What predicts poor collection of medication among children with asthma? A case-control study

Abstract

Compliance with asthma medication is recognised to be a problem. Acquisition of medication is the first step towards compliance. Factors predicting poor collection of prophylactic medication were investigated.A case/control study was conducted. Cases were children who had had at least two consultations for poorly controlled asthma in 1 yr and collected prescriptions of prophylactic medication irregularly. Controls were children whose prescriptions were collected as instructed.Levels of knowledge about asthma and asthma medication were high in both groups. Parents of cases were more likely to perceive their child's asthma to be moderate or severe and more likely to report that their child's asthma was not well controlled. They reported more night-time symptoms, exercise symptoms and school absence. Parents of cases were less likely to report that administering inhalers was part of the evening routine. They were less likely to perceive their child's prophylactic medication to be very effective and more reluctant to administer prophylactic medication.Some parents may decide to undertreat their children, although lack of organised routine may contribute to poor compliance. Parents need guidance on interpreting symptoms and support in establishing routines for the administration of medication.

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

“…Also, children living in a household with a single-adult and 3 children had increased hazards of discontinuation. 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.…”

Adherence with Preventive Medication in Childhood Asthma

“…Family dysfunction has been associated with reduced adherence [12, 21, 56]. Families without strong routines are less likely to fill prescriptions for asthma medication [60]. Non-adherence is greater in families with high levels of conflict and behavioural problems in their children [56].…”

“…However, numerous studies have failed to correlate asthma knowledge with the level of adherence [21, 42, 60–63], and simply providing information does not necessarily improve adherence [36]. Patients report higher levels of adherence with medication prescribed by physicians who communicate well [57, 58] and whose interactions were described as collaborative rather than authoritarian or generic [51].…”

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta 2 agonists for the treatment of chronic asthma in children under the age of 12 years

“…Concordance is likely to be enhanced if both the parent/carer and the child are involved and if using inhalers is part of the household routine. 64 There was also an indication from this study that some parents are apprehensive about long-term prophylactic treatment and would rather treat their children's asthma as a series of acute events (often requiring courses of oral corticosteroids). 64 Education programmes have been shown to improve concordance in adults and may also play a role in improving concordance within families.…”

“…The authors comment that this may be due to non-concordance or due to individuals adjusting their ICS dose as a result of improvements in asthma control. 63 Poor concordance is associated with poor asthma control 64 and increased exacerbation frequency 65 in children. Concordance is likely to be enhanced if both the parent/carer and the child are involved and if using inhalers is part of the household routine.…”