title: Prescription patterns, adherence and characteristics of non-adherence in children with asthma in primary care.
abstract: Adherence to treatment remains important for successful asthma management. Knowledge about asthma medication use and adherence in real-life offers opportunities to improve asthma treatment in children.
  
  
  OBJECTIVE
  To describe prescription patterns, adherence and factors of adherence to drugs in children with asthma.
  
  
  METHODS
  Population-based cohort study in a Dutch primary care database (IPCI), containing medical records of 176,516 children, aged 5-18 years, between 2000 and 2012. From asthma medication prescriptions, age, gender, seasonal and calendar year rates were calculated. Adherence was calculated using medication possession ratio (MPR) and ratio of controller to total asthma drug (CTT). Characteristics of children with high-vs.-low adherence were compared.
  
  
  RESULTS
  The total asthma cohort (n = 14,303; 35,181 person-years (PY) of follow-up) was mainly treated with short-acting β2-agonists (SABA; 40 users/100 PY) and inhaled corticosteroids (ICS; 32/100 PY). Median MPR for ICS was 56%. Children with good adherence (Q4 = MPR > 87%) were younger at start of ICS, more often visited specialists and had more exacerbations during follow-up compared to children with low adherence (Q1 = MPR < 37%).
  
  
  CONCLUSIONS
  In Dutch primary care children with asthma were mainly prescribed SABA, and ICS. Adherence to ICS was relatively low. Characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence is driven by treatment need or intensity of medical follow-up.
authors.affiliation: Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Engelkes
authors.affiliation: Department of Paediatrics Division of Respiratology and Allergology Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Hettie M
authors.initials: HM
authors.lastname: Janssens
authors.affiliation: Department of Paediatrics Division of Respiratology and Allergology Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.affiliation: Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.affiliation: Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Katia M C
authors.initials: KM
authors.lastname: Verhamme
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D044382:Population Groups; D055656:Prescriptions; D011320:Primary Health Care; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists
keywords: asthma treatment; cohort study; paediatric asthma; prescription patterns; treatment adherence