PT  - JOURNAL ARTICLE
AU  - Ted Klok
AU  - Susanne Lubbers
AU  - Ad Kaptein
AU  - Eric Duiverman
AU  - Paul Brand
TI  - Barriers to adherence to inhaled corticosteroids in a high adherent population of children with asthma
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - 3280
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/3280.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/3280.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - IntroductionAlthough reasons for nonadherence to inhaled corticosteroids (ICS) have been widely studied, an in-depth understanding of barriers to adherence in children is lacking.MethodsWe measured ICS adherence electronically for 1 year in children (2-12 yr) with asthma who received comprehensive care and strict follow-up in our hospital-based asthma clinic. After completion of this study, we performed in-depth interviews with parents of children with the lowest and highest adherence rates. Verbatim transcripts were analyzed with standard qualitative research methods.ResultsParents of 20 children (median age 5,9 yrs, range 4-13 yrs) were interviewed. All parents had the intention to use ICS on a regular basis. Two patterns of low adherence were identified. One group of (highly educated) parents deliberately did not use the ICS according to doctor's advice, but adjusted the ICS dose based on their perception of asthma control in their child, leading to regular use of ICS, but at a dose lower than prescribed. The other group of parents (most with lower educational levels) were faced with barriers impeding regular ICS use. These barriers included chaotic family life and parenting problems. A common and striking finding was the low adherence rate in children 8-12 yrs of age, who were given full responsibility for taking their ICS without parental support or supervision.ConclusionAlthough comprehensive asthma care prevents intentional non-adherence, family driven barriers remain an important cause of non-adherence. The excessive responsibility put on school-aged children to organize their own ICS medication taking is a common and possibly modifiable barrier.