NONCOMPLIANCE AND TREATMENT FAILURE IN CHILDREN WITH ASTHMA

Background: Accurate and reliable information about children's use of inhaled medications is needed because of the growing reliance on these drugs in the treatment of asthma and the excessive morbidity and mort ality attributable to this disease. Objective: This study was designed to evaluate the adherence of children with asthma to regimens of inha led corticosteroids and beta-agonists. Methods: Data collected electro nically by metered-dose inhaler. monitors were compared with data reco rded by patients on traditional diary cards. A volunteer sample of 24 children, between 8 and 12 years old, who had asthma for which they we re receiving both inhaled corticosteroids and beta-agonists, participa ted over a 13-week period. Each child was accompanied by a parent to a ll study visits. The main outcome measures were the use of medication as reported by diary card entries and recorded by electronic monitorin g and disease exacerbation, as indicated by requirement for oral corti costeroids. Results: The median use of inhaled corticosteroids reporte d by patients on their diaries was 95.4%, whereas the median actual us e was 58.4%. More than 90% of patients exaggerated their use of inhale d steroids, and diary entries of even the least compliant subjects ref lected a high level of adherence The children who experienced exacerba tion of disease sufficient to require a burst of oral corticosteroids differed markedly from the others in their adherence to prescribed the rapy as recorded by the electronic monitors. The median compliance wit h inhaled corticosteroids was 13.7% for those who experienced exacerba tions and 68.2% for those who did not. Conclusions: Electronic monitor ing demonstrated much lower adherence to prescribed therapy than was r eported by patients on diary cards. Low rates of compliance with presc ribed inhaled corticosteroids were associated with exacerbation of dis ease. Poor control of asthma should alert the physician to the possibi lity of noncompliance.