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

Abstract

Parents often overreport adherence to asthma treatment regimens making accurate assessment of medication adherence in clinical practice difficult. This study was conducted to compare two adherence assessment methods clinicians may choose from when assessing patient inhaled corticosteroid (ICS) adherence: parental report and dose counter measurements of metered-dose inhaler (MDI) actuation. Participants included children (N = 50) with persistent asthma and their parents (N = 50). At enrollment, children received a new, marked ICS at the dose prescribed by their physician. Thirty days following enrollment, we measured ICS adherence by parental report and objectively, with a dose counter. Parental report overestimated ICS adherence when compared to dose counter. We found a statistically significant overall difference between parental report and objectively measured adherence. A dose counter that most ICS inhalers are equipped with may be a more reliable alternative measure of ICS adherence in a clinical practice setting.

Preventive asthma medication discontinuation among children enrolled in fee-for-service Medicaid

“…This finding is consistent with prior research suggesting that discontinuation is greater in families lacking adequate social support and in those without strong routines, instruction, and supervision [47,48]. Consistent with other studies [30,[41][42][43], in this study a leukotriene modifier combined with ICS was associated with lower hazards of discontinuation when compared to inhalational therapies alone (i.e. ICS, long-acting b 2 -agonists, or mast cell stabilizers).…”

“…Covariates were chosen that have been found in other research to be predictive of discontinuation: age at first preventive asthma medication claim, sex [9,[34][35][36][37][38][39][40], race/ ethnicity [4,9,10,21,38,41], urbanicity [41], geographic location [9], reported highest educational attainment by any family member [35,37,39,42], family structure [39,40,43], reported health status [9], presence of chronic conditions besides asthma [7,35], healthcare out-of-pocket costs [12], presence of a primary care provider [5,6], and preventive asthma medication regimen [7,20,36].…”

An information‐motivation‐behavioural‐based model and adherence to inhalation therapy and other health outcomes in patients with chronic obstructive pulmonary disease: A pilot randomized controlled trial

“…The adherence rate of the inhalation regimen was calculated as a ratio of the number of doses taken to the number of doses prescribed (Bender et al, ; Reznik & Ozuah, ). The quantity of doses inhaled was estimated by the quantity of doses remaining, as the newer dry powder inhalers (DPIs) and pressurized metered dose inhalers (MDIs) contain built‐in dose counters that show the remaining doses inside the device.…”

Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir® HFA) with and without integrated dose counters

“…As a rescue/relief agent, albuterol sulfate inhalation aerosol is used to improve the symptoms of asthma while the preventer/controller agents are being titrated 11,12. Accurate tracking of the administered dose is, therefore, critically important for optimal asthma control and for potentially reducing the rates of unscheduled health care utilization, and thus the cost of care, in patients with asthma 13–16…”