What We Mean When We Talk About Adherence In Respiratory Medicine

Bernard Vrijens, Alexandra L. Dima, Eric Van Ganse, Job F. M. van Boven, Michelle N. Eakin, Juliet M. Foster, Marijn de Bruin, Alison Chisholm, David Price

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98 Citations (Scopus)
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Adequate medication adherence is key for optimal benefit of pharmacological treatments. A wealth of research has been conducted to understand and identify opportunities to intervene to improve medication adherence, but variations in adherence definitions within prior research have led to ambiguity in study findings. The lack of a standard taxonomy hinders the development of cumulative science in adherence research. This article reviews the newly established Ascertaining Barriers to Compliance (ABC) taxonomy for medication adherence with a particular focus on its relevance and applicability within the context of asthma and chronic obstructive pulmonary disease management. Building on traditional definitions and concepts within medication adherence, the ABC taxonomy considers the temporal sequence of steps a patient must undertake to be defined as “adherent to treatment”: (A) initiation, (B) implementation, and (C) persistence. We explain the clinical and research relevance of differentiating between these phases, point to differences in its applicability in observational and experimental research, review strengths and limitations of available measures, and highlight recent findings on specific determinants of these behaviors. Finally, we provide recommendations for research and practice with a view to supporting and sign posting opportunities to improve future respiratory medication adherence and associated research.
Original languageEnglish
Pages (from-to)802-812
Number of pages11
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Issue number5
Early online date30 Aug 2016
Publication statusPublished - Sept 2016

Bibliographical note

The Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org) supported the Expert Adherence Panel Meeting at which many of the concepts presented in this paper were first discussed. REG also supported the manuscript submission costs. ALD, EvG, and MdB have received funding from the European Community's 7th Framework (FP7/2007-2013) under grant agreement no. 282593. Teva supported the meeting costs at which the concepts in this paper were discussed by the co-authors and the open access publication fee for this article. The authors had full editorial control over the ideas presented.


  • medication adherence
  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • initiation
  • implementation
  • persistence
  • ABC taxonomy


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