Despite referral to a high-risk clinic for poorly controlled asthma, controller medication therapy adherence remained poor in a real-world pediatric clinic, explains William Anderson, MD, of the Children’s Hospital Colorado and University of Colorado School of Medicine, who presented a study at scientific sessions at the recent virtual annual meeting of the 2021 American Academy of Allergy Asthma & Immunology (AAAAI).

The study aimed to find out if patients with poor asthma control may be motivated to use controller therapy to improve symptoms. It was conducted at a multi-disciplinary asthma clinic, designed for patients with either difficult-to-control or severe asthma.  “Patients are typically referred to this clinic if they have had recurrent hospitalizations or emergency room visits, or they still do not have good asthma control despite guidelines-based therapy,” Dr. Anderson says. “We wanted to examine the adherence patterns of our patients and determine if they were taking their medications or not.”

Adherence Dropped Off Over the Summer

 The researchers utilized data from electronic medication monitors (EMMs) to evaluate controller medication adherence in pediatric patients following enrollment in the high-risk clinic. Patients who had been referred for recurrent unscheduled healthcare visits and/or uncontrolled asthma volunteered to have an EMM attached to their controller, which recorded actuations and provided audio reminders.

Twenty patients (45% female, 35% White; mean age 12 years) were enrolled from October 2019 to July 2020.  Of total patients, 95% were on inhaled corticosteroid (ICS)/long-acting, beta-agonist (LABA) therapy, with 5% on ICS alone. The media duration of EMM use was 203 days.

Mean controlling adherence was 57.3% (standard deviation [SD] 41.4%), which decreased from a peak of 71.3% (SD 2.3%) to a nadir of 49.5% (SD 2.7%), with the greatest decline from days 8-106 before plateauing. The proportion of autumn, winter, spring, and summer days consisting of 100% as 44.5%, 41.6%, 47, 1%, and 34%, respectively.

 “We found that patients usually started with a higher adherence, but then had a drop over time,” he says. “In general, at about 160 days is where they usually settled into their baseline, where they then remained for the duration. In terms of the seasons, we found that the during the summer months, there was an increase in the frequency of patients who had very low adherence, 0% to 25%. During the school year, there was no significant difference in their adherence pattern, but their adherence did drop over the summer, which could potentially be secondary to some of the loss of structure that comes with the school year.”

Although Dr. Anderson and colleagues admit that overall adherence of 57% was lower than they had anticipated, they noted that adherence was comparable, if not higher than, some other real-world studies.  “Knowing individual adherence patterns will allow clinicians to tailor control interventions,” the authors write.


Objective Controller Medication Adherence Patterns in Pediatric Patients with Asthma in a High-Risk Multidisciplinary Asthma Clinic was presented at AAAAI 2021. Advance/journals/ymai/AAAAI_2021_LateBreaking_Abstracts.pdf

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