McNally Kelly A, Rohan Jennifer, Schluchter Mark, Riekert Kristin A, Vavrek Pamela, Schmidt Amy, Redline Susan, Kercsmar Carolyn, Drotar Dennis
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Asthma. 2009 Nov;46(9):921-7. doi: 10.3109/02770900903229651.
High rates of asthma treatment nonadherence have been reported, particularly in economically disadvantaged African American youth. The relationship between adherence to combined medication treatment and asthma outcomes has potential clinical significance but is not well understood. Using electronic monitoring, we describe the pattern of adherence to daily corticosteroid (fluticasone) and leukotriene receptor antagonist (montelukast) medication over the course of 1 year in a population of African American youth with moderate to severe asthma. On average, adherence to montelukast was higher than adherence to fluticasone (p < 0.01); however, for both medications, adherence rates significantly declined over the course of the study. After 1 year, participants took only 31% of prescribed doses of montelukast and 23% of prescribed doses of fluticasone. The decline in adherence to both fluticasone (p < 0.05) and montelukast (p < 0.001) was related to increased healthcare utilization. Furthermore, asthma symptom ratings were related montelukast (p < 0.001), but not fluticasone adherence. These results suggest that adherence promotion intervention strategies are warranted to improve health-related outcomes in families who are at-risk for treatment nonadherence.
据报道，哮喘治疗的不依从率很高，尤其是在经济上处于不利地位的非裔美国青少年中。联合药物治疗的依从性与哮喘治疗效果之间的关系具有潜在的临床意义，但目前尚不清楚。我们使用电子监测，描述了患有中度至重度哮喘的非裔美国青少年人群在1年期间每日使用皮质类固醇（氟替卡松）和白三烯受体拮抗剂（孟鲁司特）药物的依从模式。平均而言，孟鲁司特的依从性高于氟替卡松（p < 0.01）；然而，对于这两种药物，在研究过程中依从率均显著下降。1年后，参与者仅服用了规定剂量的31%的孟鲁司特和23%的氟替卡松。氟替卡松（p < 0.05）和孟鲁司特（p < 0.001）依从性的下降与医疗保健利用率的增加有关。此外，哮喘症状评分与孟鲁司特依从性相关（p < 0.001），但与氟替卡松依从性无关。这些结果表明，有必要采取促进依从性的干预策略，以改善有治疗不依从风险的家庭的健康相关结局。
