Métodos empregados na verificação da adesão à corticoterapia inalatória em crianças e adolescentes: taxas encontradas e suas implicações para a prática clínica

Abstract

Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis. Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. In some countries, pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil. The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.Keywords: Patient compliance; Asthma/therapy; Asthma/prevention & control. ResumoAdesão inadequada à corticoterapia inalatória é comum e contribui para um controle clínico insatisfatório, aumento da morbidade, mortalidade e dos custos do setor. Este artigo de revisão foi conduzido utilizando-se bancos de dados Medline, HighWire, Literatura Latino-Americana e do Caribe em Ciências da Saúde e pesquisa direta, entre 1992 e 2008. Os métodos para avaliar a adesão, citados em ordem crescente de sua objetividade, são: relato do paciente ou seus familiares, julgamento clínico, pesagem da medicação, dispensação de medicação, dosadores eletrônicos e análise bioquímica (pouco utilizada). As taxas de adesão variaram de 30 a 70%. A adesão determinada pelo relato do paciente/ familiares e julgamento clínico é reconhecidamente exagerada quando comparada à obtida através do dosador eletrônico. O clínico deve sempre lembrar que as taxas reais de adesão são menores do que as relatadas pelo paciente e isso deve ser considerado, se não houver bom controle da doença. A pesagem do spray quantifica a medicação e infere adesão, porém pode ocorrer esvaziamento deliberado e compartilhamento da medicação. A farmácia fornece datas de dispensação e recarga da medicação. Esta estratégia é v...

Measurement of Inhaled Corticosteroid Adherence in Inner-City, Minority Children with Persistent Asthma by Parental Report and Integrated Dose Counter

“…However, these devices are costly [10] and prone to mechanical failure [11, 12], making them impractical for office or clinic practices. In turn, many pediatricians rely on parental report of ICS adherence to guide asthma management in children with persistent asthma [13].…”

Towards tailored and targeted adherence assessment to optimise asthma management

“…For a more extensive comparison, we refer to previous reviews that compared adherence measurement methods in asthma. 8 , 9 , 28 Table 1 was the result of thorough assessment of these previous reviews and a final consensus between the authors of this article.…”

“…Direct biochemical measurement is an unbiased method to assess actual intake, but is costly and invasive and only provides a point estimate of adherence. 9 , 28 In-depth patient interviews by a healthcare provider can provide insight in most types of non-adherent behaviour, yet they require regular face-to-face meetings and effective patient–provider communication to obtain a continuous measure. 10 , 29 Longitudinal measurement of adherence by prescription refills provides a continuous and remotely accessible alternative.…”

“… 10 , 29 Longitudinal measurement of adherence by prescription refills provides a continuous and remotely accessible alternative. 28 However, this method of measuring adherence lacks discriminative properties regarding the three types of non-adherence and cannot detect a poor inhalation technique.…”

Adolescência e manejo da asma: a perspectiva dos assistidos na atenção primária à saúde

“…Vai além, prescinde concordância, consentimento do paciente ao tratamento proposto, que, no caso da asma, envolve o uso de medicações, o controle dos alérgenos e irritantes ambientais e o acompanhamento nos serviços de saúde. A adesão leva em conta a relação profissional de saúde-paciente 5. A adesão ao tratamento da asma determina o reconhecimento e a valorização de algo muito mais complexo do que protocolos, normas e consensos: o doente, aquele que vivencia a doença em seu contexto de vida.…”