Medication Compliance and Childhood Asthma
Thomas L. Creer Ohio University
In the past two decades, a number of effective medications have been introduced for the treatment of asthma. Advances with theophylline, beta agonists, cromolyn sodium, and inhaled corticosteroids have greatly expanded the arsenal of drugs available to physicians in tailoring a treatment regimen for a child with asthma ( Ellis, 1988). The burst of newer and more efficacious medications was accompanied by the widespread dissemination of technologies that provided more objective measurement of the degree of compliance in patients with asthma. Ironically, it was the development of technologies, particularly high-pressure chromatography for assessing serum theophylline, that generated much of the research on compliance in the past decade. It had long been suspected that asthmatic patients did not comply with prescribed medication regimens, but the report by Eney and Goldstein ( 1976), which showed that only 11% of their sample of asthmatic children had therapeutic levels of theophylline in their blood, jolted many physicians as to the extent of the problem of noncompliance, and to the reality that better medications did not necessarily insure improved management of asthma.
In the 15 years since Eney and Goldstein ( 1976) published their article, a number of studies and reviews have focused on the topic of medication compliance in patients, particularly children, with asthma ( Dirks & Kinsman, 1982; Jerome, Wigal, & Creer, 1987; Spector, 1985; Spector et al., 1986; Voyles & Menendez, 1983). The general conclusion is that medication compliance is best conceived of as a continuum ranging from total compliance to total noncompliance. There is always uncertainty about compliance in that, even if a test reveals a patient is correctly taking medications as prescribed, his or her behavior may not remain consistent over time ( Spector et al., 1986). In addition, a number