Abstract
Adherence to inhaled corticosteroids (ICS) is known to be suboptimal, which might result in poor asthma control. Knowledge on real life adherence and characteristics of children with suboptimal adherence offer opportunities to improve asthma treatment.
Objective: To evaluate adherence (Medication Possession Rate=MPR) to ICS in children and to describe characteristics of good vs. suboptimal ICS adherence.
Methods: Population-based cohort study within a Dutch primary care database (IPCI), containing medical records of 176,516 children. First, children with physician diagnosed asthma, aged 5-18 years between 2000-2012, were selected. Amongst all children with ICS prescriptions during follow-up, MPR was calculated. Amongst children with ≥2years of follow-up and >1 ICS prescription, characteristics were compared between children with good vs.suboptimal adherence.
Results: In the asthma cohort (n=14,303), 4000 children had >1 ICS prescription, mean MPR was 64%. In children with ≥2 years of follow-up and >1 ICS (n=2,397) mean MPR was 66%; 69% had a MPR<80%. Children with good adherence (Q4=MPR>87%) were younger at start ICS, more often consulted a pediatrician and had more exacerbations during follow-up than children with low adherence(Q1=MPR<37%). Differences were similar when comparing children with ≥80% vs.<80% MPR.
Conclusion: In Dutch primary care ICS adherence in children was suboptimal. Characteristics of children with good adherence were compatible with more severe asthma suggesting that adherence is driven by treatment need or intensity of medical follow-up. To study the association between adherence and exacerbations, methodological sound studies are needed to minimize confounding by asthma severity.
- Copyright ©ERS 2015