Children who didn't follow prescription instructions had a significantly greater chance of having a severe asthma attack than children who took medication correctly. Failing to use prescribed asthma medication correctly worsens asthma attacks, can lead to hospitalization and emergency room visits, and can, in some cases, cause death.
Diaries kept by 24 children between 8 and 12 years old showed corticosteroid use was 95.4 percent; reported beta-agonist use was 78.2 percent. But a miniature computer attached to inhalers used by the children showed the actual use was dramatically lower. Actual use was 62.1 percent for beta-agonists and 58.4 percent for corticosteroids.
In addition, both medications usually are taken at certain times during the day. When researchers accounted for this, the compliance numbers grew even worse: beta-agonists, 48 percent; corticosteroids, 32 percent. Corticosteroids decrease inflammation and swelling in the airways. Beta-agonists relax smooth airway muscle.
"Accurate and reliable information about children's use of inhaled medications is needed because of the growing reliance on these drugs in the treatment of asthma," says Henry Milgrom, M.D., a National Jewish staff physician and principal investigator of the study. "Inadequate control of asthma should alert the physician to the possibility of noncompliance. As clinicians we must finds ways to encourage patients to comply with their therapy. It is essential that we acknowledge and accept responsibility for patient compliance."
Children involved in the study who suffered severe asthma attacks followed prescription instructions only 13.7 percent of the time. But children in the study who didn't have severe asthma attacks complied with prescription instructions 68.2 percent of the time.
There are about 15 million people in the United States who have asthma; 4.8 million are children under 18. Asthma is the third ranking cause of hospitalization for children under age 15; the disease accounts for 10 million lost school days every year.
"Forty-three percent of the disease's economic impact relates to emergency room use, hospitalization and death," Dr. Milgrom says.
The 24 children used a "diary card" to record the date and time an inhaler was used. (Parents took responsibility for supervising the recording of information.) The inhalers used by the children were modified with a small electronic monitoring device that recorded the exact date and time of use.
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