Determinants of medication adherence in children presenting to the emergency department with asthma

Abstract

Background: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, however adherence remains poor, leading to morbidity and mortality. In order to target adherence interventions to those who need it most, it is important to identify factors associated with adherence, yet these are not fully understood in children. This study aimed to identify factors associated with ICS adherence in children. Methods: Adherence was monitored electronically over six-months in children aged 6 to 15 who attended the emergency department for asthma and were prescribed ICS. Participants completed questionnaires assessing family demographics, such as household size, access to primary care, relationship with health professionals and family cohesiveness; asthma responsibility, asthma knowledge and learning styles. Multivariable analysis of factors associated with adherence was conducted. Findings: One hundred and one children (mean age 8.9 years, 51% male) participated. Median preventer adherence was 30% of prescribed (25th percentile 17%, 75th percentile 48%). Four factors were statistically significantly associated with adherence: female sex (12% greater adherence), Asian ethnicity (19% greater adherence versus non-Asian ethnicities), living with a lower number of people in the household (adherence decreased by 3% per person), and younger age at diagnosis (adherence decreased by 3% for every later year of diagnosis) (all p<0.02). Discussion: In children attending the emergency department for asthma, males and children of non-Asian ethnicity were at higher risk for poor ICS adherence, indicating that they may benefit most from adherence intervention. Further research is recommended to replicate and extend our findings in other children with high-risk asthma.