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Adherence to oral montelukast and inhaled fluticasone in children with persistent asthma
1Department of Pediatrics, University of Florida, Gainesville, USA. shermjm@peds.ufl.edu
Insights
Children with persistent asthma showed suboptimal adherence to both montelukast and fluticasone. Montelukast adherence was higher than fluticasone, suggesting better medication consistency for this oral asthma medication.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Asthma Management
Background:
- Persistent asthma in children requires continuous controller medication.
- Adherence to oral montelukast and inhaled fluticasone is crucial for effective asthma management.
- Suboptimal adherence can lead to poor disease control and increased healthcare utilization.
Purpose of the Study:
- To evaluate adherence rates to oral montelukast and inhaled fluticasone in pediatric patients with persistent asthma.
- To determine the influence of age, monotherapy versus combination therapy, and duration of treatment on medication adherence.
Main Methods:
- Retrospective analysis of prescription refill histories from pharmacies and Medicaid records.
- Inclusion of 171 children with persistent asthma on continuous controller therapy for at least 90 days.
- Calculation of adherence rates based on refilled versus prescribed doses over a mean observation period of 203 days for montelukast and 314 days for fluticasone.
Main Results:
- Median adherence was 59% for montelukast and 44% for fluticasone.
- Adherence did not significantly correlate with patient age, observation period length, or therapy type (monotherapy vs. combination).
- The odds of very poor adherence (<50%) were twice as high for fluticasone compared to montelukast.
Conclusions:
- Adherence to both montelukast and fluticasone in children with persistent asthma was suboptimal.
- Patients demonstrated higher adherence rates to oral montelukast compared to inhaled fluticasone.
- Further research is needed to ascertain if improved montelukast adherence correlates with better asthma control.
Study Objective:
To evaluate adherence to oral montelukast and inhaled fluticasone in children with persistent asthma and to determine if age, monotherapy, and duration of therapy affect adherence.
Design:
Retrospective analysis.
Setting:
Pediatric pulmonary clinic.
Patients:
One hundred seventy-one children with asthma who required continuous treatment with a controller agent year-round and in whom montelukast and/or fluticasone had been prescribed for at least 90 days.
Intervention:
Montelukast monotherapy had been prescribed for 54 patients, fluticasone monotherapy for 48 patients, and combination therapy for 69 patients.
Measurements And Main Results:
Prescription refill histories were obtained from pharmacies identified by the parents or from Medicaid pharmacy reimbursement records. The maximum possible adherence was calculated as [(no. of doses refilled)/(no. of doses prescribed)] x 100, for a mean observation period of 203 days (range 84-365 days) for montelukast and 314 days (range 97-365 days) for fluticasone. Median adherence rates were 59% (95% confidence interval [CI] 48-65%) for montelukast and 44% (90% CI 35-50%) for fluticasone. Adherence did not significantly correlate with age, length of observation period, or whether the patient was receiving monotherapy or combination therapy. The odds ratio for very poor adherence (< 50%) was 2.0 (95% CI 1.3-3.2) for fluticasone relative to montelukast.
Conclusions:
Adherence to both drugs was suboptimal. However, these data indicate that our patients were likely to take montelukast more consistently than fluticasone. Whether this translates into better asthma control requires further study.
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