Observational studyFrontiers in immunology2026
Inhaled treatment adherence patterns and related barriers across three monthly follow-up waves among patients with cough variant asthma: a clinical natural language processing study.
Observational study in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To characterize adherence and adherence-related text features across three monthly telephone follow-ups among adults with cough variant asthma (CVA) newly initiating maintenance inhaled therapy and to evaluate their contemporaneous associations. Methods: This single-center, three-wave observational cohort classified adherence during the preceding month as high or low based on reported treatment implementation; records with insufficient information were unevaluable. A manually validated, rule-enhanced clinical natural language processing approach extracted seven non-mutually exclusive text features, including four prespecified patient-perceived barriers. Logistic generalized estimating equations (GEE) estimated population-averaged contemporaneous associations with high adherence. Complete-case GEE and wave-specific Firth models were conducted as sensitivity analyses. Results: Among 767 patients, adherence was evaluable for 732, 697, and 602 at Waves 1, 2, and 3, respectively; high adherence was documented in 94.4%, 73.9%, and 47.0% of evaluable records. Intentional discontinuation or dose reduction increased from 4.8% to 26.5%. The primary GEE included 2,031 observations. Lower odds of high adherence were associated with access or financial barriers (OR 0.28, 95% CI 0.16-0.49; P<0.001), illness- or treatment-related beliefs (OR 0.19, 95% CI 0.06-0.63; P = 0.007), and side-effect concerns or poor tolerability (OR 0.43, 95% CI 0.19-0.96; P = 0.040). Similar associations for access or financial barriers and illness- or treatment-related beliefs were observed in the complete-case and Wave 3 Firth analyses. Conclusions: High adherence was documented less frequently and patient-initiated treatment reduction more frequently at later waves. Access or financial barriers showed the most consistent contemporaneous association with lower odds of high adherence, whereas associations with illness- or treatment-related beliefs and side-effect concerns were less consistent across analyses. These record-based observational findings require prospective confirmation.
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