Noncompliance to prescribed-as-needed (PRN) medication use in asthma: Usage patterns and patient characteristics

Asthmatic patients ( N = 88) in intensive medical treatment used supplemental, as-needed (PRN) medications relative to daily pulmonary function levels according to four patterns. Only 33% used PRNs appropriately, taking PRNs frequently on days when airway obstruction was present, and infrequently on days when it was not present. The remaining patterns were clearly noncompliant in that actual usage bore no resemblance to recommended usage, i.e., to relieve the distress of acute airway obstruction. Twenty percent of the patients overused PRNs, 20% underused them, and 27% used PRNs in an arbitrary fashion relative to airway obstruction. While there were no differences among any PRN usage groups in the actual severity of the asthma, differences did exist along psychological dimensions, including general personality, and more specifically in how asthma and its treatment were viewed and experienced. Discussion centered upon the personal styles associated with PRN noncompliance, and how these styles and related behaviors contribute to the maintenance of illness and to the defeat of medical treatment.