Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol

Abstract

Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.

Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial

“…Within patients with high adherence rates (MARS > 19, n = 158) there was no effect of the intervention, although less can be achieved in patients with higher medication adherence rates. These patients also had significant better asthma control, which is in line with previous studies where adherence was related to better asthma control [4,30]. However, still 73.4% of these adherent patients had no control over their disease (CARAT ≤24).…”

“…Poor inhaled corticosteroid (ICS) adherence is common, i.e., only 22%-63% of the asthma patients is adherent [1]. These poor adherence rates result in poorly controlled asthma and thereby an increased risk of exacerbations, healthcare utilization, rescue medication use, healthcare costs, and decreased quality of life [1][2][3][4]. To reach sufficient asthma control, asthma patients should adhere to the prescribed medication regimen.…”

Adherence to Asthma Controller Therapy Among Children in Majmaah City, Saudi Arabia

“…A recent study conducted in Brazil evaluated the adherence rate to asthma medications among children and adolescents with moderate asthma by using the inhaler’s dose counter during follow-up visits, and it found good adherence of up to 87.7% among participants, which had helped lead to asthma control [ 21 ]. A cross-sectional study conducted in Saudi Arabia studied the adherence among children by using the Morisky Medication Adherence Scale and found an adherence rate of 64.9% to asthma medication, which is similar to what had been reported in the past [ 22 ].…”

<p>New insights to improve treatment adherence in asthma and COPD</p>

“…In contrast, asthma can present at any age,26 and younger children with asthma may also have difficulty using inhalers correctly, especially in terms of inhalation technique 27. Concerns about adverse effects, such as growth suppression and osteoporosis,28,29 and particularly about the necessity of steroid treatment (inhaled or oral),30 may cause parents of children with asthma to be less likely to enforce adherence to prescribed therapy 31. Some clinicians may also be hesitant to prescribe inhaled corticosteroids (ICSs) to children for these same reasons 32.…”

“…A study in pediatric patients with moderate persistent asthma showed that medication adherence was also a strong determinant of asthma control (as defined by the 2018 GINA report) 2,30Table 1Summary of study results linking inhaled medication adherence to patient outcomes in asthmaStudyPopulationStudy designMeasure(s) of adherenceOutcomesBender 201056US patients aged 18–65 yearsRandomized clinical trialElectronic dose counterChanges in canister weight (budesonide/formoterol only)IVR significantly improved adherence by 32% ( P =0.003)BMQ showed a greater upward shift in medication beliefs for the IVR group ( P =0.007)No difference observed in AQLQ or ACT between groupsMelani 201125Italian patients aged ≥14 yearsCross-sectional, observational study of patients using an inhaler regularly at homeInvestigator-observed placebo inhaler useSuboptimal inhaler technique increased risk of hospitalization (47%, P =0.001) and the use of the ER (62%, P =0.0006), antibiotics (50%, P =0.00004), and OCSs (54%, P =0.00003)Petrie 201235New Zealander patients aged 16–45 yearsRandomized clinical trialPatient-reportedAverage adherence over time was significantly higher in the intervention group (57.8%) than the control group (43.2%, P =0.003)Patients with an average adherence ≥80% included significantly more patients from the intervention group (25.9%) compared with the control group (10.6%, P= 0.034)Perceptions of controller medication necessity, long-term nature of asthma, and asthma control were all positively increased in the intervention group relative to the control group (all P <0.05)Vollmer 201357US patients aged ≥18 yearsPragmatic clinical trialmMPR ≥0.8Primary analysis: IVR significantly increased adherence by 0.02 ( P =0.002) compared with usual carePost hoc analysis (receiving ≥2 IVR contacts): adherence increased by 0.06 ( P <0.001)No difference observed in asthma morbidity (SABA use or urgent asthma health care use)Ismaila 201438Canadian patients aged ≥12 yearsObservational study of patients taking FSCMPR ≥80%Persistence: ≤30-day treatment gap...…”