a Centre for Behavioural Medicine, UCL School of Pharmacy , University College London , London , UK.
b National Heart and Lung Institute , Imperial College , London , UK.
Expert Rev Clin Immunol. 2018 Dec;14(12):1055-1063. doi: 10.1080/1744666X.2018.1532290. Epub 2018 Oct 15.
Poor adherence in children with asthma is a major cause of asthma attacks and poor control, leads to large health-care costs, and has been identified as a factor in asthma deaths. However, it is difficult to detect and frequently overlooked leading to inappropriate escalation of asthma treatment. There is a need for cost effective ways to monitor adherence in order to intervene to change this modifiable behavior. Areas covered: Several measurement tools have been developed to assess adherence in adults and children with asthma. The current methods for measuring adherence, both subjective and objective, have several flaws and even the current gold standard, electronic monitoring devices (EMDs), has limitations. This review will outline and critique the adherence monitoring tools and highlight ways in which they have been used for the purpose of intervention. Expert commentary: Although advances have been made in adherence monitoring, we still have some way to go in creating the ideal monitoring tool. There are no validated tailored self-monitoring questionnaires for children with asthma and most objective measures, such as prescription refill rate and weighing canisters, overestimate adherence. Current EMDs, although useful, need improved accuracy to ensure that both actuation and inhalation are measured, and the devices need to be affordable for use in routine health-care practice.
儿童哮喘患者用药顺应性差是哮喘发作和控制不佳的主要原因，会导致高额的医疗费用，并且已被确定为哮喘死亡的一个因素。然而，这种情况很难被发现，并且常常被忽视，导致哮喘治疗的不适当升级。因此，需要有经济有效的方法来监测用药顺应性，以便进行干预以改变这种可改变的行为。
已经开发出几种测量工具来评估成人和儿童哮喘患者的用药顺应性。目前用于测量顺应性的方法，包括主观和客观方法，都存在一些缺陷，即使是目前的金标准，电子监测设备（EMD）也存在局限性。这篇综述将概述和评价顺应性监测工具，并强调它们在干预目的方面的应用。
尽管在顺应性监测方面已经取得了进展，但我们仍需要在创建理想的监测工具方面取得一些进展。目前还没有针对哮喘儿童的经过验证的定制自我监测问卷，大多数客观测量方法，如处方续配率和计量罐称重，都高估了顺应性。目前的 EMD 虽然有用，但需要提高准确性，以确保测量到触发和吸入，并且设备需要负担得起，以便在常规医疗实践中使用。
