Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods.
BACKGROUND
Suboptimal adherence to inhaled steroids is a known problem in children and adolescents, even when medications are administered under parental supervision. This study aimed to verify the adherence rate to beclomethasone dipropionate (BDP) by four currently available methods.


METHODS
In this concurrent cohort study, 102 randomly selected asthmatic children and adolescents aged 3-14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser); Meditrack Products, Hudson, MA, USA) monitor, and canister weight.


RESULTS
Mean adherence rates to BDP by self and/or parent report, pharmacy records, Doser, and canister weight were 97.9% (95% CI 88.0-98.6), 70.0% (95% CI 67.6-72.4), 51.5% (95% CI 48.3-54.6), and 46.3% (95% CI 44.1-48.4), respectively. Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76 (95% CI 0.65-0.87).


CONCLUSIONS
Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice.
Department of Pediatrics, Medical Sciences School, Campos Sales Pediatric Pulmonology Outpatient Clinic, Belo Horizonte Municipal Health Authority and Lucas Machado Foundation.
N S
NS
Jentzsch
Pediatric Pulmonology Unit, University Hospital.
P A M
PAM
Camargos
Department of Statistics, Exact Sciences Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil.
E A
EA
Colosimo
Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France.
J
J
Bousquet
D000280:Administration, Inhalation; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001507:Beclomethasone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D018670:Monitoring, Ambulatory / Q000379:methods; D010594:Pharmacies; D012646:Self Administration; D012720:Severity of Illness Index; D016903:Drug Monitoring
D018927:Anti-Asthmatic Agents; D001507:Beclomethasone