Noncompliance and prevarication in life threatening adolescent asthma

Four cases of noncompliant steroid dependent adolescent asthmatics who intentionally lied about their compliance are presented. All four were followed in the Allergy Clinic at Northwestern Memorial Hospital. Each had psychosocial or family problems which contributed to deliberate failure to take necessary medications and then to lie about it. Frequent E. R. visits, missed school, and hospitalizations for life threatening asthma attacks were seen in these patients. Changes in personal patient patterns of asthma, lack of predicted response to adequate therapeutic regimens, and obvious lack of proper parental supervision were the clues to the correct diagnosis. Undetectable serum prednisolone levels confirmed the diagnosis in one case. We describe the clinical course of these patients including confrontation about noncompliance and therapeutic regimens that have resulted in control of their asthma.