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Adherence to montelukast versus inhaled corticosteroids in children with asthma
Edward R Carter1, Madhu Ananthakrishnan
1Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington, USA. edward.carter@seattlechildrens.org
Insights
Children with persistent asthma showed similar adherence rates for montelukast and inhaled corticosteroids (ICS). Adherence to both asthma medications was suboptimal, indicating a need for improved medication management strategies.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Health Services Research
Background:
- Persistent asthma in children requires consistent medication adherence for effective management.
- Montelukast and inhaled corticosteroids (ICS) are common treatment options.
- Understanding adherence patterns is crucial for optimizing asthma care.
Purpose of the Study:
- To compare medication adherence between montelukast and ICS in pediatric patients with persistent asthma.
- To identify factors influencing adherence to these asthma medications.
- To evaluate the effectiveness of current adherence monitoring methods.
Main Methods:
- Retrospective study using pharmacy and medical records from a military medical center.
- Inclusion of 141 pediatric patients (3-18 years) with persistent asthma.
- Calculation of adherence rates based on filled vs. prescribed medication doses over a 6-month period.
Main Results:
- No significant difference in mean adherence rates between montelukast (71%) and ICS (67%).
- Similar proportions of patients achieved 'good adherence' (≥70%) for both montelukast (51%) and ICS (41%).
- Comparable rates of 'very poor adherence' (<50%) were observed for montelukast (19%) and ICS (26%).
Conclusions:
- Children with asthma demonstrate comparable adherence to montelukast and ICS.
- Adherence to both medication classes is suboptimal, even with accessible healthcare systems.
- Further interventions are needed to improve medication adherence in pediatric asthma management.
Abstract:
Our objective was to compare adherence to montelukast with adherence to inhaled corticosteroids (ICS) in children with persistent asthma. In this retrospective study, we obtained data from a computerized hospital pharmacy database and medical records on 14l patients, 3-18 years of age, who received care for asthma at a military medical center. For each patient, we collected fill/refill data from a consecutive 6-month period and calculated an adherence rate, i.e., (# doses filled/# doses prescribed) x 100. We then determined whether the patient had "good adherence" (adherence rate, > or =70%) or "very poor adherence" (adherence rate, <50%). Eighty-one children were prescribed montelukast, and 104 took ICS; 44 of these children took both. The majority of patients had mild or moderate persistent asthma. There was no significant difference between mean adherence rates: 71% (95% CI, 65-77%) for montelukast vs. 67% (95% CI, 61-73%) for ICS. Fifty-one percent of patients taking montelukast had good adherence, compared to 41% in the ICS group (P = 0.27). Nineteen percent of the montelukast group and 26% of the ICS group had very poor adherence (P = 0.31). Using pharmacy refill data, we found that children with asthma were no more likely to take montelukast than inhaled corticosteroids. Adherence to both medications was suboptimal, even in a system that provides free and easy access to medications.
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