Choice of Words Is Critical when Explaining Asthma Adverse Effects


A new study looks at patient perception of adverse effects with asthma, and recommends that pharmacists change their emphasis when counseling about potential adverse effects to include prevention strategies.

Current rates of adherence to asthma medications are between 30% and 70%. Articles, reviews, news items, and research findings have emphasized and re-emphasized the need to improve patient adherence to asthma medications for years. Regardless, nonadherence persists. Poor adherence leads to unnecessary emergency room visits, hospitalizations, and healthcare costs. In asthma, the cornerstone of treatment is the inhaler, and adverse effects are rare, but some patients perceive that the risks are greater than they are.

A new study published inResearch in Social and Administrative Pharmacylooks at patient perception of adverse effects, and recommends that pharmacists change their emphasis when counseling about potential adverse effects to include prevention strategies. The researchers assess patients’ willingness to use a hypothetical medication, and their perceptions of medication safety using a hypothetical situation. They described an asthma medication that had the potential to cause fungal infections of the throat.

The study randomized 601 participants to 9 situations, all of which described different probabilities of developing infection. The situations also differed. In some, pharmacists simply informed patients of the risk. In others, pharmacists also discussed prevention strategies.

Study participants who were told the probability of fungal infection was 20% were less willing to take the medication than if they were not told of the potential, or if the potential was lower than 5%.

Study participants were more amenable to taking the medication if the counseling pharmacists provided a prevention strategy.

The researchers indicated that there are clinical implications to their findings. Patients need to know about potential adverse effects, but they also need to know if mitigation strategies can help them avoid adverse outcomes.

Describing reasonable precautions may improve medication uptake and adherence. Advising patients to rinse out the mouth and gargle after using a steroid inhaler is one counseling tip. Using a spacer can also help. A barrier to spacer use is their cost, which insurance may not cover. Advising patients of spacers’ advantages, explaining that the cost is small and the return great, and calling the patient’s physician for a prescription can help.


Bitonti M, Patel P, Dickinson R, Knapp P, Blalock SJ. The effect of counseling on willingness to use a hypothetical medication and perceptions of medication safety.Res Social Adm Pharm. 2018;14(3):295-302.

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