Engelkes Marjolein, Janssens Hettie M, de Jongste Johan C, Sturkenboom Miriam C J M, Verhamme Katia M C
Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
Department of Paediatrics Division of Respiratology and Allergology Medicine, Erasmus University/Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Allergy Immunol. 2016 Mar;27(2):201-8. doi: 10.1111/pai.12507. Epub 2015 Dec 21.
Adherence to treatment remains important for successful asthma management. Knowledge about asthma medication use and adherence in real-life offers opportunities to improve asthma treatment in children.
To describe prescription patterns, adherence and factors of adherence to drugs in children with asthma.
Population-based cohort study in a Dutch primary care database (IPCI), containing medical records of 176,516 children, aged 5-18 years, between 2000 and 2012. From asthma medication prescriptions, age, gender, seasonal and calendar year rates were calculated. Adherence was calculated using medication possession ratio (MPR) and ratio of controller to total asthma drug (CTT). Characteristics of children with high-vs.-low adherence were compared.
The total asthma cohort (n = 14,303; 35,181 person-years (PY) of follow-up) was mainly treated with short-acting β2-agonists (SABA; 40 users/100 PY) and inhaled corticosteroids (ICS; 32/100 PY). Median MPR for ICS was 56%. Children with good adherence (Q4 = MPR > 87%) were younger at start of ICS, more often visited specialists and had more exacerbations during follow-up compared to children with low adherence (Q1 = MPR < 37%).
In Dutch primary care children with asthma were mainly prescribed SABA, and ICS. Adherence to ICS was relatively low. Characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence is driven by treatment need or intensity of medical follow-up.
坚持治疗对于成功管理哮喘仍然很重要。了解哮喘药物在现实生活中的使用情况和依从性为改善儿童哮喘治疗提供了机会。
描述哮喘儿童的处方模式、药物依从性及其影响因素。
基于荷兰初级保健数据库（IPCI）进行的人群队列研究，该数据库包含2000年至2012年间176,516名5至18岁儿童的医疗记录。从哮喘药物处方中计算年龄、性别、季节和历年使用率。使用药物持有率（MPR）和控制药物与哮喘总药物的比例（CTT）计算依从性。比较高依从性和低依从性儿童的特征。
哮喘总队列（n = 14,303；随访35,181人年（PY））主要使用短效β2激动剂（SABA；40使用者/100 PY）和吸入性糖皮质激素（ICS；32/100 PY）进行治疗。ICS的MPR中位数为56%。与低依从性儿童（Q1 = MPR < 37%）相比，依从性良好的儿童（Q4 = MPR > 87%）在开始使用ICS时年龄更小，更常看专科医生，随访期间病情加重次数更多。
在荷兰初级保健中，哮喘儿童主要使用SABA和ICS进行处方治疗。ICS的依从性相对较低。依从性良好的儿童特征与更严重的哮喘相符，这表明依从性是由治疗需求或医疗随访强度驱动的。
