title: Poor adherence to self-medication instructions in children with asthma and their parents.
abstract: This study describes a self-treatment program for parents of children with asthma. The aim was to prevent asthma exacerbations by learning to recognise prodromal signs and acting upon them by increasing inhaled corticosteroids (ICS). The study questions were: (1) can we teach parents and children to recognise prodromal signs? (2) are instructions to increase inhalation medication followed? (3) will frequency and severity of asthma attacks diminish subsequently? Due to physicians' changed attitude towards prescription of ICS, fewer children could be recruited who were "ICS-naive" than expected. Twenty-nine children of the age of 4-11 years with moderate asthma, participated in a one year prospective randomised study. Structured information was given to all patients on asthma, symptoms and medication. The experimental group received additional information on recognising prodromal signs and doubling ICS during one week. Only in 25% of the patients who recognised prodromal signs the dose of ICS was doubled (as prescribed), in 75% inadequately or not at all. Recognition of prodromal signs was poor as well as compliance to increase as-needed medication. No significant decrease of asthma symptoms occurred in the experimental group. Clinical implications are important for self-treatment instructions: an individually tailored and multi-component program should be offered by health care providers in order to help the patient to recognise early alarm symptoms, comply to self-treatment instructions and to make adaptations for continuous self-regulation.
authors.affiliation: Asthma Centre Heideheuvel Soestdijkerstraatweg 1291213 VX Hilversum The Netherlands. vcolland@heideheuvel.nl
authors.forename: Vivian T
authors.initials: VT
authors.lastname: Colland
authors.forename: Liesbeth E M
authors.initials: LE
authors.lastname: van Essen-Zandvliet
authors.forename: Caroline
authors.initials: C
authors.lastname: Lans
authors.forename: Anne
authors.initials: A
authors.lastname: Denteneer
authors.forename: Paul
authors.initials: P
authors.lastname: Westers
authors.forename: Hein J L
authors.initials: HJ
authors.lastname: Brackel
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D008297:Male; D010290:Parents; D010349:Patient Compliance; D010353:Patient Education as Topic; D011446:Prospective Studies; D012648:Self Care; D016037:Single-Blind Method
chemical_list: D005938:Glucocorticoids