TY - JOUR
T1 - Nonadherence to inhaled corticosteroids: A characteristic of the pediatric obese-asthma phenotype?
AU - Orriëns, Lynn B.
AU - Vijverberg, Susanne J. H.
AU - Maitland—van der Zee, Anke H.
AU - Longo, Cristina
N1 - Funding Information: The authors would like to acknowledge the support of the Utrecht Pharmacy Practice network for Education and Research, the Academic Medical Center of the University of Amsterdam, Radboud University, and the parents and children participating in the PACMAN study. Funding Information: The authors would like to acknowledge the support of the Utrecht Pharmacy Practice network for Education and Research, the Academic Medical Center of the University of Amsterdam, Radboud University, and the parents and children participating in the PACMAN study. Funding Information: The PACMAN study was initially funded by an unrestricted grant from GlaxoSmithKline; however, GlaxoSmithKline had no role in the design, analysis, or interpretation of the results in this study. Dr Maitland‐van der Zee received a fee for participating in advisory boards for Boehringer lngelheim and AstraZeneca, and received unrestricted research grants from GSK and Boehringer Ingelheim. The other authors have no relevant conflicts of interest to disclose. Publisher Copyright: © 2021 Wiley Periodicals LLC
PY - 2021/5
Y1 - 2021/5
N2 - Background: Children with excess weight and asthma tend to respond less well to inhaled corticosteroids (ICS) than children with normal weight, potentially resulting in nonadherence to ICS. Objectives: To assess whether excess weight (body mass index ≥85th percentile) was associated with general, unintentional, and intentional nonadherence to ICS in children with asthma. Methods: We analyzed data from 566 children aged 4–13 years with asthma, who used ICS as maintenance therapy, from the cross-sectional Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects study. General nonadherence was measured objectively with the proportion of days covered (<50%) and subjectively with the parent-reported Medication Adherence Rating Scale (MARS <21) reflecting parent-reported nonadherent behavior. Unintentional and intentional nonadherence were defined as forgetting to take medication and deliberately changing or skipping doses, respectively, from specific items of the MARS. We performed logistic regression analyses, stratifying estimates by asthma severity and age group. Results: Excess weight was associated with a trend towards increased odds of parent-reported nonadherent behavior (odds ratio [OR]: 1.54; 95% confidence interval [CI]: 0.84–2.81) and objectively measured general nonadherence, but only in moderate-to-severe asthma (OR: 1.71; 95% CI: 0.84–3.48). The odds of intentional, but not unintentional, nonadherence seemed to be greater in children with excess weight than normal weight (OR: 1.94; 95% CI: 0.94–4.01), and the association appeared to be stronger in younger (OR: 2.17; 95% CI 1.00–4.73) versus older children (OR: 1.18; 95% CI: 0.36–3.94). Conclusions: Excess weight was associated with general nonadherence to ICS, but only in children with moderate-to-severe asthma, and nonadherent behavior, which seemed to be intentional.
AB - Background: Children with excess weight and asthma tend to respond less well to inhaled corticosteroids (ICS) than children with normal weight, potentially resulting in nonadherence to ICS. Objectives: To assess whether excess weight (body mass index ≥85th percentile) was associated with general, unintentional, and intentional nonadherence to ICS in children with asthma. Methods: We analyzed data from 566 children aged 4–13 years with asthma, who used ICS as maintenance therapy, from the cross-sectional Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects study. General nonadherence was measured objectively with the proportion of days covered (<50%) and subjectively with the parent-reported Medication Adherence Rating Scale (MARS <21) reflecting parent-reported nonadherent behavior. Unintentional and intentional nonadherence were defined as forgetting to take medication and deliberately changing or skipping doses, respectively, from specific items of the MARS. We performed logistic regression analyses, stratifying estimates by asthma severity and age group. Results: Excess weight was associated with a trend towards increased odds of parent-reported nonadherent behavior (odds ratio [OR]: 1.54; 95% confidence interval [CI]: 0.84–2.81) and objectively measured general nonadherence, but only in moderate-to-severe asthma (OR: 1.71; 95% CI: 0.84–3.48). The odds of intentional, but not unintentional, nonadherence seemed to be greater in children with excess weight than normal weight (OR: 1.94; 95% CI: 0.94–4.01), and the association appeared to be stronger in younger (OR: 2.17; 95% CI 1.00–4.73) versus older children (OR: 1.18; 95% CI: 0.36–3.94). Conclusions: Excess weight was associated with general nonadherence to ICS, but only in children with moderate-to-severe asthma, and nonadherent behavior, which seemed to be intentional.
KW - body mass index
KW - child
KW - medication adherence
KW - overweight
UR - http://www.scopus.com/inward/record.url?scp=85099292960&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ppul.25253
DO - https://doi.org/10.1002/ppul.25253
M3 - Article
C2 - 33434419
SN - 8755-6863
VL - 56
SP - 948
EP - 956
JO - Pediatric pulmonology
JF - Pediatric pulmonology
IS - 5
ER -