Adherence to oral montelukast and inhaled fluticasone in children with persistent asthma

Study Objective. To evaluate adherence to oral montelukast and inhaled flut icasone in children with persistent asthma and to determine if age, monothe rapy, and duration of therapy affect adherence. Design. Retrospective analysis. Setting. Pediatric pulmonary clinic. Patients. One hundred seventy-one children with asthma who required continu ous treatment with a controller agent year-round and in whom montelukast an d/or fluticasone had been prescribed for at least 90 days. Intervention. Montelukast monotherapy had been prescribed for 54 patients, fluticasone monotherapy for 48 patients, and combination therapy for 69 pat ients. Measurements and Main Results. Prescription refill histories were obtained from pharmacies identified by the parents or from Medicaid pharmacy reimbur sement records. The maximum possible adherence was calculated as [(no. of d oses refilled)/(no. of doses prescribed)] x 100, for a mean observation per iod of 203 days (range 84-365 days) for montelukast and 314 days (range 97- 365 days) for fluticasone. Median adherence rates were 59% (95% confidence interval [CI] 48-65%) for montelukast and 44% (90% CI 35-50%) for fluticaso ne. Adherence did not significantly correlate with age, length of observati on period, or whether the patient was receiving monotherapy or combination therapy. The odds ratio for very poor adherence (< 50%) was 2.0 (95% CI 1.3 -3.2) for fluticasone relative to montelukast. Conclusions. Adherence to both drugs was suboptimal. However, these data in dicate that our patients were likely to take montelukast more consistently than fluticasone. Whether this translates into better asthma control requir es further study.