title: True adherence with the Turbuhaler in young children with asthma.
abstract: OBJECTIVE
  To investigate true adherence with a dry powder inhaler, the Turbuhaler (TBH), in children with asthma. True adherence was calculated by multiplying adherence to treatment with inhaler competence, that is correct use of the inhaler.
  
  
  METHODS
  In an 18-month study, children aged 5-10 years with asthma received twice daily budesonide via a TBH. Parents and children were trained in the correct use of the inhaler before the study started. For each inhalation, peak inspiratory flow through the TBH (PIF(TBH)) was recorded with an electronic pneumotachograph. The PIF(TBH) recordings were used to calculate true adherence for the first and last 45-day periods in the study by multiplying adherence in using the device (percentage of days with PIF(TBH) recordings) with inhaler competence (correct use of inhaler defined as PIF(TBH) values >40 l/min).
  
  
  METHODS
  True adherence, adherence, inhaler competence and PIF(TBH).
  
  
  RESULTS
  115 children were treated. The mean (morning and evening) true adherence during the first 45 days was 81.6% (range 78.1-86.4%) and during the last 45 days 57.4% (44.0-66.9%). Mean adherence was 86.0% and 59.3%, whereas mean inhaler competence was 94.7% and 96.2%, respectively. Thus the decline in true adherence was due to the decline in adherence. The largest decline in true adherence occurred in older children.
  
  
  CONCLUSIONS
  True adherence with budesonide TBH treatment decreased significantly during the 18-month study due to a decrease in adherence. Inhaler competence with the correct use of the budesonide TBH was high and unchanged over the study period.
authors.affiliation: Department of Allergy, Helsinki University Hospital, Finland. kurt.nikander@philips.com
authors.forename: K
authors.initials: K
authors.lastname: Nikander
authors.forename: M
authors.initials: M
authors.lastname: Turpeinen
authors.forename: A S
authors.initials: AS
authors.lastname: Pelkonen
authors.forename: T
authors.initials: T
authors.lastname: Bengtsson
authors.forename: O
authors.initials: O
authors.lastname: Selroos
authors.forename: T
authors.initials: T
authors.lastname: Haahtela
mesh_terms: D000280:Administration, Inhalation; D000367:Age Factors; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D058995:Dry Powder Inhalers; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010366:Peak Expiratory Flow Rate; D012646:Self Administration; D020377:Self Efficacy
chemical_list: D001993:Bronchodilator Agents; D019819:Budesonide