Asthma Care: Education and Adherence Maureen George PhD RN AE-C
FAAN University of Pennsylvania Philadelphia Slide 2 DEFINITION:
Willingness to start, and how closely one follows, the treatment
regimen Adherence is not a dichotomy Chronic underuse Erratic
patterns of use Mixed Administration technique Primary vs.
secondary Unwitting (unintentional) vs. deliberate (intentional) No
factors reliably predict adherence Adherence: A process and an
outcome Slide 3 44-72% adherence to ICS Apter, Boston, George, et
al., JACI 2003 8-13% continue to refill ICS after 12 months Bender,
Pedan and Varasteh. JACI 2006 Marceau, Lemiere, Berbiche, Perreault
and Blais. JACI 2006 64-91% adhere to PFM in clinical trials
Reddel,Toelle,Marks,Ware,Jenkins& Woolcock. Thorax 2007 27%
perform environmental remediation Huss, Squire, Carpenter et al.,
JACI 1992 Rates of non-adherence in asthma Slide 4 Adherence in
children and adolescents Adherence to treatment ranges from 43% to
100%,with an average of 58% in developed countries. Burkhart &
Dunbar-Jacob In: Hayman, Mahom & Turner, eds. Chronic illness
in children: An evidence-based approach. 2002:199-229. The
adherence of infants and toddlers to recommended treatment regimens
is largely determined by the ability of the parent to understand
the recommended management. As age increases, children have the
cognitive ability to carry out treatment tasks, but continue to
need parental supervision. Greater parental perception of their
childs vulnerability is directly correlated with sustained
adherence Spurrier et al. Pediatric Pulmonology, 2000, 29:8893.
Slide 5 Adherence in children and adolescents Behavioral techniques
designed to help children, such as goal- setting, cueing, and
rewards or tokens, have been found to improve adherence in the
school-aged population. Rapoff M. Adherence to pediatric medical
regimens. New York, Plenum, 1999 Increasing numbers of single and
working parents have shifted more of the responsibility for disease
management to the child. Children and adolescents who assume early
sole responsibility for their treatment regimen are less adherent
and in poorer control of their disease. The more conflict in the
home or between the parent and the child, the worse the adherence.
Slide 6 Ways to measure adherence Self-report Electronic monitoring
Provider estimate Biologic assay Electronic records Prescription
utilization Appointment keeping Slide 7 Adherence to TID Inhaled
Bronchodilator % Reported or Recorded Adherence Rand, et al (1992).
AJRCCM, 146, 1559-1564 Slide 8 Telephoning the patient's pharmacy
to assess adherence with asthma medications by measuring refill
rate for prescriptions Sherman, James MD; Hutson, Alan PhD;
Baumstein, Sandra PharmD; Hendeles, Leslie PharmD Journal of
Pediatrics. 136(4):532-6, 2000 Apr Asthma controllers Slide 9 9
Stempel DA. Respir Med. 2005;99:1263-1267. ICS = Inhaled
corticosteroid; LTRA = Leukotriene Receptor Antagonist; LABA=Long
Action Beta 2 Agonist * P
