From frustration to opportunity: Reframing medication adherence in pediatric asthma

What is it about?

Asthma impacts individuals of all ages and rates of nonadherence among children and adult patients are suboptimal. Several costs and benefits to each method of assessing adherence (e.g., self-report, pharmacy fil records, dose counting) are present, making estimating rates of patient adherence challenging. Currently, electronic medication monitoring systems are considered the gold standard and most objective measurement of adherence. Several patient, family, provider, and system level factors which are related to adherence are also of importance. For example, socioeconomic status, medication beliefs, parental involvement in the medication regimen, and communication with the prescribing provider are all known to impact adherence. The field has moved toward a patient-centered model of healthcare decision-making and collaboration between patients and providers has been observed to lead to improvements in adherence. Additionally, multicomponent interventions to boost adherence behaviors are becoming more common and have demonstrated efficacy.

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Photo by Chris Benson on Unsplash

Photo by Chris Benson on Unsplash

Why is it important?

Hoch De Keyser and colleagues offer a comprehensive review of rates of nonadherence among pediatric patients with asthma, associated measurement challenges, various factors impacting adherence, ways to address adherence barriers, and offer links to clinical work. Links between improvements in adherence and observed clinical outcomes remains unclear as asthma control is further complicated by environmental factors, disease severity, and “optimal” adherence is unknown. Authors suggest that for those whose poor adherence is in fact a key factor in poor disease control, multicomponent factors might be particularly beneficial. Alternatively, for patients with adequate adherence and poor asthma control, biologic mediation might be of importance. Future research is needed to better identify patients who might benefit from a multicomponent intervention approach the most and establish more cost-effective modalities of delivering these treatments.