Assessment of therapeutic compliance and its associated factors in tunisian adult asthmatic patients


Haifa Zaibi
Asma Allouche
Emna Ben Jemia
Hend Ouertani
Meriem Ferchichi
Jihen Ben Amar
Hichem Aouina


Introduction: Despite therapeutic advances, morbidity attributed to asthma continues to increase. This seems partly to be due to poor adherence.
Aim: To assess therapeutic adherence and the association between poor compliance and asthma control.
Methods: We carried out a descriptive cross-sectional study on a sample of 150 asthmatics, followed in the pneumology department of Charles
Nicolle hospital for more than 6 months. The survey took place over 1 month. The 4-item Morisky questionnaire (MMAS-4) was used to assess
adherence to therapy.
Results: Our patients had a median age of 44.2 years and a sex ratio of 0.47. Asthma was severe in 48% of cases and poorly controlled in 34% of cases.
Adherence was poor in 66% of patients. Factors significantly associated with adherence were educationlevel (p=0.02), socio- economic status (p = 0.01),
treatment cost (p= 0.02), its availability (p=0.04) and its free cost (p = 0.001), consultation waiting time (p=0.03) and knowledge on asthma (p=0,04).
We retained in multivariate analyze two factors determining therapeutic adherence, which are socio-economic status (OR = 2.02 ; [1.2-6.26]) and
participation in the therapeutic choice (OR = 1.2 ; 95% CI [2.02-4.25]).
Conclusions: It appears that medication adherence is widely influenced by socio-economic status. So, improving these conditions would guarantee
better treatment compliance.


Asthma, Therapeutic compliance, Control



  1. Loftus PA, Wise SK. Epidemiology and economic burden of asthma. Int Forum Allergy Rhinol. 2015;5(1):7-10.
  2. Demoly P, Godard P, Bousquet J. Une synthèse sur l’épidémiologie de l’asthme. Rev. Francaise D Allergol. Et D Immunol. Clin 2005;45:464-75
  3. Nafti S, Taright S, El Ftouh M, et al. Prevalence of asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study. Respir Med. 2009;103 (2):2–11
  4. Toujani S, Mjid M, Ouahchi Y et al. Clin Respir J. 2018;12(2):608-15
  5. Makela MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481-90.
  6. Jébrak G, Houdouin V, Terrioux P, Lambert N, Maitre B, Ruppert AM. Observance thérapeutique dans l’asthme : variation selon les classes d’âge. Comment l’améliorer ? Apport des nouvelles technologies. Rev Mal Resp. 2022;39:442-54
  7. Devillier P, Ghasarossian C, Terrioux P, Schiratti M, Leutenegger E. Observance du traitement de fond dans l’asthme persistant de l’adulte en pratique courante. Rev Mal Resp. 2018;35:269-78
  8. Morisky DE, Aang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication has adherence measure in year outpatient setting. J Clin Hypertens 2008;10(5):348-54.
  9. Godard P, Boucot I, Pribil C, Huas D. Phénotype des patients asthmatiques selon le score dérivé de l’Asthma Control Test®. Rev Mal Respir. 2010;27:1039-48
  10. Kondla A, Glaab T, Pedersini R, Lommatzsch M. Asthma control in patients treated with inhaled corticosteroids and long-acting beta agonists: A population-based analysis in Germany. Respir Med. 2016;118:58-64
  11. Pedersen S, Reddel H. pocket guide for health professionals updates 2018. GINA. 2018;10(3):150-87.
  12. Liu H, Golin C, Miller L et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med 2014;134(10):968-77.
  13. Hamelmann E, Szefler SJ, Lau S. Severe asthma in children and adolescents. Allergy 2019;74(37):22802.
  14. Janežič A, Locatelli I, Kos M. Criterion validity of 8-item morisky medication adherence scale in patients with asthma. PLoS ONE 2017;12(11):1018-2835.
  15. Belloumi N, Jarraya D, Bachouche I et al. Observance thérapeutique chez les asthmatiques évaluée au score de Morisky. Rev Fr Allergol. 2019;59(3):296-7
  16. Bahloul N, Badri I, Ketata W, Kchaou A, Feki W, Moussa N, et al. Factors associated with adherence to asthma treatment with inhaled corticosteroids alone or in combination. Rev Mal Respir 2016;33(78):875-1041.
  17. Fauroux B, Just J, Couvreur J, Grimfeld A, Tournier G. Knowledge of and support for the treatment of childhood asthma: results of a prospective survey. Rev Pneumol Clin 2013;48(38):12-8.
  18. Cochrane GM, Horne R, P. Chanez P. Compliance in asthma. Respir Med. 1999;93: 763-9
  19. Barr RG, Somers SC, Speizer FE, Camargo CAJAoim. Patient factors and medication guideline adherence among older women with asthma. Arch Intern Med 2002;162(15):1761-8.
  20. Schultz A, Martin AC. Outpatient Management of Asthma in Children. Clinical Medicine Insights: Pediatrics. 2013;7:13–24
  21. Wade S, Islam S, Holden G, Kruszon D, Mitchell H. Division of responsibility for asthma management tasks between caregivers and children in the Inner city. J Dev Behav Pediatr 2016;20(2):93-8.
  22. Sulaiman I, Greene G, MacHale E et al. A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma. Eur Respir J. 2018;51(1).
  23. Mjid M, Belloumi N, Hedhli A et al. Facteurs influençant le contrôle de l'asthme chez l'adulte tunisien. Rev Fr Allergol 2017;57:408–12