Bender BG, Bartlett SJ, Rand CS, Turner C, Wamboldt FS, Zhang L. Pediatrics. 2007;120(3). Available at: www.pediatrics.org/cgi/content/full/120/3/e471
PURPOSE OF THE STUDY. To examine the effect of different modes of reporting adherence on the accuracy of self-administration of inhaled corticosteroids in asthmatic children under conditions mimicking a clinical trial.
STUDY POPULATION. A total of 104 asthmatic children, 8 to 18 years old, who were being treated for asthma with regular use of inhaled corticosteroids were studied. One parent was required to participate with each child.
METHODS. Each parent/child pair was assigned to 1 of 3 self-reporting modes: audio computer-assisted self-interview (ACASI), face-to-face interview with a member of the study staff, or self-administered paper-and-pencil questionnaire. The same mode was administered at each study visit for any given parent/child pair: baseline and at 1, 2, 3, and 4 months. Corticosteroid metered-dose inhalers were fitted with an electronic chronometer that captured the time and date of metered-dose inhaler dispensing, freshly initialized at baseline and at each study visit. Adherence was determined by dividing the number of puffs recorded by the number of puffs prescribed. Self-assessment of adherence was determined similarly for the 3 modes. The recall time frames were 1 week and 1 day. The primary outcome was self-reporting discrepancy (percent adherence recorded minus percent self-adherence self-reported). A positive discrepancy score represented underreporting, a negative score represented overreporting, and zero represented exact reporting. Adequate accuracy was considered when the discrepancy score was ±25%.
RESULTS. Children and parents overrepresented adherence for both the 1-week and 1-day monitoring periods. Adherence discrepancy was the greatest in the ACASI mode (adequate accuracy for children and parents, respectively, was 32% and 27% for 1-day recall and 47% and 38% for 1-week recall). The best accuracy was for the 1-day recall in children interviewed face-to-face (50% adequate). Larger discrepancies were observed in both children and parent with the other modes.
CONCLUSIONS. Self-reporting of adherence was insufficient even under the best of circumstances regardless of the mode of self-reporting used in this study.
REVIEWER COMMENTS. The recently updated National Asthma Education and Prevention Program report underscored the need to address adherence when considering a step up in asthma medication. Inaccurate accounting for adherence may taint clinical trials that examine treatment outcomes and on which guidelines are based. Several studies have used electronic chronologs to monitor adherence. Even then, dose dumping (dispensing several puffs in the air over a short period to boost the number of dispensings recorded) has been reported. You can lead a patient to an inhaler, but you can’t make them inhale.
- Copyright © 2008 by the American Academy of Pediatrics