Patterns of Quick-Relief and Long-term Controller Medication Use in Pediatric Asthma

Abstract

Purpose of the Study. To simultaneously examine adherence to long-term controller and quick-relief medications and to contrast patterns of medication use in children with asthma. Study Population. There were 75 children aged 8 to 16 years diagnosed with persistent asthma and prescribed quick-relief and long-term medications by metered-dose inhaler. Participants were a subsample of a larger adherence study. Methods. This was a cross-sectional, 1-month follow-up study. The primary outcome measure was adherence to both medications as measured by electronic monitoring devices. A classification framework for contrasting adherence patterns between medication classes was developed to identify cases for individual analysis. Results. High levels of nonadherence to long-term controller medications (median: 46% of prescribed doses taken) and variable patterns of quick-relief medication use (range: 0–251 doses over the month) were documented, but consistent relationships between patterns of medication use across both classes were not found. Individual cases identified by the classification scheme illustrated the complexity and clinical utility of contrasting adherence patterns. Conclusions. Monitoring long-term controller medication adherence may be more predictive of morbidity than quick-relief medication use except in outlier cases, in which monitoring both medication types may be valuable for clinical and empirical purposes. Reviewer Comments. Medication adherence has long been identified as a key factor in overall asthma outcome. For example, self-reporting quick-relief and long-term controller medication use, canister weighing, pharmacy records, and electronic monitoring have all been used to assess medication adherence. Of these methods, electronic monitoring, which is the most costly and technologically complex, is generally accepted as the most accurate method for monitoring adherence. Inadequate daily medication adherence has been widely documented in patients with asthma and has been linked to morbidity and increased health care costs. Although it was not surprising that nonadherence to long-term controller medications was common in this investigation, it was very interesting that no statistically significant relationship was found between adherence with quick-relief and long-term controller medication classes. For example, the investigators’ hypothesis that quick-relief and long-term controller medication use would demonstrate an inverse relationship (eg, higher long-term controller medication use corresponding to lower reliance on quick-relief medications) was not confirmed. The investigators suggest that novel strategies to enhance appropriate medication use, such as better tracking the use of long-term controller medications and providing feedback regarding actual use, may be effective in improving adherence in asthma patients.