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Pediatr Pulmonol. 2015 Nov;50(11):1060-4. doi: 10.1002/ppul.23138. Epub 2014 Dec 2.

Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits.

Author information

1
Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.
2
UMCG Postgraduate School of Medicine, University Medical Center and University of Groningen, Groningen, The Netherlands.

Abstract

OBJECTIVE:

To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.

STUDY DESIGN:

One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A  > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).

RESULTS:

Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).

CONCLUSIONS:

There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.

KEYWORDS:

adherence; asthma and early wheeze; inhaled corticosteroids; self management; white coat adherence

PMID:
25469915
DOI:
10.1002/ppul.23138
[Indexed for MEDLINE]

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