Department of Hospital Pharmacy, Erasmus Medical Center, Room L-030, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Eur J Clin Pharmacol. 2013 Mar;69(3):683-90. doi: 10.1007/s00228-012-1380-9. Epub 2012 Sep 7.
To investigate the association of ethnicity with objectively, electronically measured adherence to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in the city of Amsterdam.
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 a Real Time Medication Monitoring (RTMM) system. Ethnicity and other potential risk factors, such as socio-economic status, asthma control and parental medication beliefs, were extracted from medical records or parent interviews. The association between adherence and ethnicity was analysed using multivariate linear regression analysis.
A total of 90 children (aged 1-11 years) were included in the study and data of 87 children were used for analysis. Average adherence to ICS was 49.3 %. Native Dutch children showed higher adherence to ICS than Moroccan children (55.9 vs. 42.5 %, respectively; p = 0.044, univariate analysis). After correction for confounders (>3 annual visits to the paediatric outpatient clinic, regular use of a spacer during inhalation), the final regression model showed that ethnicity was independently associated with adherence (p = 0.028).
In our Western European population of inner city children with asthma, poor adherence to ICS was a serious problem, and even somewhat more so in ethnic minorities. Paediatricians involved in asthma treatment should be aware of these cultural differences in medication-taking behaviour, but further studies are needed to elucidate the causal mechanism.
在阿姆斯特丹的多文化儿童哮喘人群中，研究种族与吸入性皮质类固醇（ICS）客观、电子测量的依从性之间的关系。
该研究设计为前瞻性、观察性多中心研究，对摩洛哥裔和荷兰裔哮喘儿童队列进行 ICS 依从性和 ICS 依从性潜在危险因素的测量。每位患者使用实时药物监测（RTMM）系统进行为期 3 个月的电子依从性测量。从病历或家长访谈中提取种族和其他潜在的危险因素，如社会经济地位、哮喘控制和家长用药信念。使用多元线性回归分析来分析依从性与种族之间的关系。
共纳入 90 名（年龄 1-11 岁）儿童进行研究，其中 87 名儿童的数据用于分析。ICS 的平均依从率为 49.3%。荷兰裔儿童的 ICS 依从性高于摩洛哥裔儿童（分别为 55.9%和 42.5%；p=0.044，单因素分析）。在校正混杂因素（每年就诊儿科门诊次数>3 次、常规使用吸入时用 spacer）后，最终回归模型显示种族与依从性独立相关（p=0.028）。
在我们的西欧城市儿童哮喘人群中，ICS 依从性差是一个严重的问题，少数民族的情况甚至更为严重。参与哮喘治疗的儿科医生应注意这些服药行为的文化差异，但需要进一步研究阐明因果机制。
