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True adherence with the Turbuhaler in young children with asthma
  1. K Nikander1,
  2. M Turpeinen2,
  3. A S Pelkonen2,
  4. T Bengtsson3,
  5. O Selroos4,
  6. T Haahtela2
  1. 1Philips Respironics, Parsippany, New Jersey, USA
  2. 2Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
  3. 3AstraZeneca R&D, Lund, Sweden
  4. 4Semeco AB, Ängelholm, Sweden
  1. Correspondence to K Nikander, Philips Respironics, Respiratory Drug Delivery, 5 Wood Hollow Road, Parsippany, NJ 07054, USA; kurt.nikander{at}


Objective To investigate true adherence with a dry powder inhaler, the Turbuhaler (TBH), in children with asthma. True adherence was calculated by multiplying adherence to treatment with inhaler competence, that is correct use of the inhaler.

Patients and design In an 18-month study, children aged 5–10 years with asthma received twice daily budesonide via a TBH. Parents and children were trained in the correct use of the inhaler before the study started. For each inhalation, peak inspiratory flow through the TBH (PIFTBH) was recorded with an electronic pneumotachograph. The PIFTBH recordings were used to calculate true adherence for the first and last 45-day periods in the study by multiplying adherence in using the device (percentage of days with PIFTBH recordings) with inhaler competence (correct use of inhaler defined as PIFTBH values >40 l/min).

Main outcome measures True adherence, adherence, inhaler competence and PIFTBH.

Results 115 children were treated. The mean (morning and evening) true adherence during the first 45 days was 81.6% (range 78.1–86.4%) and during the last 45 days 57.4% (44.0–66.9%). Mean adherence was 86.0% and 59.3%, whereas mean inhaler competence was 94.7% and 96.2%, respectively. Thus the decline in true adherence was due to the decline in adherence. The largest decline in true adherence occurred in older children.

Conclusions True adherence with budesonide TBH treatment decreased significantly during the 18-month study due to a decrease in adherence. Inhaler competence with the correct use of the budesonide TBH was high and unchanged over the study period.

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  • Funding The study was sponsored by the Helsinki University Central Hospital (grant TYH 2303) and AstraZeneca, Lund, Sweden. This study was performed at the Department of Allergy at Helsinki University Hospital.

  • Competing interests T Bengtsson is an employee of AstraZeneca.

  • Ethics approval This study was conducted with the approval of the Helsinki University Hospital ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.