Adherence to combined montelukast and fluticasone treatment in economically disadvantaged african american youth with asthma.
High rates of asthma treatment nonadherence have been reported, particularly in economically disadvantaged African American youth. The relationship between adherence to combined medication treatment and asthma outcomes has potential clinical significance but is not well understood. Using electronic monitoring, we describe the pattern of adherence to daily corticosteroid (fluticasone) and leukotriene receptor antagonist (montelukast) medication over the course of 1 year in a population of African American youth with moderate to severe asthma. On average, adherence to montelukast was higher than adherence to fluticasone (p < 0.01); however, for both medications, adherence rates significantly declined over the course of the study. After 1 year, participants took only 31% of prescribed doses of montelukast and 23% of prescribed doses of fluticasone. The decline in adherence to both fluticasone (p < 0.05) and montelukast (p < 0.001) was related to increased healthcare utilization. Furthermore, asthma symptom ratings were related montelukast (p < 0.001), but not fluticasone adherence. These results suggest that adherence promotion intervention strategies are warranted to improve health-related outcomes in families who are at-risk for treatment nonadherence.
McNally
Kelly A
KA
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. mcnallka@email.uc.edu
Rohan
Jennifer
J
Schluchter
Mark
M
Riekert
Kristin A
KA
Vavrek
Pamela
P
Schmidt
Amy
A
Redline
Susan
S
Kercsmar
Carolyn
C
Drotar
Dennis
D
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D001741:Black or African American; D000420:Albuterol / Q000627:therapeutic use; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D013440:Sulfides; D013997:Time Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
D000085:Acetates; D000730:Androstadienes; D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast; D000420:Albuterol