"Half of This, Half of That"

“The work of being a patient can be a fulfilling part of a person’s life. There are the small triumphs of figuring out how to get through the day without being stumped by fatigue or pain, of improvising in the routine of surprises, of seeming spontaneous, thanks to meticulous planning, of kicking uncertainty and disease in the ass! Says Dr. Victor Montori in his book Why We Revolt, a patient revolution for careful and kind care.

Many patients only take half of the prescribed dosage of their oral corticosteroids

Oral corticosteroids (OCS) are prescribed in asthma to treat inflammation. It is part of the Step 5 therapies of the GINA guidelines.¹ There is a study that I was looking to reference but I could not find it. It is a rheumatology study in the Lancet that references a study, where half the of the patients only took about half of the amount of OCS but had similar results. This begs the question, why?

Do some people feel better on a lesser amount?

Are there factors of cost or access that come in to play? What about side effects? Unfortunately, a lot of factors get mislabeled as the patient not being non-compliant. There are certainly times when I believe that this is probably true. I have found that there is often very little dialogue about out what medications do, the benefits, side effects, how long we are going to be on them etc. I think that these are contributing factors. Personally, when I was initially prescribed steroids at the onset of my severe asthma diagnosis, there was NO mention that I would need to be on them long term. If this was something that I knew at the onset. I may have approached my treatment options differently. I certainly would have asked a lot more questions about their need, mechanism of actions and long-term consequences. These range from thinning skin, cataracts, the constant battle of managing healthy body weight while on prednisone and psychological impacts. It is important to note that individual experiences may differ.

Another study found that only 26% of asthma patients were compliant with OCS use.² Some of this was chalked up to patients being forgetful or feeling better, therefore not maintaining treatment. It raises an interesting question. If half of the amount of something would do the same job as double the dose, then why would a double dose be prescribed? I don’t think there is an easy answer to the question, and it's probably a question for another day. I am interested if anyone has any experience in this? I would suspect that this probably has something to do with efficacy and perhaps the severity of disease but I will have to delve into this in another post.

What do you think?

What are your thoughts? Have you ever taken half of a prescribed dose or crafted your own regimen? If so, what was your rationale, did you consult your physician or feedback on why this was better? In my experience medication alterations have been in response to experience adverse events or periods of improvement and titrating downwards. How may this be co-designed in a more effective manner?