Associations Between Self-Reported Adherence to Asthma Anti-Inflammatory Therapy and Risk Factors for Non-Adherence (NA) in Pediatric Patients

Background:  Identifying patient adherence status and reasons for non-adherence are important components of asthma management. GINA 2008 Guidelines have identified risk-factors associated with poor adherence

Methods:  

361 parents of children with intermittent and persistent asthma (59.6% male; 64.1% Caucasian; mean age 8.07 yrs.) completed the AsthmaPACT, a 96-item asthma survey hosted by the Asthma and Allergy Foundation of America website. The AsthmaPACT identifies risk-factors for not following treatment recommendations as well as medication use. Asthma surveys were completed from August 2009 thru June 2011.

Results:

 Descriptive statistics indicated that 259 of the sample reported giving their child one or more of the anti-inflammatory medication prescribed. Of these, 69 (27%) were diagnosed as NA, operationalized as whether a parent reported giving the child anti-inflammatory medication "less than prescribed by their physician". During the 4 weeks prior to completing the survey, 43.0% were having symptoms daily and 39.4% were using albuterol MDI daily.  In this cross-sectional data set, items intended to relate risk factors to NA were examined using chi square (χ²). Parents who claimed that their child receives less anti-inflammatory medication than prescribed, were more likely to report: 1) symptoms from emotional states: crying χ²(df=2)=8.643 p=0.013; frustration χ²(df=2) 6.202 p=0.045; anger χ²(df=2)=11.029  p=0.0042); Parent more likely to see child as anxious or a worrier χ²(df=2)=6.527 p=0.038  2) Child’s Quality of Life (QoL): is more likely to be effected at school χ²(df=2)=12.963 p=0.002; and interfere with family activities χ²(df=2)=8.856 p=0.012; 3) Parent's QoL is more likely to interfere with work  χ²(df=2)=16.517 p<0.001; recreational activities χ²(df=2) 17.759 p<0.001 and family activities χ² (df=2)=16.517p<0.001. 4) Parents are more likely: not to agree regarding asthma management χ²(df=2)=7.677 p=0.022; not to agree with relatives/caregivers on how to manage asthma χ²(df2)=9.853 p=0.007;  lack confidence in teachers/school personnel to manage asthma at school  χ²(df=2)=20.216  p<0.001. 

 Conclusions: The AsthmaPACT provides an assessment of 1) risk-factors for non-adherence and 2) patient self-report of adherence, and is readily available as a tool to individuals with asthma who have access to the Internet. Findings in this study are consistent with GINA 2008 Guidelines regarding common risk-factors for non-adherence and specifically to the child's emotional state and QoL for both the child and parent. The AsthmaPACT might be considered for symptomatic patients to identify barriers to treatment and diagnose adherence status.