Related Experiment Video
Updated: Apr 6, 2026
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Long-term adherence to inhaled corticosteroids in children with asthma: Observational study
Ted Klok1, Adrian A Kaptein2, Eric J Duiverman3
1Princess Amalia Children's Center, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Insights
Childhood asthma medication adherence remains challenging even with parental agreement on treatment. Interventions beyond current guidelines are needed to improve adherence in pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Behavioral Science
- Health Services Research
Background:
- Childhood asthma controller medication non-adherence is linked to parental factors like illness perceptions.
- Modifiable determinants of non-adherence in pediatric asthma have not been extensively studied.
- A comprehensive asthma care program with shared decision-making was implemented.
Purpose of the Study:
- To assess long-term adherence to controller medication in children with asthma.
- To identify determinants of adherence within a shared decision-making care program.
- To evaluate the impact of parental illness perceptions and medication beliefs on adherence.
Main Methods:
- Observational study of 135 children (2-12 years) with asthma.
- One-year adherence to inhaled corticosteroids measured via electronic monitoring.
- Parental illness perceptions, medication beliefs, and asthma control assessed using validated questionnaires.
Main Results:
- Median adherence was 84%; 41% of children had suboptimal adherence (≥80%), correlating with poorer asthma control.
- Parents reported high medication necessity and strong concordance with the medical model of asthma.
- Differences in perceptions between adherent and non-adherent families were minimal.
Conclusions:
- Suboptimal adherence can persist in pediatric asthma despite strong medical team-parental concordance on perceptions and beliefs.
- Socio-economic barriers were not the primary drivers of non-adherence in this cohort.
- Improving adherence in all children with asthma requires novel interventions beyond current management guidelines.
Introduction:
Non-adherence to daily controller medication in childhood asthma is strongly dependent on potentially modifiable factors such as parental illness perceptions and medication beliefs. The extent to which adherence in children can be improved by addressing modifiable determinants of non-adherence has not been studied to date, however. We assessed long-term adherence and its determinants in children with asthma enrolled in a comprehensive asthma care program employing shared decision making with parents.
Methods:
Observational study in 135 children 2-12 years of age with asthma attending a hospital-based outpatient clinic. One-year adherence to inhaled corticosteroids was measured by electronic devices. Parental illness perceptions and medication beliefs, and asthma control were assessed by validated questionnaires.
Results:
Median (interquartile range) adherence was 84% (70-92%). 55 children (41%) did not achieve the pre-defined level of good adherence (≥80%) and this was associated with poorer asthma control. Parental perceived medication necessity was high, with a median (interquartile range) BMQ necessity score of 17 (16-20). Parents' replies to the five key questions on the core issues of the program showed high concordance of their illness perceptions and medication beliefs with the medical model of asthma and its treatment. Differences in these perceptions between adherent and non-adherent families were small and non-significant.
Conclusions:
Poor adherence may persist in children despite a high level of concordance between medical team and parents on illness perceptions and medication beliefs, even in the absence of socio-economic barriers to good adherence. Achieving good adherence in all children is a complex task, requiring interventions not covered in current guidelines of managing asthma in children.
Related Concept Videos
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:23Inhaled Medications