montelukast discontinuation as step-down strategies for adults with well-controlled asthma, noting that direct evidence supporting ICS dose reduction was limited. Real-world research using South Korea’s National Health Insurance data also set out to compare the efficacy, safety, and adherence of ICS/LABA combination inhalers across device types and components in newly diagnosed patients. These sources address different treatment comparisons and do not establish one conclusion that applies across all of them.
Taking Control: Optimizing Your Asthma Treatment
The study underscores the urgent need for multifaceted interventions to address ICS underutilization. This includes improving access to affordable medications, enhancing patient education, and developing culturally appropriate asthma management guidelines.
Guidelines, Access, and Unequal Inhaler Use
The Global Initiative for Asthma 2023 update preferentially recommends ICS-formoterol inhalers at all treatment steps for people aged 12 and older: as anti-inflammatory reliever (AIR) therapy at steps 1 and 2, and as single maintenance and reliever therapy (SMART) from step 3 onward. A separate review defines ICS underutilization to include use below the regimen recommended for a patient’s asthma-management step, primary nonadherence, discontinuation, or lack of an ICS prescription in persistent asthma. A 2026 report says White adults with asthma used ICS, LABA, and LAMA inhalers at higher rates than other groups, while minority groups used fewer controller medications and relied more on SABA inhalers. It notes that frequent SABA reliance often signals asthma that is not well controlled and may be undertreated.
Here are some actionable steps you can take to improve your asthma management:
<ul><li><b>Talk to Your Doctor:</b> Discuss your concerns about medication costs, side effects, or any other barriers you're facing. Your doctor can help you find solutions, such as alternative medications or patient assistance programs.</li><li><b>Educate Yourself:</b> Learn as much as you can about asthma and the role of ICS medications in controlling your symptoms.</li><li><b>Adhere to Your Treatment Plan:</b> Use your ICS medications as prescribed, even when you're feeling well. This will help prevent flare-ups and improve your long-term respiratory health.</li><li><b>Advocate for Change:</b> Support policies and initiatives that promote access to affordable medications and improve asthma care in your community.</li></ul>