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Developmental Trajectories and Influencing Factors of Inhaled Corticosteroid (ICS) Adherence in Pediatric Asthma
Wenqi Li1, Xialian Yu1,2, Yan Gao2
1School of Nursing Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
Insights
Understanding inhaled corticosteroid (ICS) adherence in pediatric asthma is crucial. This study identified four adherence trajectories, highlighting the need for personalized interventions in remote care settings for better asthma control.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Digital Health
Background:
- Pediatric asthma management relies on inhaled corticosteroids (ICS) for long-term control.
- Remote collaborative models, like the China Childhood Asthma Action Plan (CCAAP), are increasingly used for pediatric asthma care.
- Understanding medication adherence patterns is vital for optimizing treatment outcomes in these settings.
Purpose of the Study:
- To explore the developmental trajectories of ICS medication adherence in pediatric asthma patients.
- To identify factors influencing these adherence trajectories within a remote collaborative care model.
- To inform personalized interventions for improving pediatric asthma management.
Main Methods:
- Convenience sampling of 249 pediatric asthma patients managed via the CCAAP model.
- Utilized questionnaires for general information, asthma knowledge, medication adherence, and inhaled medication errors.
- Latent Category Growth Analysis (LCGA) to identify adherence trajectories and logistic regression to analyze influencing factors.
Main Results:
- Four distinct ICS adherence trajectories were identified: Declining (6.02%), Rapid Improvement (8.03%), Persistent (71.08%), and Gradual Improvement (14.86%).
- Significant differences among groups were observed in parental education, peak flow meter use, steroid concerns, exacerbation history, asthma knowledge, and medication error rates.
- Key determinants for Rapid Improvement included asthma knowledge and peak flow meter use, while recent severe exacerbations and medication errors were linked to the Declining group.
Conclusions:
- ICS adherence in pediatric asthma within the CCAAP telemedicine model shows significant heterogeneity.
- Identifying distinct adherence trajectories allows for early detection of non-adherence risks.
- Personalized interventions based on these trajectories can enhance asthma control, optimize resource allocation, and improve long-term outcomes in remote pediatric asthma care.
Background:
This study aimed to explore the developmental trajectories and influencing factors of inhaled corticosteroid (ICS) medication adherence among pediatric asthma patients managed through the remote collaborative model based on the China Childhood Asthma Action Plan (CCAAP).
Methods:
A total of 249 pediatric asthma patients who were followed up at a respiratory specialty outpatient clinic between January 2022 and November 2024 were recruited using convenience sampling. The instruments consisted of a general information questionnaire, the Chinese version of the Bronchial Asthma Medication Adherence Scale, an asthma knowledge questionnaire, and an inhaled medication error rate assessment form. Medication adherence was evaluated at baseline and at 1, 3, and 6 months. Latent Category Growth Analysis (LCGA) was employed to identify adherence trajectories, and unordered multinomial logistic regression was conducted to examine the influencing factors.
Results:
Four distinct adherence trajectories were identified, including the Declining Adherence group (6.02%), the Rapid Improvement group (8.03%), the Persistent Adherence group (71.08%), and the Gradual Improvement group (14.86%). The groups differed significantly in parental education, peak flow meter usage, concerns regarding steroid medication, history of severe exacerbations, asthma knowledge level, and 6-month medication error rate. Multivariate analysis indicated that pre-visit asthma knowledge, 6-month medication error rate, peak flow meter usage, concerns about steroid medication, and parental education were significant determinants of the Rapid Improvement group. Severe exacerbations at 3 months were related to the Gradual Improvement group, whereas recent severe exacerbations and the 6-month medication error rate were associated with the Declining Adherence group.
Conclusion:
ICS adherence within the CCAAP telemedicine-based management model demonstrates substantial heterogeneity. Identifying distinct trajectories enables early detection of non-adherence risk and supports personalized intervention strategies, which may significantly improve asthma control and resource allocation in remote care settings. Implementing stratified management based on these findings can enhance long-term treatment efficacy and pediatric asthma outcomes.
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