Suboptimal persistence with inhaled corticosteroid monotherapy among children with persistent asthma in the UK

Zhang, Qiaoyi; Taylor, Stephanie; Sazonov, Vasilisa; Thomas, Michael; Price, David

doi:10.4104/pcrj.2010.00061

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Only half of the children having received a first prescription of ICS have an ongoing prescription 1 year later ( poor persistence), and adherence rates to daily ICS use range from 30% to 70% in different studies. [5][6][7] Patients and their parents are usually held responsible for the poor persistence and adherence to ICS treatment, 8 9 and interventions to enhance medication adherence are focused on how healthcare providers can improve patients' and their parents' adherence behaviour. 10 In disagreement with childhood asthma management guidelines, most children with asthma are not being followed up regularly in primary care, 11 12 and many children with an ICS prescription have not been diagnosed with persistent asthma.…”

Section: Key Messagesmentioning

confidence: 99%

General practitioners’ prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study

et al. 2013

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ObjectivesTo evaluate general practitioners’ (GPs’) prescribing behaviour as a determinant of persistence with and adherence to inhaled corticosteroids (ICS) in children.DesignProspective observational study of persistence with and adherence to ICS followed by a focus group study of the GPs prescribing this treatment.Setting7 primary care practices in the area of Zwolle, the Netherlands.Participants134 children aged 2–12 years had been prescribed ICS in the year before the study started by their 19 GPs.Main outcome measuresPatterns and motives of GPs’ prescribing behaviour and the relationship with persistence with and adherence to ICS.ResultsGPs’ prescribing behaviour was characterised by prescribing short courses of ICS to children with various respiratory symptoms without follow-up for making a diagnosis of asthma. This was driven by the GPs’ pragmatic approach to deal with the large number of children with respiratory symptoms, and by beliefs about ICS which differed from currently available evidence. This prescribing behaviour was the main reason why 68 (51%) children did not persist with the use of ICS. In children with persistent use of ICS and a GP's advice to use ICS on a daily basis, the median (IQR) adherence was 70% (41–84%), and was similar for patients with persistent asthma and children lacking a diagnosis or symptoms of asthma.ConclusionsInappropriate prescription of ICS to children by GPs is common and drives the lack of persistence with ICS therapy in primary care. This finding should be taken into account when interpreting data from large prescription database studies. Improving primary healthcare providers’ knowledge and competence in diagnosing and managing asthma in children is needed.

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Section: Key Messagesmentioning

confidence: 99%

General practitioners’ prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study

et al. 2013

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“…A review of 19 studies shows treatment adherence ranged from 22% to 63% and that 24% of exacerbations and 60% of asthma-related hospitalisations were attributable to poor adherence 18. Zhang et al 19 found a persistence of 33.6% in children with persistent asthma on monotherapy. Our results are similar or perhaps slightly higher than those reported but are still low.…”

Section: Discussionmentioning

confidence: 99%

Treatment persistence and exacerbations in patients with asthma initiating treatment with inhaled corticosteroids and beta-adrenergic agonists: retrospective cohort study

et al. 2022

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ObjectiveTo determine treatment persistence and exacerbations in patients initiating inhaler treatment with fixed-dose combinations of inhaled corticosteroids/long-acting beta-2-adrenergic agonists (ICS/LABA) for the treatment of asthma.DesignRetrospective observational study conducted by review of electronic medical records (database: Fundación RediSS).SettingRetrospective cohort study. The follow-up period was 1 year.ParticipantsThe study included patients aged ≥18 years who started treatment with ICS/LABA and met the inclusion/exclusion criteria.Main outcomes and measuresThe study groups were fluticasone propionate/salmeterol (FP/SAL), beclomethasone/formoterol (BDP/FORM), budesonide/formoterol (BUD/FORM), fluticasone furoate/vilanterol (FF/VI) and fluticasone propionate/formoterol (FP/FORM). The main measurements were persistence, medication possession ratio (MPR) and exacerbations. Statistical significance was established as p<0.05.ResultsIn total, 3203 patients were recruited for the study. By groups, 31.1% FP/SAL, 28.6% BDP/FORM, 25.0% BUD/FORM, 8.2% FF/VI and 7.0% FP/FORM. The mean age was 52.2 years, 60.8% were female and 44.9% had persistent-moderate asthma. Treatment persistence was 61.7% (95% CI 60.0% to 63.4%) and by study group it was FP/SAL: 60.7%, BDP/FORM: 61.2%, BUD/FORM: 60.3%, FF/VI: 66.7% and FP/FORM: 67.6% (p=0.046). MPR by study group was FP/SAL: 74.3%, BDP/FORM: 73.8%, BUD/FORM: 74.6%, FF/VI: 79.4% and FP/FORM: 80.6% (p=0.028). The mortality rate was 2.9%. By treatment group, exacerbations were FP/SAL: 21.9% (95% CI 19.3% to 24.5%), BDP/FORM: 22.2% (95% CI 19.5% to 24.9%), BUD/FORM: 22.8% (95% CI 19.9% to 25.7%), FF/VI: 17.9% (95% CI 14.9% to 20.7%) and FP/FORM: 16.0% (95% CI 12.2% to 19.3%), p=0.036.ConclusionsPatients undergoing treatment with FP/FORM and FF/VI versus FP/SAL, BDP/FORM and BUD/FORM were associated with greater treatment adherence (persistence, MPR) and lower rates of exacerbations. However, further studies will be needed to strengthen the consistency of the results.

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“…Certainly, underprescribing is one factor in this; this can happen through an oversight or a failure on the part of a clinician to appreciate the chronicity or severity of a patient's asthma symptoms. Patients are also frequently noncompliant with inhalers for other reasons, including failure on the part of the provider to communicate the urgency of maintaining the daily regimen; patient concerns over side effects; lack of access to the medications; dis-comfort on the part of the patient over the use of inhaler devices; or some combination of these factors (Conn, Halterman, Lynch, & Cabana, 2007;Deis, Spiro, Jenkins, Buckles, & Arnold, 2010;McQuaid et al, 2009;Roy, Battle, Lurslurchachai, Halm & Wisnivesky, 2011;Zhang, Taylor, Sazonov, Thomas, & Price, 2011). Garro et al (2011) cite another study by Reeves, Bohm, Korzeniewski, and Brown (2006) that showed that 36% of children with asthma who visited an ED were not on appropriate controller medications, although this study may have counted patients as "appropriate" who took a leukotriene receptor antagonist (e.g., montelukast and zafirlukast), unlike the patients in the study of Garro et al Even so, the remainder-those 64% who were on controller medicineseems to show a remarkably high rate of medication compliance for patients with asthma who visit an ED, albeit one that allows plenty of room for improvement.…”

Section: Clint's Perspectivementioning

confidence: 99%

Inhaled Corticosteroid Prescribing From the Emergency Department for Children With Asthma

Shedd

Evans²

2012

Advanced Emergency Nursing Journal

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In the article "Frequency of Prescription of Inhaled Corticosteroids to Children With Asthma in U.S. Emergency Departments," the authors conducted a secondary data analysis from the National Hospital Ambulatory Medical Care Survey database to examine inhaled corticosteroid prescribing patterns of providers caring for children with asthma visiting emergency departments. We review and critique this article and use a case study module to illustrate the importance of the research findings and how they relate to practice in the emergency department in light of current national guidelines for managing asthma exacerbations.

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Suboptimal persistence with inhaled corticosteroid monotherapy among children with persistent asthma in the UK

Cited by 5 publications

References 21 publications

General practitioners’ prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study

General practitioners’ prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study

Treatment persistence and exacerbations in patients with asthma initiating treatment with inhaled corticosteroids and beta-adrenergic agonists: retrospective cohort study

Inhaled Corticosteroid Prescribing From the Emergency Department for Children With Asthma

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