Understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.

We reviewed patient choice to follow HCP advice to adjust asthma treatment in a UK-based randomised, controlled, single-blind (study participant), multicentre, parallel group 48-week clinical study comparing biomarker-directed treatment adjustment with standard care in severe asthma.

Of 1572 treatment advisories (291 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR 3.10, 95% CI 1.68–5.73) and prior study medication changes (two or more changes: OR 2.77, 95% CI 1.51–5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR 0.54, 95% CI 0.32–0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR 29.28, 95% CI 16.07–53.36) when compared with those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.

Belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for the generalisability of models of care in severe asthma and require further focused studies.

了解为什么重症哮喘患者不遵循医疗保健提供者 (HCP) 的建议来调整治疗对于实现个性化的疾病管理至关重要。

在一项英国随机、对照、单盲（研究参与者）、多中心、平行组 48 周临床研究中，我们回顾了患者选择以遵循 HCP 建议调整哮喘治疗，该研究比较了重度哮喘中生物标志物指导的治疗调整与标准治疗.

在 1572 份治疗建议（291 名参与者）中，1377 例（87.6%）遵循了指导。与减少（70.3%）或增加（67.1%）治疗相比，患者更有可能遵循建议继续治疗（96.7%），64%的患者遵循所有治疗建议。属于少数族裔群体（OR 3.10，95% CI 1.68-5.73）和先前研究药物变化（两个或更多变化：OR 2.77，95% CI 1.51-5.10）与未遵循治疗建议相关的多变量分析。相比之下，前一年的急诊室出勤率（OR 0.54，95% CI 0.32-0.92）与遵循治疗建议有关。与要求维持治疗的患者相比，使用或停用口服皮质类固醇的效果最大（OR 29.28, 95% CI 16.07–53.36）。

属于少数族裔群体和多次先前的治疗调整与不遵循 HCP 治疗建议有关。患者对英国专科中心的 HCP 建议的反应也不同。这些发现对重症哮喘护理模型的普遍性具有重要意义，需要进一步集中研究。