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Kids with Asthma: Are They Taking Their Medicine?

Asthmatic children and their parents may not accurately report how the children use their asthma medication, according to a new study.

A comparison of children's and parents' reports of how often they used a daily inhaled asthma-controller (corticosteroid) versus objective measurements of how much they actually used revealed that children used on average <50% of their prescribed doses.

The study was conducted by Bruce Bender, PhD, a professor of psychiatry at the University of Colorado, and colleagues of the National Jewish Medical and Research Center in Denver. Results were presented at the annual meeting of the American Academy of Allergy, Asthma, & Immunology in March and by MedPage Today on March 7, 2006.

"In the treatment of asthma, we have this big disconnect," said Dr Bender, according to MedPage Today. "On the one hand we have these evidence-based guidelines that persistent moderate to severe illness needs to be treated with a daily controller medication, in other words, inhaled corticosteroids."

He added, "On the other hand, we have patients who do what they're willing to do and what they agree with. "And the disconnect is huge: most patients don't follow a daily treatment regimen, now matter how good their doctor is."

Clinical Trial

The four-month study by Dr Bender and colleagues included 123 children aged 8-18 years who required daily asthma-controller medication.

The researchers compared patient self-reports of the frequency of controller-medication use with actual use (as measured by inhaler-canister weight and by metering system, including the electronic Doser and MDILog devices, or the Advair (fluticasone and salmeterol) mechanical delivery device counter).

Total adherence to the prescribed asthma-controller regimen averaged 45% over four months and across the three monitoring devices.

About 57% of the children used less than half of their prescribed doses, and about 25% of them used less than one quarter of their medication. The researchers also discovered that adherence to the prescribed dosing regimen decreased from the first to second month of monitoring, but leveled out thereafter, "suggesting that one-month monitoring may not provide a fully accurate assessment of adherence."

Limits of the study included variation in the accuracy of the three measuring devices, and the fact that limiting the daily recorded medication levels to ≤100% of the prescribed dosage made readings from the two electronic devices (Doser and MDILog) more accurate, but did not do the same for the Advair mechanical counter.

According to MedPage Today, The investigators concluded that "remarkably poor controller medication adherence in a community sample of children with asthma establishes again that non-adherence remains a major barrier to successful treatment. No measurement strategy has yet demonstrated complete accuracy in recording adherence behavior. Careful management of electronically recorded adherence data is necessary to reduce measurement error."

Dr Bender reportedly said that, in one of his previous studies, the patients' fear of side effects was the primary factor preventing children from taking their asthma medicine. Moreover, because asthma is an intermittent disease for many patients, they may be reluctant to take medication when they have no symptoms, and parents often have concerns that their children may become dependent on inhalers.

Posted: March 2006