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The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children.

Vasbinder, E.C., Dahhan, N., Wolf, B., Zoer, J., Blankman, E., Bosman, D., Dijk, L. van, Bemt, P.M.L.A. van den. The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children. Pharmacoepidemiology and Drug Safety: 2011, 20(suppl. 1) S315. Abstract. 27th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 14-17 Augustus 2011, Chicago.
Background: Regular use of ICS can improve asthma control and reduce hospital admissions and mortality. Still, nonadherence is an important problem in asthma. Poor adherence seems to be a particular concern amongst ethnic minority patients and some evidence exits that ethnic disparities in asthma severity may be caused by poor adherence to ICS. Objectives: To investigate the impact of ethnicity on objectively, electronically measured adherence to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in the city of Amsterdam. Methods: The study was designed as a prospective, observational multicenter study in which adherence to ICS and potential risk factors for adherence to ICS were measured in a cohort of Moroccan and native Dutch children with asthma. Electronic adherence measurements were performed for 3 months per patient using Real Time Medication Monitoring (RTMM). Ethnicity and other potential risk factors such as socio-economic status, asthma control, asthma severity and parental medication beliefs were extracted from medical records or parent interviews. The association between adherence and ethnicity was analyzed using multivariate linear regression analysis. Results: 94 children (aged 1–11 years) were included in the study and data of 87 children were used for analysis. On average, adherence to ICS was 49.3%. Native Dutch children showed higher adherence to ICS than Moroccans (55.9% vs. 42.5%, p=0.044, univariate analysis). Potential risk factors that were associated with adherence univariately (p0.2) were - next to ethnicity - subsequently entered into the multivariate model, resulting in a model including ‘>3 annual visits to the paediatric outpatient clinic’ and ‘regular use of a spacer during inhalation’. This model showed that ethnicity was independently associated with adherence (p=0.028). Conclusions: Poor adherence to ICS is a major concern, especially in ethnic minority children with asthma. Paediatricians involved in asthma treatment should be aware of the impact of ethnicity on adherence to ICS and could use this information to further enhance adherence and thus optimize asthma therapy in children. (aut. ref.)