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
- 1Affiliated Haiyan Hospital of Jiaxing University, Haiyan People’s Hospital
- 2School of Public Health, Zhejiang University School of Medicine
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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BibTeX
@article{zhang2026inhaled,
title = {{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}},
author = {Chun-juan Zhang and Qiu-yue Shen and Xiu-juan Ma and Min-feng Zhou},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1966303},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1966303/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Chun-juan Zhang
AU - Qiu-yue Shen
AU - Xiu-juan Ma
AU - Min-feng Zhou
PY - 2026
DA - 2026/10/05
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1966303
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1966303/full
AB - 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.
SN - 1664-3224
ER -