Improving adherence in paediatric respiratory disease

Abstract

Educational aimsTo review the evidence on determinants of adherence in children with chronic respiratory disease.To discuss the “common sense model” as a method to understand medication-taking behaviour in children.To review the importance of illness perceptions and medication beliefs in determining adherence to maintenance medication in children with chronic respiratory disease.To present recommendations to optimise adherence through enhancing involvement of patients and parents in consultations of children with chronic respiratory disease.SummaryIn children with chronic respiratory disease, nonadherence to maintenance medication is common. Observational studies, however, show that good adherence can be achieved and maintained. This review will discuss the current state of the evidence on adherence and its determinants in children with chronic respiratory disease. It will highlight the importance of illness perceptions and medication beliefs as strong drivers of adherence, based on the common sense model of how people deal with a chronic illness. Exploring such cognitions by interested enquiry of the patient's perspective will help the clinician to identify and overcome barriers to adherence. When decisions on treatment are made according to the principle of shared decision making, concordance between patient and healthcare provider is aided, which improves adherence.

Technical Factors That May Influence mHealth Adherence in Children With Chronic Pulmonary Diseases: Scoping Review

“…The notion of adherence to treatment refers to “the extent to which a person's behavior, in terms of taking medications, following diets, or executing lifestyle changes, coincides with medical or health advice.”6 (p516) The lack of adherence to treatment has been described as a “worldwide problem of striking magnitude.” Adherence levels rarely exceed 50% in people with chronic diseases 7. In cases of CPD, poor adherence among children receiving pharmacological and nonpharmacological treatment has been related to inferior clinical outcomes such as pulmonary exacerbations, lung function decline, risk of hospitalization, and increased health care costs 8. In addition, adherence to treatment may be challenging, especially for younger children, younger than 18 years, given that they are asked to engage for up to 2 hours per day in conventional respiratory therapy sessions in order to mitigate lung function decline 9.…”

“…In addition, adherence to treatment may be challenging, especially for younger children, younger than 18 years, given that they are asked to engage for up to 2 hours per day in conventional respiratory therapy sessions in order to mitigate lung function decline 9. There appears to be an urgent need for actions targeted to increase adherence rates in order to potentially reduce the physical, mental, and socioeconomic effects of chronic pediatric pulmonary diseases 8,10…”

Detecting technical factors that influence compliance to non-pharmacological treatment using mHealth technology in children with chronic pulmonary disease: a scoping review protocol

“…Noteworthy, in the management of chronic lung disease, adherence is considered crucial to treatment (either to pharmacological or to non-pharmacological). 6 Adherence to treatment has been described as a worldwide problem of striking magnitude and it reaches approximately 50% in most chronic diseases. 7 More specifically in pediatric population, poor adherence often leads to poorer clinical outcomes such as pulmonary exacerbations, lung function decline, risk of hospitalization and increased health care costs.…”