Adherence in childhood asthma: the elephant in the room

Abstract

Adherence to inhaled steroids is suboptimal in many children with asthma and can lead to poor disease control. Many previous studies in paediatric populations have used subjective and inaccurate adherence measurements, reducing their validity. Adherence studies now often use objective electronic monitoring, which can give us an accurate indication of the extent of non-adherence in children with asthma. A review of the studies using electronic adherence monitoring shows that half of them report mean adherence rates of 50% or below, and the majority report rates below 75%. Reasons for non-adherence are both intentional and non-intentional, incorporating illness perceptions, medication beliefs and practical adherence barriers. Interventions to improve adherence in the paediatric population have had limited success, with the most effective containing both educational and behavioural aspects.

Modern Strategies for the Therapy of Persistent Bronchial Asthma in Adolescents

“…Важность этого наблюдения продиктована тем, что у детей и подростков приверженность к приему еже-дневной ингаляционной базисной терапии, по данным электронного мониторинга, не превышает 50% [16]. По другим данным, приверженность к использованию инга-ляционных глюкокортикостероидов в подростковом воз-расте составляет от 25 до 35%, в возрасте 16-17 лет -менее 30% [17].…”

Consenso chileno SER-SOCHINEP para el manejo del asma severo en el niño

“…La no adherencia al tratamiento es la principal causa de mal control en los pacientes asmáticos 28 . Se ha demostrado que la adherencia a los medicamentos controladores debe superar el 75% de lo indicado para que el control del asma sea satisfactorio 29,30 . Desgraciadamente se ha visto que los niveles de adherencia en pacientes asmáticos oscilan entre el 30 y 50% de las dosis prescritas 11,29 .…”

“…Se ha demostrado que la adherencia a los medicamentos controladores debe superar el 75% de lo indicado para que el control del asma sea satisfactorio 29,30 . Desgraciadamente se ha visto que los niveles de adherencia en pacientes asmáticos oscilan entre el 30 y 50% de las dosis prescritas 11,29 . La deficiente adherencia al tratamiento se asocia a falta de control de la enfermedad y aumento del riesgo de exacerbaciones.…”

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…In general, 30-70% of people on long-term preventer therapy do not maintain the high levels of adherence necessary for good asthma control. Suboptimal levels of adherence are found in adults [11]; children [14,15] and adolescents [14][15][16].…”