Inhaler recognition as a marker for adherence in pediatric patients with asthma

Background: Poor adherence to daily asthma controller medications contributes to increased emergency department (ED) visits and hospitalizations in children. A simple bedside tool to assess adherence is needed in clinical settings. Objective: The objective was to determine whether a child's or a caregiver's ability to recognize the prescribed daily controller inhaler is associated with poor adherence and increased asthma morbidity. Methods: A retrospective chart review was conducted on 163 pediatric patients (ages 3-18 years) admitted for asthma exacerbation on patient's and/or caregiver's ability to identify the patient's prescribed daily controller inhaler. Patients were classified as recognizing or not recognizing their inhaler. Clinical outcomes, including ED visits, hospital admissions, systemic corticosteroid use, and adherence markers (prescription refills and follow-up visits), were compared between the groups. Results: The patients unable to recognize their inhaler had significantly poorer adherence, with fewer prescription refills (p = 0.001) and lower rates of specialty follow-up (p ≤ 0.001). These patients also had higher rates of asthma-related ED visits (p = 0.003) and systemic corticosteroid use (p = 0.010). No significant association was found with inpatient admissions, impairment of daily symptoms, or frequency of albuterol use. Patients with three or more intensive care unit admissions in the past year were more likely to recognize their inhalers (p = 0.013), possibly due to increased exposure to asthma education. Conclusion: The inability to recognize a prescribed daily controller inhaler is associated with poor adherence and increased asthma-related ED visits and systemic corticosteroid use. This simple bedside assessment may help identify patients at high risk and guide targeted interventions to improve adherence and asthma outcome.