The Adherence Paradox in Uncontrolled Moderate-To-Severe Asthma: A Qualitative Study of Patient Experiences and Unmet Needs.

In clinical practice, a significant subgroup of patients with moderate-to-severe asthma reports persistent symptoms and substantial impairment in daily functioning despite high adherence to prescribed inhaled therapy. However, their lived experiences and unmet needs remain poorly understood. This descriptive phenomenological study aimed to explore the illness experiences, related barriers, and unmet needs of adults with moderate-to-severe asthma who remained persistently uncontrolled despite objectively verified high adherence to prescribed inhaled maintenance therapy. In-depth, semi-structured interviews were conducted with 14 adult patients between June and November 2025 in a specialty asthma clinic at a tertiary-level hospital in China, and the data were analyzed using Colaizzi's seven-step phenomenological method. Four overarching themes were identified, revealing a multidimensional hidden burden: (1) physiological instability, characterized by persistent symptoms and comorbidity-driven symptom amplification; (2) life-space constriction, involving occupational vulnerability, stigma, and defensive withdrawal; (3) psychological duality, in which fear and vigilance coexisted with resigned habituation; and (4) therapeutic dilemmas, including corticosteroid anxiety and dependence, financial toxicity, and fears of therapeutic futility. These findings show that persistent poor control in highly adherent patients is experienced not simply as ongoing symptoms, but as a multidimensional burden. This adherence paradox challenges the assumption that high adherence invariably indicates satisfactory control. The findings also highlight the need for nurse-led follow-up and future intervention studies focusing on symptom interpretation, uncertainty management, and treatment-related concerns in this subgroup.