Medication Adherence Control Research Articles

Asthma beliefs and overuse of short-acting beta-adrenergic receptor agonists among older adults

Objective Short-acting Beta-adrenergic Receptor Agonists (SABA) carry a risk of worse asthma outcomes when overused. Beliefs about asthma controller medications are associated with medication-taking behaviors in older adults, but the association of medication beliefs with SABA use has not been previously examined. We aimed to investigate the association of asthma and controller medication beliefs with SABA use among older patients with asthma. Methods We performed a cross-sectional analysis of data on adults ≥ 60 years old with moderate to severe asthma in New York City, NY (n = 234). SABA overuse was defined as the average of ≥1 inhalation per day and controller medication adherence as ≥80% of expected inhalations, measured electronically. Illness and medication beliefs were measured using the Brief-Illness Perception Questionnaire and Beliefs about Medications Questionnaire, respectively. The associations of medication-taking behaviors with beliefs were examined in multivariable logistic regression models. Results The mean age was 67.6 ± 6.5 years, 84% were female, 26% were Black and 53% were Hispanic. 35% of participants overused SABA and 21% had adequate controller medication adherence. Overuse of SABA was not significantly associated with controller medication beliefs (Necessity: odds ratio [OR] 1.04, 95% confidence interval [CI] [0.97–1.12], p = 0.28, Concerns: OR 0.95 [95% CI 0.88, 1.03], p = 0.23) or asthma beliefs (OR 1.06 [95% CI 0.99, 1.15], p = 0.11). SABA overuse was also not significantly associated with controller medication adherence (OR 2.20 [95% CI 0.88, 5.51], p = 0.09). Conclusions SABA overuse was common among older adults with asthma and was not significantly associated with asthma controller medication or illness beliefs.

Disparities in adolescent controller medication adherence, treatment barriers, and asthma control.

Disparities in asthma persist despite advances in interventions. Adherence and self-management behaviors are critical yet challenging during adolescence. Treatment barriers include individual factors as well as structural and social determinants of health. To determine differences in controller medication adherence, asthma control, and treatment barriers by race, income, and insurance and whether racial disparities persist when controlling for income and insurance. Associations between adherence, barriers, and control were also examined. Adolescents completed measures of treatment barriers and asthma control. Controller medication adherence was measured electronically. Descriptive statistics, means comparisons, and analyses of covariance were conducted. One hundred twenty-five adolescents participated (Mage = 14.55, SD = 2.01, 37.6% Black or African American, 55.2% White). Black or African American adolescents had significantly lower adherence than White adolescents, t(105) = 2.79, p = .006, Cohen's d = .55. This difference was not significant when controlling for income and insurance (p > .05). There was a significant difference in asthma control, F(1,86) = 4.07, p = .047, ηp 2 = .045, where Black or African American adolescents had better asthma control scores than White adolescents. Feeling tired of living with asthma was the most common barrier among all adolescents (62.4%). More Black or African American adolescents endorsed difficulty getting to the pharmacy than White adolescents, X2 (1, N = 116) = 4.86, p = .027. Racial disparities in asthma may be partially driven by income, insurance, and pharmacy access. Asthma burnout may be important to address for all adolescents with asthma.

Effects of Ergonomic Exercises on Systolic and Diastolic Blood Pressure of Hypertensive Elderly in Sitopeng Cirebon, Indonesia

Background: Hypertension is a chronic, non-communicable disease that often shows no symptoms but can cause heart failure, stroke, myocardial infarction, atrial fibrillation, and even premature death. The majority of hypertension sufferers in Indonesia are elderly (57.6%). Ergonomic exercise is recommended in the non-pharmacological management of hypertension because it can reduce blood pressure. Aims: To know the effect of ergonomic exercise three times and once per week on systolic and diastolic pressure in hypertensive elderly. Methods: The design is an experiment consisted of two groups before and after intervention; the population is hypertensive elderly in Sitopeng, Cirebon City. The sample sizes were determined by the formula (t-1) (r-1) > 15, where t is the treatment group and r are the replication, so the total sample was 32 hypertensive elderly people who were selected using simple random sampling techniques, and data analysis was carried out using the independent T-test and paired T-test. Results: Ergonomics exercises 3 times per week can reduce systolic pressure in elderly people with hypertension (p = 0.001<0.05), but there was no significant difference between the ergonomic exercise groups 3 times and 1 time per week treatment in systolic (p = 0.520) and diastolic pressure (p = 0.095>0.05). Conclusion: Ergonomic exercise provides good benefits in reducing systole and diastole pressure in elderly people with hypertension. Maximum benefits can be obtained if the elderly perform ergonomic exercise movements perfectly, control medication adherence, and follow a low-salt diet. Recommendation: Give the guidebook to each participant, which they take home and are assisted by family to memorize the movements. Always maintain compliance with taking medication and a low-salt diet.

Improvement of asthma control in adult patients using extrafine inhaled beclomethasone/formoterol fixed combination as maintenance therapy as well as maintenance and reliever therapy – CONTROL study

IntroductionExtrafine formulation of beclomethasone/formoterol fixed combination (BDP/F pMDI HFA) is approved for both fixed maintenance and maintenance and reliever therapy (MART) of asthma, and recent data has proven that BDP/F pMDI HFA maintenance and reliever therapy is an effective alternative to other regimens. ObjectiveThis study aimed to assess the level of asthma control in a real-life setting in adult patients using extrafine BDP/F pMDI HFA fixed combination in a pressurized metered-dose inhaler (pMDI) as fixed maintenance dosing as well as maintenance and maintenance and reliever therapy. Additionally, we examined patients’ satisfaction with the inhaler device and compliance with therapy as essential factors determining asthma control. MethodsThis multicenter prospective non-interventional observational study lasted 4 months with 3 patient visits. We used the Asthma Control Questionnaire 7 (ACQ-7) to evaluate the degree of asthma control and Morisky Medication Adherence Scale (MMAS-4) to assess compliance. A self-developed questionnaire was used to assess satisfaction with the inhaler device. Results2179 patients using BDP/F pMDI HFA fixed combination as maintenance and reliever therapy or BDP/F pMDI HFA as maintenance therapy and SABA (short-acting beta2-agonist) as a reliever for at least 2 months were included. During the prospective follow-up, we observed an upward trend in the FEV1% (forced expiratory volume in 1 s) predicted values, improvement in the control of symptoms as indicated by a decline in the mean ACQ-7 score was noted (1.62 at Visit 1 vs. 1.21 at Visit 2 vs. 0.94 at Visit 3, p < 0.001) and increase in patients’ compliance (the number of patients that reported forgetting at times to take their medication was reduced from 49.7 % to 27.1 %, p < 0.001). At the same time, we noted a reduction in the number of as-needed doses used for symptom relief (p < 0.001). Most patients were satisfied with the pMDI, considered it easy and convenient to use, and preferred it to a dry powder inhaler (p < 0.001). ConclusionsThe use of extrafine BDP/F pMDI HFA as maintenance as well as reliever therapy seems to be associated with increased asthma control and better compliance to therapy.

A meta-analysis of the impact of pharmacist interventions on clinical outcomes in patients with type-2 diabetes

ObjectiveTo evaluate the effects of pharmacist interventions in type-2 diabetes patients by collecting and evaluating literature. MethodsA systematic search was conducted across six databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Cochrane Library, from January 2001 to January 2023. Randomized controlled trials evaluating the clinical outcomes of pharmacist interventions on type-2 diabetes patients were searched, and data were extracted and analysed by RevMan version 5.4 software. ResultsA total of 35 studies involving 4827 patients were included. Meta-analysis demonstrated that pharmacist interventions had an influence on improving patients’ HbA1c (MD=−0.70), LDL-C (MD=−5.51), SBP (MD=−4.58), DBP (MD=−1.90], BMI (MD=−0.47) and FBG (MD=−19.82), but there was no evidence from the study that pharmacist interventions could significantly improve HDL-C (MD=−0.61), TC (MD=−5.12) or TG (MD=−3.14). In addition, medication adherence was significantly improved. ConclusionPharmacist interventions significantly improved HbA1c, BP, and LDL-C control levels, BMI, and medication adherence in type-2 diabetes patients, but there was no evidence from this study that pharmacist interventions significantly improved HDL-C, TC, or TG. Practice implicationsEffective pharmacist interventions are important to improve type-2 diabetes patients’ clinical outcomes.

The utility of the necessity-concerns framework (NCF) in explaining adherence and parental beliefs about controller medication in Saudi Arabian children with asthma

Objective This study aims to assess beliefs about asthma controller medications among parents of Saudi Arabian children with asthma and the association between these beliefs and medication adherence using the Necessity-Concerns Framework. Methods A cross-sectional survey was provided to parents of children with asthma when they brought their children to routine appointments at local public clinics between May 16 and July 10, 2018. Participants electronically filled out validated Arabic versions of the Medication Adherence Reported Scale (MARS) and Beliefs About Medications Questionnaire (BMQ). Descriptive statistics were used to characterize the study participants, while hierarchical linear regression analysis assessed associations between parental beliefs about controller medications and medication adherence. Results A total of 381 parents of children with asthma completed the study survey. The vast majority (89%) of study participants were non-adherent to their children’s prescribed medications while only 11% were adherent. Additionally, our study revealed a significantly positive association between adherence and parents’ beliefs in the necessity of the medication (p < .001), with concerns about the adverse effects of medication being negatively associated with parental adherence. A higher mean score for medication adherence was reported among the ambivalent groups compared to the accepting, indifferent, and skeptical groups. Conclusions Medication adherence among parents of children with asthma was relatively low. In addition, necessity beliefs were significantly associated with parental adherence to controller medications for their children with asthma. Further studies are warranted to investigate potential factors contributing to poor parental adherence and develop tailored interventions that support parental medication adherence for their asthmatic children.

Impact of a digital therapeutic on adult asthma

Abstract Background Asthma impacts 334 million people globally. Medication adherence is estimated at 50% worldwide. Digital therapeutics (DTx) may improve medication adherence and health outcomes. Methods Prospective, single cohort observational study of 104 adults with asthma managed on inhaled corticosteroids. Subjects had 90-day access to Aptar Digital Health respiratory platform: HeroTracker to monitor adherence, spirometer for lung function, and BreatheSmart mobile app with real-time alerts. Primary outcomes: asthma control, rescue medication use. Secondary outcomes: controller medication adherence, patient feedback. Results Subjects completed Asthma Control Test (ACT) at baseline (T0); 96% (N = 100) completed ACT at 90 days (T1). Between T0 and T1, ACT scores increased significantly (baseline: 16.5 ± 4.7; ΔT0 to T1: + 2.8, 95% CI (2.0, 3.6), p-value &amp;lt;0.001); rescue medication use decreased 44% ((95% CI: 14.1, 63.5), p-value = 0.008); adherence to controller medication decreased 10.7% ((95% CI: 6.4, 15.1), p-value &amp;lt;0.001). 82.5% of subjects reported platform very/somewhat easy to use, 97.5% rated spirometer very/somewhat easy to use, 92.5% reported alerts very/somewhat helpful. Platform rating mean score = 7.825/10 (1-10; 10=high). Conclusions DTx may improve asthma control and decrease rescue medication use. T1 medication adherence was 17% higher than global medication adherence. Patient feedback was positive.

Asthma routinization, family asthma management, caregiver depressive symptoms, and medication adherence in Head Start preschool children.

Medication adherence is suboptimal in childhood asthma. Children rely on caregivers to manage medication administration. It is important to detect families who are at risk for poor adherence or to identify potential areas that can assist families with better adherence to asthma medications in order to improve asthma outcomes. We investigated the association between asthma routines, family asthma management knowledge and skills, and caregiver depressive symptoms with daily controller medication adherence among Head Start preschool children in Baltimore City. Our study included 256 low-income urban preschool children who were prescribed a daily controller medication. Asthma routinization (by the Asthma Routines Questionnaire), family asthma management [by the Family Asthma Management System Scale (FAMSS)], and caregiver depressive symptoms (by the Center for Epidemiological Studies - Depression) were assessed at baseline. The medication possession ratio (MPR) to measure adherence to daily controller medications was calculated at baseline and 12 months from pharmacy fill records. Multiple regression models evaluated the relationship between asthma routinization, the FAMSS, the CES-D, and MPR. Results indicated that only 7% of families had an MPR above 80% at baseline, and 24% of caregivers had clinically significant depressive symptoms. Higher asthma medication routines were associated with higher MPR at baseline (b = 0.05, p = 0.03). Higher family asthma management was associated with higher MPR at both baseline (b = 0.04, p < 0.01) and 12 months (b = 0.05, p < 0.01). Our findings highlight the importance of family asthma management and maintaining medication routines over time to improve asthma controller medication adherence.

Impact of web application support versus standard management on adherence with adjuvant hormone therapy in patients treated for breast cancer: the WEBAPPAC study

BackgroundNon-metastatic breast cancer treatment is mainly based on surgery, with or without chemotherapy, radiotherapy and/or hormone therapy. To reduce the risk of hormone receptor positive (HR+) disease recurrence, hormone therapy is prescribed for at least 5 years. It may induce adverse drug reactions (ADRs) as joint pain, sexual dysfunction, weight increase, fatigue, mood disorders and vasomotor symptoms. Around 30–40% of patients withhold hormone therapy within 5 years after initiation. Based on encouraging results of mobile health in patient follow-up, we developed a web-application addressed for breast cancer patients initiating adjuvant hormonal therapy and aimed to assess its impact on hormone therapy adherence, ADRs management, and health-related quality of life.MethodsThe WEBAPPAC trial is a randomized, open-label, prospective, single-center phase 3 study aiming to assess the interest of a web-application support as compared to standard management among breast cancer patients initiating hormone therapy. The main endpoint is the proportion of patients with hormone therapy adherence failure within 18 months after treatment start, in each arm. Eligible patients will be 1:1 randomized between the WEBAPPAC web-application support (experimental arm,) or standard support (control arm), with stratification on type of hormone therapy (Aromatase inhibitor or Tamoxifen). We plan to enroll 438 patients overall. Failure to hormone therapy will be assessed using the Morisky 8-item self-questionnaire (MMSA8), patient adherence logbook, and medical consultations. Secondary outcomes include hormone therapy adherence at 6 months, pain (Visual Analogue Scale and Brief Pain Inventory), quality of life (EORTC QLQ-C30 and BR23 self-questionnaires), anxiety and depression (Hospital and Depression Scale), and return to work and/or daily activities. The user experience with the WEBAPPAC web-application will be assessed using the System Usability Scale (SUS) questionnaire.DiscussionHormone therapy discontinuation or adherence failure in breast cancer patients may be indirectly related to an increased risk of recurrence. A better control of medication adherence, through the detection of side effects and some proposed actions trying to reduce them, appears therefore essential to limit the risk of disease recurrence. The WEBAPPAC web-application thus aims better monitoring and allowing higher level of responsiveness in case of ADRs, thus improving treatment adherence.Trial registrationNCT04554927, registered September 18, 2020.Protocol versionVersion 2.1 dated from December 21, 2021.

Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa

Abstract:&#x0D; Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications.&#x0D; Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar&#x0D; Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI &lt;25kg/m2.&#x0D; Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.&#x0D; In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c &lt;7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17.&#x0D; Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c.&#x0D; Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medications

New Caregiver Diagnoses of Severe Depression and Child Asthma Controller Medication Adherence.

Children with asthma who have depressed caregivers are known to be less adherent to medication regimes. However, it is less clear how adherence responds to a caregiver's new diagnosis of severe depression or whether there is a similar relationship with other serious caregiver diagnoses. The hypothesis is that adherence worsens both with new diagnoses of depression and possibly with new diagnoses of other serious conditions. This study follows a cohort of 341,444 continuously insured children with asthma before and after a caregiver's new diagnosis of severe depression or another serious health condition. The effect of a new depression diagnosis on a child's medication adherence is compared to the effect of new diagnoses of other common caregiver chronic conditions including diabetes, cancer, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease. Results show that children's medication adherence declines following a caregiver's new diagnosis of severe depression, but that it also declines following a caregiver's new diagnosis of diabetes. There is no association with new diagnoses of the other caregiver chronic conditions examined. Children whose caregivers have a new diagnosis of depression or diabetes may be at increased risk of deterioration in their medication adherence. These caregivers may benefit from additional support and follow-up. The relationship between caregivers' health and children's medication adherence is complex and deserves further study.

Medication Adherence and Asthma Control with Once-Daily Indacaterol/Glycopyrronium/Mometasone Furoate Breezhaler Digital Companion: 90-Day Analysis from Germany.

Suboptimal adherence to inhaled asthma therapy is associated with poor clinical outcomes. Digital companion paired inhaler devices record medication use and provide reminders, thereby improving treatment adherence and asthma outcomes. This analysis assessed the impact of indacaterol/glycopyrronium/mometasone furoate (IND/GLY/MF) Breezhaler® digital companion on medication adherence and symptom control in adults with asthma from Germany. This retrospective analysis included adults (≥ 18years) with asthma and prescribed Breezhaler digital companion. Assessments included: mean medication adherence (number of puffs taken/prescribed × 100) and change in Asthma Control Test (ACT) scores [well controlled (≥ 20), not well controlled (15-20) and poorly controlled (≤ 15)] at 1month after the first ACT (second ACT). The percent of patients with ≥ 80% medication adherence (days 16-30 and 76-90) and the change in ACT (baseline and ≥ 30days) were analysed. Of the 163 patients with 90days data, ≥ 80% medication adherence was achieved in 82.8% and 72.4% of patients at months 1 and 3, respectively. Change in asthma control was examined in ~ 60% (n = 97) of patients who completed ≥ 2 ACTs through the application. At baseline, 33.0% of patients were well controlled and 53.6% were well controlled at second ACT. Furthermore, 43.3% patients reported very poor control at baseline which decreased to 22.7% at second ACT. The use of IND/GLY/MF (Breezhaler) with a digital companion (sensor + application) may be associated with improved symptom control and high level of controller medication adherence in patients with asthma.

The Relationship Between Pediatric Attention-Deficit/Hyperactivity Disorder Symptoms and Asthma Management

PurposeChildren with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and asthma are at an increased risk for adverse health outcomes and reduced quality of life. The objective of these analyses was to examine if self-reported ADHD symptoms in children with asthma are associated with asthma control, asthma controller medication adherence, quick relief medication use, pulmonary function, and acute healthcare utilization. MethodsWe analyzed data from a larger study testing a behavioral intervention for Black and Latinx children with asthma aged 10–17 years and their caregivers. Participants completed the Conners-3AI self-report assessment for ADHD symptoms. Asthma medication usage data were collected for 3 weeks following baseline via electronic devices fitted to participants' asthma medications. Other outcome measures included the Asthma Control Test, self-reported healthcare utilization, and pulmonary function measured by spirometry testing. ResultsThe study sample consisted of 302 pediatric participants with an average age of 12.8 years. Increased ADHD symptoms were directly associated with reduced adherence to controller medications, but no evidence of mediation was observed. Direct effects of ADHD symptoms on quick-relief medication use, health care utilization, asthma control, or pulmonary function were not observed. However, the effect of ADHD symptoms on emergency room visits was mediated by controller medication adherence. DiscussionADHD symptoms were associated with significantly reduced asthma controller medication adherence and indirectly with emergency room visits. There are significant potential clinical implications to these findings, including the need for the development of interventions for pediatric asthma patients with ADHD.

Predictors of adherence to controller medication in urban African American emerging adults with uncontrolled persistent asthma

Background African American emerging adults tend to have low adherence to asthma controller medication, as well as a disproportionate burden of asthma morbidity and mortality. This study explored constructs from the Information-Motivation-Behavioral Skills model as predictors of controller medication adherence in urban African Americans ages 18–29 (N=152) with uncontrolled asthma using multiple measures of self-reported adherence. Methods Structural equation modeling (SEM) was employed to test the hypothesized mediation model that specified the relationship among psychological distress, substance use, asthma knowledge, motivation, self-efficacy, and adherence. Results Results suggested that motivation is an important predictor of adherence to medication; moreover, higher self-efficacy was associated with higher motivation. Results also highlighted psychological distress as an important intervention target to improve medication adherence in emerging adults. Conclusions The model tested in this study may offer a feasible framework for beginning to understand adherence to controller medication in this population.

Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management

PurposeIt is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; ‘accurate use’), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). MethodsWe analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12–16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. ResultsOf 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12–3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83–6.54), health care (OR: 0.39, 95% CI: 0.20–0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10–3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DiscussionAdolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.

Adherence and Self-management Interventions among Systemically Marginalized and Underserved Youth with Asthma.

Asthma disproportionately impacts youth who have been systemically marginalized and underserved, henceforth termed underserved for brevity. Disparities are driven by systemic and structural racism and social determinants of health. We aimed to synthesize findings from interventions delivered among youth who have been underserved, highlight effective intervention strategies, and provide recommendations to promote health equity. To demonstrate, we also present a case example of clinical application. We conducted a systematic literature search of randomized trials among youth (≤18 years old) who are often underserved, delivered in clinical, community, or home-based settings with medication adherence and/or self-management behaviors as an intervention outcome. We used descriptive statistics to synthesize study characteristics and outcomes. Twenty four articles, representing 21 unique interventions, met inclusion criteria. Forty-six percent reported significant improvements in adherence or self-management for the intervention group. Self-management interventions focused on symptom recognition and monitoring demonstrated the greatest percentage of significant intervention findings (71.4%); controller medication adherence interventions demonstrated the fewest (33.3%). Interventions are not consistently effective for youth who have been underserved. Findings suggest that pediatric psychologists can help patients from underserved backgrounds by bolstering symptom recognition and monitoring skills, providing self-management skill education, and problem-solving ways to reduce triggers through individually tailored, multicomponent approaches. Pediatric psychologists should simultaneously strive to consider and address systemic, structural, and social determinants of asthma disparities in their work.

The Impact of Caregiver Depression on Child Asthma Outcomes: Pathways and Mechanisms

Depression is common in caregivers of children with asthma and is associated with poor outcomes in their child. No prior studies have longitudinally examined caregiver depression remission as a predictor of improvement in child asthma control. This 2-site study examined whether the proportion of time a caregiver was in depression remission predicted subsequent child asthma control at exit. Caregivers (n= 205) with current major depressive disorder and their children, ages 7 to 17, with persistent asthma were observed every 4 weeks for 52 weeks. Caregiver depressive symptoms were measured using the 17-item Hamilton Rating Scale for Depression (HRSD). Child asthma was assessed with the (Childhood) Asthma Control Test (cACT/ACT) and spirometry, and depression with the Children's Depression Inventory (CDI). Linear regression analyses were conducted with change in cACT/ACT, CDI, and forced expiratory volume in 1 second (FEV1)% predicted as outcomes and proportion of time the caregiver was in remission (HRSD score ≤ 7) as the predictor. Multilevel mediation analyses examined the role of child depressive symptoms and asthma controller medication adherence. Children were, on average, 54.1% female and 11 years old. Caregiver proportion of time in HRSD-assessed remission of depression was a significant predictor of improvement in cACT/ACT, CDI, and FEV1% predicted. Child CDI score, but not medication adherence, mediated the relationship between caregiver HRSD scores and child asthma control scores. Improvement in caregiver depression positively influences child asthma outcomes partially through improvement in child depressive symptom severity. Caregiver depression screening and treatment might lead to improvement in child asthma outcomes.

Feasibility of supported self-management with a pictorial action plan to improve asthma control

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre–post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference −19.7; 95% CI −34.7 to −3.1; 6 months: % difference −20.3; 95% CI −5.8 to −3.2), one or more emergency visit (1 month: % difference −28.6; 95% CI −41.2 to −15.5; 3 months: % difference −18.0; 95% CI −32.2 to −3.0; 6 months: % difference −20.3; 95% CI −34.9 to −4.6), and one or more asthma admission (1 month: % difference −14.3; 95% CI −25.2 to −5.3; 6 months: % difference −11.9; 95% CI −23.2 to −1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530.

FACTORS AFFECTING UNCONTROLLED ASTHMAAMONG CHILD PATIENTS IN DAMMAM, AL-KHOBAR, 2020

INTRODUCTIONAsthma is a chronic inammatory disease that usually begins at the early stages of life. The recurrent attacks of breathlessness and wheezing are characteristics of asthma and the severity of the signs varies from one person to another. AIM This study aimed to evaluate the most factors affecting control of asthma among child patients seen in public health and its relation to ER visits and admission. Patients and methods This is a cross-sectional study conducted among children who had a documented diagnosis of bronchial asthma conrmed by the le obtained from the Ministry of Health, Armed Forces Hospital, and King Fahad University Hospital in Dammam and Alkhobar. A selfadministered questionnaire was distributed among study subjects and written informed consent was explained to the parents. Asthma Control Test (ACT) questionnaire was used to measure the level of asthma control. RESULTS 119 children with asthma were able to recruit (50.4% males vs 49.6% females). The most commonly used for the treatment of asthma was inhalers (93.3%) specically Ventolin (64%) while the proportion of patients who were using nebulizers at home was 40.3%. Uncontrolled asthma was found among 25.2% and low adherence to medication was found among 84.9%. There was an inverse signicant correlation being observed between asthma control score and medication adherence score (r=-518; p&lt;0.001). Factors associated with uncontrolled asthma were a history of allergy, 2 times or less admission to hospital, and the use of nebulizers at home. CONCLUSIONWhile one-fourth of children had uncontrolled asthma, however, their adherence to medication was low. Children with a previous history of allergy, those with increased hospital admission, and those who were using nebulizers at home had an increased risk of uncontrolled asthma.

Controller Medication Use and Exacerbations for Children and Adults With Asthma in High-Deductible Health Plans

To examine the association between enrollment in high-deductible health plans (HDHPs) and asthma controller medication use and exacerbations.A longitudinal cohort of children (4–17 years old) and adults (18–64 years old) on employer-sponsored insurance, who had at least 24 months of continuous insurance enrollment.Identified from a national administrative claims database in the United States, patients with persistent asthma were selected, and their insurance was categorized as a HDHP, defined as an annual individual deductible of ≥$1000, or a traditional plan, with deductibles of $0–500. Enrollees in a HDHP were only those who switched from a traditional plan after 12 months to a HDHP for the following 12 months. A differences-in-differences analyses design was used to compare outcomes between patients who switched to a HDHP to that of controls, who remained in a traditional plan for the 24 months. Outcomes included controller medication fills, adherence, and asthma exacerbations.The study sample included 7275 children and 17 614 adults with HDHPs. In the differences-in-differences analyses among children, there were no differences in controller medical fill rates, except for a significant reduction in fills for inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) (−0.04; 95% confidence interval: −0.07 to −0.01). There were also no significant changes in the proportion of days covered by a controller medication (ie, adherence measure), steroid bursts, or asthma-related ED visits, comparing children with HDHPs to controls. Among adults with HDHPs, there were also no significant differences in outcomes.The findings are consistent with previous adult studies that revealed that enrollment in HDHPs have minimal to no decrease in medication use and without significant changes in health outcomes. The authors think this is partly due to HDHPs exempting medications, like asthma controller medications, from deductibles. These medications are instead paid in a copayment arrangement.This insurance policy approach reveals that HDHPs can be designed to support affordable coverage but also preserve necessary asthma care for patients.