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Usefulness of parental response to questions about adherence to prescribed inhaled corticosteroids in young children
  1. André Schultz1,2,3,4,
  2. Peter D Sly2,5,
  3. Guicheng Zhang1,
  4. André Venter4,
  5. Sunalene G Devadason1,6,
  6. Peter Niels le Souëf1,2
  1. 1School of Paediatric and Child Health, University of Western Australia, Perth, Australia
  2. 2Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
  3. 3Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
  4. 4Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
  5. 5Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia
  6. 6Division of Clinical Research, Princess Margaret Hospital for Children, Perth, Australia
  1. Corresponding author Dr André Schultz, Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth, WA 6840, Australia; andre.schultz{at}


Background Adherence to prescribed inhaled medication is often low in young children. Poor adherence to medication may contribute to lack of symptom control. Doctors are not good at predicting the adherence rates of their patients, and parental report of adherence does not correlate with objective measures of adherence. The objective of this study was to investigate whether parental admission of non-adherence and reasons given for non-adherence correlated with objectively measured adherence.

Methods Adherence to prescribed inhaled corticosteroid treatment was monitored electronically in 132 children aged 2–6 years who were participating in a randomised controlled trial comparing different inhaler devices. Follow-up was carried out every 3 months for a year. Parental answers to simple questions about adherence were compared to electronically measured adherence.

Results Mean adherence ranged from zero to 100%. Intra-participant adherence varied throughout the year-long study period (mean variance for individual children between quarterly periods was 28.5%). Parents who reported missed doses, generally missed at least half of the prescribed doses. Parents who reported that not a single prescribed dose was missed, still missed 20% of doses on average. Adherence was particularly low when parents cited initiating their own trial off medication as a reason for missing doses.

Conclusions By examining parental response to questions enquiring whether any doses were missed, healthcare providers can gain a modest degree of insight into their patients’ true adherence to prescribed medication. Adherence to prescribed asthma medication is extremely variable in young children.

Trial registration number Data from this study were derived from a randomised controlled trial (ACTRN12608000294358).

  • Respiratory
  • Paediatric Practice

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  • Funding This work was supported by the National Institutes of Health (R01 HL70967). Guicheng Zhang is supported by the Bright Spark Foundation.

  • Competing interests The fluticasone pMDIs used in the study were supplied by GlaxoSmithKline, Australia. The valved holding chambers used in the study were partially sponsored by Visiomed, Australia. The sponsors did not have access to the data and played no part in the analyses or interpretation of the data.

  • Ethics approval This study was approved by Princess Margaret Hospital Research and Ethics Committee (933/EP).

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