Adherence to medication in children and adolescents with asthma: methods for monitoring and intervention

ABSTRACT

Introduction: Poor adherence in children with asthma is a major cause of asthma attacks and poor control, leads to large health-care costs, and has been identified as a factor in asthma deaths. However, it is difficult to detect and frequently overlooked leading to inappropriate escalation of asthma treatment. There is a need for cost effective ways to monitor adherence in order to intervene to change this modifiable behavior.

Areas covered: Several measurement tools have been developed to assess adherence in adults and children with asthma. The current methods for measuring adherence, both subjective and objective, have several flaws and even the current gold standard, electronic monitoring devices (EMDs), has limitations. This review will outline and critique the adherence monitoring tools and highlight ways in which they have been used for the purpose of intervention.

Expert commentary: Although advances have been made in adherence monitoring, we still have some way to go in creating the ideal monitoring tool. There are no validated tailored self-monitoring questionnaires for children with asthma and most objective measures, such as prescription refill rate and weighing canisters, overestimate adherence. Current EMDs, although useful, need improved accuracy to ensure that both actuation and inhalation are measured, and the devices need to be affordable for use in routine health-care practice.

KEYWORDS:

• Asthma
• adherence
• compliance
• electronic monitoring devices
• pediatric
• monitoring
• intervention
• self-report
• children

Declaration of interest

L Fleming has received honoraria to speak at sponsored meetings from Novartis, Boehringer-Ingelheim and Astra Zeneca and for expert consultation from Novartis, Vectura, GSK, Chiesi and Boehringer-Ingelheim. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper is not funded. L Fleming is an Asthma UK Senior Clinical Fellow and PI in the Asthma UK Centre for Applied Research, [grant number AUK-SCF-2017-399]; C Pearce is a PhD student funded by the Asthma UK Centre for Applied Research.