It's the adherence, stupid (that determines asthma control in preschool children)!

Abstract

Although guideline-based asthma care and adherence to inhaled corticosteroids are predictors of asthma control, the role of adherence in maintaining long-term asthma control is largely unknown. This study was designed to explore the relationship between adherence to inhaled corticosteroids and long-term asthma control in young children with asthma.In this observational study, 81 2-6-year-old asthmatic children, using inhaled corticosteroids, closely followed-up in a programme with extensive self-management training, were enrolled. Adherence was measured daily for 12 months using Smartinhaler (Nexus6 Ltd, Auckland, New Zealand) devices. Longterm asthma control was assessed by parents and physicians and included clinical assessment, an asthma control questionnaire and lung function measurement. We examined the association of adherence to asthma control, adjusting for seasonal influences and clinical characteristics.Median (interquartile range) adherence was 87% (70-94%), and 64 (79%) children had well-controlled asthma throughout follow-up. Adherence .80% was associated with better asthma control, and we found no important confounders of this association. Children with persistent mild symptoms had lower adherence rates (p50.028).Guideline-based asthma care was associated with good asthma control in most children. Adherence to inhaled corticosteroids was an independent strong predictor of long-term asthma control, with highest levels of asthma control found in children with adherence .80% of doses prescribed. @ERSpublications Adherence to inhaled corticosteroids strongly predicts long-term asthma control in young children

Classification and pharmacological treatment of preschool wheezing: changes since 2008

“…Atopy did not predict the response to ICS in this meta-analysis [22]. A recent report showed that the degree of asthma control achieved in 2-6 year old children was most strongly determined by their adherence to ICS treatment [23]. The lack of data on the symptom pattern in this study does not allow a firm conclusion whether this applies to both EVW and MTW.…”

Adherence: Its Role in Achieving Control Over Bronchial Asthma in Children

“…Так, в наблюдениях, в которых следование рекомендациям определялось с помощью электронных устройств, средний уровень приверженности составил 30-70% к общему количеству назначенных доз ИГКС [18]. В других работах отмечено, что уже 75%-е соблю-дение рекомендаций по использованию ИГКС дает у взрослых и детей полный или частичный контроль над астмой [18,19]. Таким образом, низкая приверженность назначенному режиму применения ИГКС значительно снижала эффективность лечения, приводила к некон-тролируемой БА и увеличивала расходы бюджетных средств [20].…”

“…Несоблюдение назначений -рас-пространенная причина персистирования симптомов у данной группы пациентов [5,10]. Исследования при-верженности и контроля над легкой или среднетяжелой астмой показали, что главной причиной хрипов, одыш-ки, ночного кашля, персистирующих слабовыраженных симптомов, которые могут провоцироваться физической нагрузкой, также является несоблюдение назначенных рекомендаций [14,19].…”

Paediatrics in Barcelona

“…They found a surprisingly high median adherence rate of 87% (interquartile range 61-94%). All studied children were taking part in an extensive self-management training programme [32]. It has been recommended that drug administrations should be reduced as a way of increasing adherence.…”