Treatment adherence among low-income, African American children with persistent asthma.
OBJECTIVE
The study aims to assess medication adherence and asthma management behaviors and their modifiable predictors in low-income children with persistent asthma.


METHODS
The authors conducted a cohort study of 143 children ages 6 to 11 prescribed a daily inhaled controller medicine that could be electronically monitored. Children were recruited from clinics or the emergency department of an urban children's hospital. Data were collected at baseline (T1) and 1 year later (T2). Outcome measures were adherence to controller medications as measured by electronic monitoring devices, observed metered-dose inhaler and spacer technique, exposure to environmental tobacco smoke, and attendance at appointments with primary health care provider.


RESULTS
Medication adherence rates varied across medications, with higher rates for montelukast than for fluticasone. Eleven percent to 15% of children demonstrated metered dose inhaler and spacer technique suggesting no drug delivery, and few (5% to 6%) evidenced significant exposure to environmental tobacco smoke. Less than half of recommended health care visits were attended over the study interval. Few psychosocial variables were associated with adherence at T1 or in the longitudinal analyses. Fluticasone adherence at T2 was predicted by caregiver asthma knowledge.


CONCLUSIONS
A substantial number of low-income children with persistent asthma receive less than half of their prescribed inhaled controller agent. Patients without Medicaid, with low levels of caregiver asthma knowledge, or with caregivers who began childrearing at a young age may be at highest risk for poor medication adherence.
Celano
Marianne P
MP
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA. mcelano@emory.edu
Linzer
Jeffrey F
JF
Demi
Alice
A
Bakeman
Roger
R
Smith
Chaundrissa Oyeshiku
CO
Croft
Shannon
S
Kobrynski
Lisa J
LJ
D000328:Adult; D001741:Black or African American; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged
D018927:Anti-Asthmatic Agents