The relationship of medication adherence and environmental factors to exacerbations in patients with severe asthma

Some patients with asthma suffer attacks, termed exacerbations, these periods of loss of control and heightened symptoms both significantly reduce quality of life and increase healthcare costs, as they are a cause of disability, hospitalisation and death. Predicting when an exacerbation may occur involves knowledge of the person's disease characteristics, knowledge of prior and current adherence to preventer treatment as well as knowledge of environmental factors that act as triggers of exacerbations.

One challenge that researchers face when trying to establish an accurate exacerbation risk prediction tool is that they cannot be certain of a patient's prior adherence to medications. This is important because both adherence to inhaler therapy and inhaler technique are often sub-optimal. Our research group has developed a technology, INCA, a system that collects data on inhaler use and when analysed accurately assesses when and how an individual uses their inhaler.

In prior studies we have studied several hundred patients with severe asthma, who are at risk of exacerbations. In these studies we have concurrently recorded lung function, allowing us to precisely identify when an exacerbation has occurred and also objectively and precisely we have assessed medication adherence over time, using the INCA technology. Digital information on concurrent environmental factors such as air quality index and prevalence of respiratory viruses is also available. This means that the interactions of environmental influences with medication adherence and personal characteristics can be assessed.

This research project aims to develop an exacerbation risk tool that incorporates knowledge of adherence with changes in environmental factors that trigger exacerbations along with personal and disesase specific characteristics. This tool could be used by both patients and clinicians to monitor lung function and warn off impending asthma attacks.


Award Date
29 June 2017
Award Value
Principal Investigator
Professor Richard Costello
Host Institution
Royal College of Surgeons in Ireland
Investigator Led Projects