Kids often skip asthma drugs

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Children with asthma who are prescribed daily medication frequently miss scheduled doses, investigators report in the Journal of Pediatrics. Authors of a second paper believe that this is because families often have difficulty incorporating daily medication into their normal routines.

Dr. Natalie Walders, at the National Jewish Medical and Research Center in Denver and her colleagues examined adherence to long-term, daily medication and use of as-needed drugs. Included were 75 children diagnosed with persistent asthma.

Over a period of month, there were high levels of nonadherence. In fact, only about 45 percent of prescribed doses were taken. Adherence was actually worse in older children than in younger ones. As might be expected, as adherence increased, trips to the emergency room and school absences declined.

Reliance on as-needed drugs varied widely, from no inhaler puffs to 18 puffs per day. The use of such drugs was not associated with adherence to daily medication recommendations or with illness during the previous year.

In the second study, Dr. Barbara H. Fiese told Reuters Health that her group examined “how families organize their daily lives in ways that can promote better medication adherence.”

To that end, Fiese, at Syracuse University in New York, and associates developed an eight-item questionnaire, which was administered to 133 families with a child with asthma. The results were correlated with medication adherence and responses to standard questionnaires on medication adherence, asthma severity and quality of life.

The maintenance of regular routines around medication use was associated with better adherence to medications, Fiese said.

“For some families, maintaining regular routines is not a big deal,” so they can readily incorporate daily medication into those routines, she pointed out.

For example, she said, “patients are often advised to keep their asthma medication by their toothbrush, so they remember to take their medication whenever they brush their teeth.” However, this assumes twice-daily brushing.

In some families, there’s a perception that this is yet another thing that needs attention. “Those families,” she added, “may need some additional support in learning how to fold medication use into their daily life so that it reduces strain and burden rather than increasing it.”

In an accompanying editorial, Dr. Cynthia S. Rand at the Johns Hopkins Center for Adherence Research in Baltimore comments that “solutions to adherence problems in asthma management will be as varied and idiosyncratic as each family being treated.”

However, she adds that “the one essential adherence intervention appropriate for all families will be open-ended, nonjudgmental provider-patient communication.”

SOURCE: Journal of Pediatrics, February 2005.

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