Measurement of Treatment
Nonadherence in Children
Bruce G. Bender Henry Milgrom Frederick S. Wamboldt National Jewish Medical Research Center, Denver, CO;
Cynthia Rand JHACC, Baltimore, MD
Nonadherence with an asthma treatment regimen contributes to treatment failure, human suffering, and unnecessary medical costs. Asthma can be treated effectively; significant improvements in pharmacotherapy have greatly enhanced our capacity to control this disease. Most notably, anti-inflammatory medications control chronic inflammation in the airways and dramatically reduce the need for hospitalization ( Donahue et al., 1997). Despite the availability of effective treatments, many asthmatic patients do not adhere to their prescribed treatment and, consequently, are at increased risk for symptom exacerbation ( Milgrom et al., 1996).
Although failure to adhere to the asthma regimen is widely recognized, the prevalence and impact of this problem are not fully recognized. Whether medication adherence is defined as proportion of appropriate use days or proportion of total prescribed medication taken, less than 50% adherence is typically reported. Creer found an average compliance rate of 48% in his review of 10 pediatric asthma adherence studies ( Creer, 1993). Although a small proportion of nonadherence involves overuse of medication, most reflects underuse. The widespread underutilization of medication in the treatment of asthma has been reported in children ( Gibson , Ferguson, Aitchison, & Paton, 1995) as well as adults ( Bailey et al., 1990) regardless of whether the prescribed medication consists of tablets ( Christiannse, Lavigne, & Lerner, 1989) or aerosolized medication ( Milgrom et al., 1996).