Compliance with inhaled therapy and morbidity from asthma

Horn, C.R.; Clark, T. J. H.; Cochrane, G. M.

doi:10.1016/s0954-6111(08)80097-2

Cited by 141 publications

(71 citation statements)

References 6 publications

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“…6 The consequences of nonadherence may include poor symptom control, excessive ␤-agonist use, high emergency department (ED) utilization, hospitalization, and even death. [7][8][9][10] Levels of adherence for asthma vary from 3% to 88% [11][12][13][14][15][16][17][18][19][20] and are unrelated to age, race, or gender. Most of the literature is compliance-focused and assumes that the patient is the problem.…”

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confidence: 99%

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

et al. 2002

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ABSTRACT. Objectives. Morbidity from asthma among children is one of the most important US health concerns. This study examines the relationship of baseline nonadherence to subsequent asthma morbidity among innercity children.Methods. A multisite, prospective, longitudinal panel study was conducted of 1199 children who were aged 4 to 9 years and had asthma and their caregivers, most of whom were parents, in emergency departments and clinics at 8 research centers in 7 US metropolitan inner-city areas. Nine morbidity indicators were collected at 3, 6, and 9 months after baseline, including hospitalizations, unscheduled visits, days of wheeze/cough, and days of reduced activities.Results. Children whose caregivers scored high on a new measure, Admitted Nonadherence, experienced significantly worse morbidity on 8 of the 9 measures. Children who scored high on a new Risk for Nonadherence measure experienced significantly worse morbidity on all 9 morbidity measures. Multiple and logistic regressions found that the adherence measures had independent significant effects on morbidity. Combining the measures improved estimates of morbidity: children whose caregivers were poor on either adherence measure had worse morbidity than those with good adherence on both, eg, rate of hospitalization was twice as high, they missed more than twice as much school, had poorer overall functioning, and experienced more days of wheezing and more restricted days of activity.Conclusions. Risk for Nonadherence and Admitted Nonadherence independently and jointly predicted subsequent asthma morbidity. Targeting risks for nonadherence may be an effective intervention strategy. Most risks can be controlled by physicians through reducing the complexity of asthma regimens, communicating effectively with caregivers about medication use, and correcting family misconceptions about asthma medication side effects. Pediatrics 2002;110(1). URL: http://www.pediatrics. org/cgi/content/full/110/1/e6; adherence, asthma, morbidity, inner-city, child.

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confidence: 99%

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

et al. 2002

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“…The tasks of this effort were twofold: 1) to determine what factors are associated with asthma morbidity in inner city children, and 2) to develop an intervention to address these factors. Nonadherence to a prescribed therapeutic program is one of the purported factors contributing to asthma morbidity and mortality in all populations 6 and is likely to contribute to asthma morbidity in inner city children with asthma. Therefore, one of the key areas of investigation in the NCICAS was compliance or adherence to an asthma management plan by patients and families.…”

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confidence: 99%

Self-reported Adherence, Management Behavior, and Barriers to Care After an Emergency Department Visit by Inner City Children With Asthma

et al. 1998

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ABSTRACT. Objective. The inability to adhere to a prescribed therapeutic program for the treatment of a chronic disease may be responsible in part for continued disease activity. This problem may be more of an issue in the treatment of asthma, a common, potentially lethal chronic condition in which the lack of symptoms may be interpreted as remission. Adherence was one of the key areas of interest for the National Cooperative Inner-City Asthma Study. The focus of this study was to identify those issues reported by families that could adversely affect their adherence to an asthma care program. The identification of barriers to adherence could then form the basis of a successful intervention program. This study describes barriers to adherence, asthma management behavior, and self-reported adherence.Methods. Patients presenting during an acute attack of asthma at an emergency department (ED) were recruited for this study. The medical record of the ED encounter was abstracted and compared with information that was obtained during a baseline interview 3 to 5 weeks later. During the baseline interview, parents were asked about health care behaviors related to adherence.Results. There were 344 children 4 to 9 years of age living in inner city census tracts in the study. Four areas of adherence (medicine use, appointment-keeping, emergency actions, and asthma attack prevention) were investigated. The parental report of medications prescribed at the ED and the information on the abstracted ED report agreed 94.9% of the time for the ␤-agonists, 86.8% for steroids, and 69.4% for cromolyn. Among respondents, 85.4% of parents reported that they are able to follow the ED recommendations almost all of the time; side effects of medicines were a concern for 81.1% of caretakers who were adherent and for 89.5% of caretakers who were nonadherent. Doubts regarding the usefulness of medications occurred in 34.4% of those considered adherent and 54.2% who admitted nonadherence. Medications were forgotten some of the time by 45.2% of the children, and 52.8% tried to get out of taking medicine. Appointments for follow-up care were kept by 69% of those given an appointment in the ED, by an estimated 60.0% of those who were told specifically to call for an appointment, and by an estimated 25.2% of those who were neither given an appointment nor told specifically to make one. Only one third of parents report that they were able to keep the child away from known asthma triggers nearly all of the time. Approximately half avoided allergens; however, only 37.5% reported avoidance of cigarette smoke. The use of preventive medicines occurred in 23.5%. Using a medicine and taking the child to a physician were reported as the first or second action during an acute attack of asthma by 72.1% of respondents.Conclusions. Adherence to an asthma-management program involves a number of areas: medication, appointment-keeping, prevention, and applying an emergency plan of action. Barriers to adherence may exist in one or all four of these areas, leading to...

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“…Although efficacious drugs for asthma control are available, long-term noncompliance with treatment (3)(4)(5)(6)(7)(8)(9)(10) , as in other chronic diseases, decreases the effectiveness of such treatments significantly, resulting in higher morbidity and mortality (11)(12)(13) . It is known that approximately half of the patients with asthma use the prescribed medication effectively (14)(15) , and there is a direct correlation between noncompliance with inhaled corticosteroid treatment and uncontrolled asthma (16) .…”

Section: Discussionmentioning

confidence: 99%

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma: Pulvinal® versus Aeroliser®

Fiterman¹,

Mattos²,

Cukier³

et al. 2004

J. bras. pneumol.

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INTRODUÇÃO: Apenas metade dos pacientes asmáticos fazem o tratamento prescrito, o que torna a baixa adesão ao tratamento um dos principais problemas no manejo desta enfermidade. É possível que dispositivos inalatórios que combinem o melhoramento tecnológico com a simplicidade e o conforto em sua utilização possam minimizar a baixa adesão ao tratamento. OBJETIVO: Comparar a aceitabilidade e preferência de dois dispositivos inalatórios para a administração de beclometasona: Clenil Pulvinal(P) e Miflasona Aeroliser (A). Secundariamente, avaliar a eficácia e tolerabilidade desses dois sistemas inalatórios, no controle da asma crônica. MÉTODO: Foi realizado um estudo multicêntrico, aberto, comparativo, randomizado, cruzado, de grupos paralelos, em pacientes com asma estável. Foram incluídos 83 pacientes com asma clinicamente estável em uso de 500 a 1000 mg/dia de beclometasona. Após 2 semanas de observação, os pacientes iniciaram aleatoriamente, por 4 semanas, com doses equivalentes de P ou A, imediatamente seguido do outro tratamento em estudo por 4 semanas. RESULTADOS: Em ambos os grupos, P e A, a dispnéia de esforço e o VEF1 melhoraram. Não houve diferença quanto à eficácia clínica ou à freqüência de efeitos colaterais. A aceitabilidade foi considerada boa ou excelente nos dois grupos. O P foi preferido por 50,6% dos pacientes e o A por 39%. Caso o paciente necessitasse continuar a medicação, o P seria escolhido por 54,5% e o A por 37,7%. CONCLUSÃO: A eficácia clínica da beclometasona administrada pelos dois dispositivos inalatórios estudados (P e A) foi semelhante, tendo ambos também igual aceitabilidade.

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Compliance with inhaled therapy and morbidity from asthma

Cited by 141 publications

References 6 publications

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children

Self-reported Adherence, Management Behavior, and Barriers to Care After an Emergency Department Visit by Inner City Children With Asthma

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma: Pulvinal® versus Aeroliser®

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