Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits.
OBJECTIVE
To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.


STUDY DESIGN
One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A  > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).


RESULTS
Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).


CONCLUSIONS
There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.
['Keemink|Yvette S|YS|', 'Klok|Ted|T|', 'Brand|Paul L P|PL|']
D000305:Adrenal Cortex Hormones D000553:Ambulatory Care D001249:Asthma D002648:Child D002675:Child, Preschool D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D055118:Medication Adherence D011446:Prospective Studies
adherence inhaled corticosteroids white coat adherence asthma and early wheeze self management