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Overcoming Obstacles to Staying on Track With Asthma Medicines

Health care professionals often talk about the importance of asthma medication compliance. What does compliance mean? It simply translates to taking the medicine your doctor prescribed in the way he or she told you to, including amount, time of day, frequency and method.

To the person with asthma, though, these directives to comply may sound a bit judgmental and lack a certain empathy. I mean, we all have good reasons for not taking our asthma medicine sometimes, right? It’s not like we don’t understand how important they are. Are you with me?

I’m not ashamed to admit that there have been times when I didn’t use my controller medicine exactly as prescribed. And I’m a nurse! While I know I should have taken the medicine, I also had what I considered valid reasons not to. And if I had to live with a little less asthma control for a time, so be it.

Asthma medication compliance is important

Here’s the facts, though. Asthma is a very treatable disease, and for most of us, asthma control is quite attainable. A combination of trigger avoidance and the right medication plan will usually achieve control in all but the most severe asthmatics. So, why are so many of us sometimes resistant to doing “the right thing” when it comes to managing our asthma?

Studies have found that 30 to 70% of us asthmatics are non-compliant with our medication at times. Even worse, they found that up to 75% of the total costs associated with asthma are probably due to poor asthma control.1 And poor asthma control is often attributed to non-compliance. Let’s look at a few reasons why asthmatics may not stay on track with their medicines all of the time.

Barriers to asthma medication compliance

There are some common obstacles that may prevent us from being totally compliant with our asthma medication.1,2

Lack of Knowledge or Understanding About the Medicine

Sometimes, people with asthma don’t take their medicines correctly simply because they didn’t understand how to do so. There are 2 main types of asthma medicines:

It’s not unusual for people to rely more on the quick relief type inhaler. This may be because its effects are more immediately noticeable when there are symptoms. Or you may not understand the difference between the two and how they work.

Have you ever visited a doctor’s office and been handed a prescription with a super quick explanation of its purpose? Did anyone take the time to truly go through how and when to use it with you? Inhaler technique, in particular, is something that is often neglected. If no one took enough time to make sure you understood how to use your medicine, this could be a reason for your non-compliance.

Financial challenges

Asthma inhalers don’t come cheap! And until very recently, there have not been any of the cheaper, generic medicines available for many years. Controller inhalers, especially, can be expensive.

Cost was the reason I was relatively non-compliant for years with my asthma controller medicine. When I became self-employed, I also became uninsured. That lasted for 12 years, until I re-married and my husband was able to obtain health insurance that covered me (This was pre-Affordable Care Act). During those years, I often stretched my controller inhaler out for a month or two longer than I should have by taking less frequent doses than prescribed. During one 2-year period, I went without a controller inhaler altogether.

What happened? Well, my asthma slowly spiraled out of control. I’m a mild intermittent asthmatic, so it took a while for me to feel the control slipping. But when I started waking up every night with uncontrollable coughing, I finally got back on track with a controller medicine. I’m fortunate that I didn’t end up in the hospital with a more life – or at least health-threatening exacerbation. I’m definitely not advocating this approach!

Lack of understanding of the importance of medicine in ongoing asthma control

Some people think that when they feel better, they no longer need to take their asthma medicine. Here’s what you need to understand though. Asthma is not curable, and the currently available medicines don’t “fix” asthma. They simply alleviate the symptoms–temporarily.

So, if you stop taking the medicines, then their effects also stop. And your asthma symptoms will return. And if you let asthma symptoms continue uncontrolled, permanent lung damage can result.

Most of us don’t love putting chemicals into our bodies or having to remember to take medicine every day, or twice a day. But do you like having your asthma symptoms interfere with your life, work, or school?

Fear of side effects

Just because asthma medicines are not “natural” substances doesn’t mean they’re potentially harmful. In reality, asthma medicines have very few known side effects. This is true even of inhaled steroids. The steroids used in asthma treatment are not at all the same as anabolic steroids that bodybuilders sometimes use. Inhaled steroids are very safe to use and the treatment of choice for most asthmatics.

If you should experience some sort of side effect with an asthma medicine, chances are it will be mild and short-lived. If not, talk with your doctor. There are many different types of asthma medications available today. With time, you should be able to find the right combination for you.

In summary

I’ve discussed a few of the more common reasons why people with asthma may not always stay on track with their medication plan. I’d love to hear in the comments your reaction to what I’ve written or any other reasons you think contribute to this issue.

If you are currently not taking your medication as your doctor has prescribed, then I encourage you to talk with your doctor openly and honestly about it. Don’t do as I did and wait till your asthma spirals out of control to come clean. There may just be a solution that you haven’t thought of that can get you back on track and into (asthma) control.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Apter AJ. Enhancing patient adhereance to asthma therapy. Accessed August 2019.
  2. McQuaid EL. Barriers to medication adherence in asthma. American College of Allergy, Asthma & Immunology. 2018;121(1):37-42. doi:


  • Shellzoo
    5 months ago

    This was a great article. There are so many reasons why we might be non-compliant with our meds. Cost is a huge factor. I have had to battle for affordable controller medications and I have very good insurance. I also feel instructions on inhaler use could be better. I am a nurse too and in the past have instructed patients how to use their inhalers but it is much different when you are using the inhaler yourself. I also dreaded using inhalers. The idea of breathing a substance into my lungs made me gag so I was horrified when I was diagnosed and given an inhaler. Thankfully I have been very compliant and just after a year my provider has found the right combo of treatments to get me good control.
    Just curious, do they make practice inhalers similar to the practice EpiPens that come with the med? Every time I refill my EpiPens, I also take time to use the practice pen so if I am having a reaction, I will be comfortable giving myself the injection.

  • Kathi MacNaughton author
    5 months ago

    Thanks, Shellzoo! Glad you enjoyed the article, and I definitely feel you on not wanting to use an inhaler. But glad you’ve been able to find the right combo to help you.

    By the way, I LOVE the idea of a practice inhaler! I have never heard of such a thing, and I agree, it would be wonderful if all asthma patients were provided one, with detailed instructions on how to use it. And what if the technology somehow measured your correct use? So that you knew if there was something you needed to improve? Wouldn’t that be cool?

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi Kathi and thanks for your response and explanation. I agree with your two cents!! I too believe that practice inhalers would be a great practical experience for patients. They could actually ‘practice’ and not waste the precious and costly medication learning how to do this properly.
    It’s a sad commentary for this industry that the very physicians who prescribed this medication do not facilitate their patients learning how to use it properly. It’s been a long standing concern for all of us as allied health care professionals.
    Warm regards,
    Leon (site moderator)

  • Kathi MacNaughton author
    5 months ago

    Hi Leon… I did see your reply yesterday about practice inhalers being available to healthcare professionals. But I was echoing Shellzoo’s suggestion that they be made available directly to asthma patients. I can tell you from personal experience that the professionals do not always teach patients how to use the inhalers that they prescribe. Personally, in 35+ years, no one has ever offered to go over inhaler technique with me. And I had never even heard of a spacer until I started writing about asthma (even though I am a nurse!). I think it would be great if when a person is first put on an inhaler, they were also supplied with a practice inhaler (with instructions). Just my two cents!

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi Kathi – when you have a chance, take a look at the reply to Shellzoo, below.
    You will note that practice inhalers are available in the industry.
    Leon (site moderator)

  • Shellzoo
    5 months ago

    Yeah, I think practice inhalers that gave feedback would be fantastic. I know a drawback would be that there are several types of inhalers but I think considering how potentially life threatening asthma can be, having practice inhalers to help improve technique would aid getting better asthma control. Also, I wonder how many people use their inhaler and hold their breath for a full ten seconds to allow the particles to get deeper into the airway. Using an inhaler is more than inhaling.

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi Shellzoo, and thanks for joining in the conversation here in response to Kathi’s article on medication compliance. To answer your question, there are ‘dummy’ inhalers made for teaching purposes. All the detail salespeople marketing these products have them. As a nurse who instructs patients on how to use inhalers, you should have no trouble getting them from the salesperson direct or from the manufacturer. Good luck! Leon (site moderator)

  • Shellzoo
    5 months ago

    It has been years since I have had to work with inhalers and give treatments since the RTs do all of that now. My responsibility now typically is to make sure the patient has inhalers and notify the RT of treatments. I think my access would be more limited as a result but it sure would be nice for new asthma patients to have inhalers they could practice with. It really requires more coordination than you would think. When I first got my inhalers, it took a few weeks before I was anywhere near proficient at using them.

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