Treatment Adherence Among Low-Income, African American Children with Persistent Asthma

Abstract

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.

Keywords :

• asthma management
• compliance
• low-income population
• medication adherence
• pediatric asthma

Acknowledgment

This study was funded by the National Institute of Mental Health and the National Center on Minority Health and Health Disparities.

Notes

1 Electronic monitoring devices were given only to those patients with recent prescriptions from their PCP or ED physician, verified by medical record review. Project staff did not prescribe medications to participants.