title: Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits.
abstract: OBJECTIVE
  To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.
  
  
  METHODS
  One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A  > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).
  
  
  RESULTS
  Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).
  
  
  CONCLUSIONS
  There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.
authors.affiliation: Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Yvette S
authors.initials: YS
authors.lastname: Keemink
authors.affiliation: Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Ted
authors.initials: T
authors.lastname: Klok
authors.affiliation: Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.|UMCG Postgraduate School of Medicine, University Medical Center and University of Groningen, Groningen, The Netherlands.
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000553:Ambulatory Care; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones
keywords: adherence; asthma and early wheeze; inhaled corticosteroids; self management; white coat adherence