{
  "abstract": "Background Poor adherence to maintenance asthma medication is associated with reduced quality of life, higher risk of death, and increased healthcare costs. Adherence assessment is challenging. Electronic monitoring devices(EMDs) provide actuation, although not inhalation, data, but are not widely available. The Medication Adherence Report Scale(MARS) is a validated adherence self-report measure. Prescription refill rate(PRR) provides data on prescriptions issued, but not whether dispensed/taken.Objective To compare adherence assessment measures for children and young people(CYP) prescribed maintenance inhaled corticosteroids(ICS) or combination ICS/long-acting beta agonist(LABA) inhalers in our paediatric difficult asthma(DA) service.Methods Retrospective analysis of data from CYP attending a tertiary paediatric asthma service. We compared EMD inhaler data, MARS score(5-point scale) or MARS-Asthma(MARS-A) (10-point scale) and PRR(ICS/ICS-LABA% uptake). We used descriptive statistics to characterise adherence assessed by each measure and Pearson’s correlation to explore relationships between measures. Mann-Whitney was used to compare Fractional Exhaled Nitric Oxide(FENO), bronchodilator reversibility(BDR) and asthma control test(ACT) between those with ‘good’(≥80%) and ‘poor’(<80%) adherence.Results 248 CYP, 117(47%) female, median age 11 y(range3y-16y3m). Median(range) EMD adherence was 77(1–100)% and PRR 66(6–150)%. Self-reported adherence using MARS and MARS-A was high with mean scores of 4.8 and 4.7 respectively.There was a weak correlation between EMD and PRR(R=0.26, p<0.006). There was no correlation between EMD and MARS(R=0.18,p=0.71) or MARS-A(R=0.033,p=0.81) or between any of the other measures.When comparing EMD data from those with good and poor adherence there was no significant difference in FENO or BDR. ‘Poor adherers’ had better ACT scores than ‘good adherers’(15.7vs12.2, z-score=2.69 p=0.007).Conclusions Median adherence was suboptimal; only 32% had good adherence based on EMD data. However, self-reported adherence was high. There was a significant but weak relationship between EMD and PRR.The higher ACT score in those with poor adherence suggests that when CYP feel their asthma control is good, they are less likely to use their ICS/ICS-LABA. However, many of these have high FENO and evidence of BDR and therefore risk an attack.This study highlights the importance of objective measures of adherence. EMDs providing inhalation as well as actuation data are needed to provide a gold-standard adherence measure.",
  "authors": [
    {
      "affiliations": [
        "Imperial College London, London, UK"
      ],
      "name": "R Dobra"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "S Makhecha"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "R Moore-Crouch"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "C Jackman"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "P Hall"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "L Fleming"
    }
  ],
  "title": "S48 Measurement of children and young people’s asthma medication adherence by patient/family report, electronic monitoring devices and prescription refill rate",
  "uid": "ffd3d45d-8c48-5f68-bbaa-1917c83418d7"
}