Lu Monica A, Ruvalcaba Elizabeth, McQuaid Elizabeth L, Rand Cynthia S, Riekert Kristin A, Eakin Michelle N
Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Front Allergy. 2023 Sep 28;4:1219868. doi: 10.3389/falgy.2023.1219868. eCollection 2023.
Medication adherence is suboptimal in childhood asthma. Children rely on caregivers to manage medication administration. It is important to detect families who are at risk for poor adherence or to identify potential areas that can assist families with better adherence to asthma medications in order to improve asthma outcomes. We investigated the association between asthma routines, family asthma management knowledge and skills, and caregiver depressive symptoms with daily controller medication adherence among Head Start preschool children in Baltimore City.
Our study included 256 low-income urban preschool children who were prescribed a daily controller medication. Asthma routinization (by the Asthma Routines Questionnaire), family asthma management [by the Family Asthma Management System Scale (FAMSS)], and caregiver depressive symptoms (by the Center for Epidemiological Studies - Depression) were assessed at baseline. The medication possession ratio (MPR) to measure adherence to daily controller medications was calculated at baseline and 12 months from pharmacy fill records. Multiple regression models evaluated the relationship between asthma routinization, the FAMSS, the CES-D, and MPR.
Results indicated that only 7% of families had an MPR above 80% at baseline, and 24% of caregivers had clinically significant depressive symptoms. Higher asthma medication routines were associated with higher MPR at baseline ( = 0.05, = 0.03). Higher family asthma management was associated with higher MPR at both baseline ( = 0.04, < 0.01) and 12 months ( = 0.05, < 0.01).
Our findings highlight the importance of family asthma management and maintaining medication routines over time to improve asthma controller medication adherence.
儿童哮喘患者的药物依从性欠佳。儿童依赖照料者来管理药物服用。识别有依从性差风险的家庭或确定有助于家庭更好地坚持服用哮喘药物的潜在领域，对于改善哮喘治疗效果非常重要。我们调查了巴尔的摩市“启智计划”学龄前儿童的哮喘日常习惯、家庭哮喘管理知识与技能以及照料者抑郁症状与每日控制药物依从性之间的关联。
我们的研究纳入了256名被开具每日控制药物的低收入城市学龄前儿童。在基线时评估哮喘日常化情况（通过哮喘日常问卷）、家庭哮喘管理情况[通过家庭哮喘管理系统量表（FAMSS）]以及照料者抑郁症状（通过流行病学研究中心抑郁量表）。根据药房配药记录计算基线时和12个月时用于衡量每日控制药物依从性的药物持有率（MPR）。多元回归模型评估哮喘日常化、FAMSS、CES - D与MPR之间的关系。
结果表明，基线时只有7%的家庭MPR高于80%，24%的照料者有临床显著的抑郁症状。较高的哮喘药物日常习惯与基线时较高的MPR相关（β = 0.05，P = 0.03）。较高的家庭哮喘管理在基线时（β = 0.04，P < 0.01）和12个月时（β = 0.05，P < 0.01）均与较高的MPR相关。
我们的研究结果凸显了家庭哮喘管理以及长期维持药物服用习惯对于提高哮喘控制药物依从性的重要性。
