Treatment compliance, passive smoking, and asthma control: a three year cohort study
- 1INSERM Unit 408, Paris, France
- 2Laboratoire Aventis, Paris, France
- 3Association pour les Etudes en Pneumologie Libérale (AEPL) and Association des Pneumologues de la Région Nord (APRN), France
- Correspondence to:
Dr D Soussan, INSERM U408 Epidémiologie, Faculté de Médecine Xavier Bichat, B.P. 416, 75870 Paris Cedex 18, France;
- Accepted 14 September 2002
Aims: To study the role of treatment compliance and parents' smoking on asthma control in children with recently diagnosed mild or moderate persistent asthma who were prescribed inhaled anti-inflammatory treatment.
Methods: Prospective cohort study of 167 children aged 6–12 years (64% boys). Patients were examined at inclusion and followed up for three years with a visit every four months. Peak expiratory flow (PEF) was measured twice a day during the week before each visit. Two control criteria were monitored: (1) symptom control = having diurnal or nocturnal exacerbations less than once a week and no symptoms between exacerbations, at all visits; and (2) PEF control = daily PEF variability <20% on each of the seven days before each visit.
Results: Symptom control was achieved by 25.1% of children and PEF control by 53.3%. Symptom control was positively related to having understood the way in which the medication worked and taking the prescribed doses (odds ratios (OR) = 3.38 and 4.82 respectively). It was inversely related to smoking within the home (OR = 0.34). PEF control was positively related to taking the prescribed doses (OR = 3.58). It was less frequently achieved if the mother smoked within the home (OR = 0.34).
Conclusions: Results suggest that, to maximise the benefits of available asthma medication and to improve health outcomes, further efforts should be made to convince the parents of asthmatic children not to smoke in the house, and to improve compliance by increasing the patients' understanding of the disease and its treatment.
- CI, confidence interval
- FEV1, forced expiratory volume in 1 second
- OR, odds ratio
- PEF, peak expiratory flow