Adherence to inhaled corticosteroids prescribed once vs twice daily in children with asthma
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Published on: April 6, 2017
Olivier Drouin1, Anna Smyrnova2, Natalie Bétinjané2
1Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada; Division of General Pediatrics, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada; Clinical Research and Knowledge Transfer Unit on Childhood Asthma (CRUCA), Research Centre, Sainte-Justine University Hospital Centre, Montréal, Quebec, Canada.
Insights
Once-daily inhaled corticosteroids (ICS) dosing in children with asthma significantly improved medication adherence compared to twice-daily regimens. This simplified ICS schedule offers a potential strategy for better asthma management in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Asthma Management
Background:
- Suboptimal adherence to inhaled corticosteroids (ICS) is a significant factor in poor asthma control among children.
- Previous adult studies indicate that simplifying ICS regimens can enhance patient adherence.
Purpose of the Study:
- To investigate whether a once-daily ICS dosing schedule improves medication adherence in pediatric asthma patients compared to a twice-daily regimen.
Main Methods:
- A retrospective observational study analyzed data from 232 children with asthma prescribed either once-daily or twice-daily ICS monotherapy.
- Medication adherence was primarily measured by the proportion of prescribed days covered (PPDC).
- Linear and logistic regression models were used to assess the impact of dosing frequency on adherence.
Main Results:
- Children on once-daily ICS demonstrated a higher median PPDC (66.8%) compared to those on twice-daily ICS (57.9%).
- Once-daily ICS was associated with a 7.2% greater mean PPDC and increased odds of achieving at least 75% adherence.
- Specifically, 71.4% of children on once-daily ICS had PPDC >= 75% versus 45.5% on twice-daily ICS.
Conclusions:
- Once-daily inhaled corticosteroid (ICS) dosing is linked to superior medication adherence in children with asthma.
- Further research is warranted to determine if this improved adherence translates to better asthma control and health outcomes.
Background:
Suboptimal adherence to inhaled corticosteroids (ICS) is associated with poor asthma control. Adult studies suggest that simplification of ICS regimen leads to better adherence.
Objective:
We aimed to determine whether once-daily, compared with twice-daily, ICS dosing was associated with better adherence among children with asthma.
Methods:
We conducted a retrospective observational study of children with asthma prescribed with either once-daily or twice-daily ICS monotherapy between 2011 and 2019. Our primary adherence outcome was the proportion of prescribed days covered (PPDC)-that is, the number of days for which the drug was dispensed by the pharmacy divided by the number of days for which it was prescribed. The impact of once-daily vs twice-daily ICS regimen on adherence was evaluated using linear multivariable regression analysis adjusting for covariates. Secondary outcomes included the proportion of patients with greater than or equal to 75% adherence analyzed using logistic regression models.
Results:
A total of 232 children (61% boys; mean age of 5.8 [3.6] years) were included; 120 children were prescribed once-daily, and 112 twice-daily, ICS. The median PPDC was 66.8% for the once-daily and 57.9% for the twice-daily group (P = .03). Children prescribed once-daily ICS had a 7.2% (95% confidence interval, 1.3-13.1) greater mean PPDC compared with the twice-daily group and greater odds of having PPDC greater than or equal to 75% (71.4% vs 45.5%; odds ratio, 1.80; 95% confidence interval, 1.01-3.26).
Conclusion:
Our findings suggest that once-daily dosing of ICS is associated with better medication adherence than twice-daily dosing. Whether the gain in adherence leads to better asthma control and health outcomes remains to be evaluated.
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