1291 Relationship Between Self-Reported and Objectively Measured Adherence to Inhaled Corticosteroids in U.S. Inner-City Children with Persistent Asthma

Abstract

Background and aims: Poor adherence to inhaled corticosteroids (ICS) has been implicated as one of the major contributors to asthma morbidity in US inner-city children. The aim of this study was to determine the relationship between self-reported and objectively measured ICS adherence in innercity children with persistent asthma.

Methods: A prospective observational study of 2-9 year-old children with persistent asthma currently prescribed ICS in the Bronx, NY. Subjects received a marked ICS inhaler at enrollment to be collected one month later. Parental self-reported adherence was measured with a validated 10-item survey. One month post-enrollment, ICS adherence was calculated using a dose counter, an objective measure of adherence. Adherence ≥75% was defined as good. We used Spearman correlation analysis to measure the relationship between selfreported and objectively measured adherence.

Results: A total of 33 children (mean age 6 (SD 2), 58% male, 52% Hispanic) participated. Overall, 76% of parents stated that they “often” or “always” give ICS pump only when their child needs it, and 36% sometimes forget to administer it. Self-reported ICS adherence was high: 85% of parents reported that they give ICS to their child exactly as the label says. Objectively measured ICS adherence was poor (mean 48%, range 2%-100%). We found no correlation between two adherence measures (Spearman's rho.004, p=.986).

Conclusions: Our findings suggest a discrepancy between self-reported ICS adherence and adherence measured objectively using a dose counter. These results may have implications for physicians who often rely on self-reported adherence in caring for patients with asthma.

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