Received 2 January 2009; received in revised form 3 February 2009; accepted 3 February 2009. published online 23 April 2009.
Background
Adherence to inhaled steroid regimens for asthma is poor in adults and children. Although it is assumed that nonadherence contributes to morbidity in older adolescents, investigation is limited.
Objective
We sought to describe adherence to preventive asthma medications and explore relevant beliefs and attitudes in older urban adolescents, including their ideas for improving adherence.
Methods
Quantitative and qualitative methods were used to collect data from a convenience sample of adolescents with asthma previously prescribed fluticasone/salmeterol (F/S). Two semistructured face-to-face interviews were conducted 1 month apart and analyzed for themes. F/S use was electronically monitored between visits and calculated as the number of actuations divided by the number of inhalations prescribed.
Results
Forty participants, (15-18 years of age, 19 female subjects, 30 black/African American subjects, 11 Medicaid-insured subjects, and 24 previously hospitalized for asthma) with a median FEV1 of 98% of predicted value (range, 67% to 127%) had median adherence of 43% (range, 4% to 89%). Adherence was not associated with FEV1 or emergency department visits. Themes emerged from interviews as follows. Teens (1) take F/S inconsistently; (2) believe F/S is “supposed to help me breathe”; (3) dislike its taste; (4) are “too busy” and “forget”; and (5) recommend “reminder” solutions to poor adherence. Twenty percent believed that taking F/S was unnecessary, and another 18% expressed ambivalence about its benefits.
Conclusion
Adherence was poor. Examining and acknowledging health beliefs of older teens in the context of their complicated lives might facilitate discussions about self-management.
aDivision of Allergy and Immunology, the Children's Hospital of Philadelphia, Philadelphia, Pa
cDivision of Adolescent Medicine, the Children's Hospital of Philadelphia, Philadelphia, Pa
bClinical and Research Consultant, Philadelphia, Pa
dDepartment of Bioengineering, University of Pennsylvania, Philadelphia, Pa
fSection of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa
ePulmonary and Critical Care Medicine, the Johns Hopkins School of Medicine, Baltimore, Md
Reprint requests: Andrea J. Apter, MD, MSc, 829 Gates Building, Hospital of the University of Pennsylvania, 3600 Spruce St, Philadelphia, PA 19104.
D. R. Naimi is supported by the American Academy of Allergy, Asthma & Immunology Sepracor Research Excellence Award and A. J. Apter is supported by grants HL070392 and HL088469.
Disclosure of potential conflict of interest: D. R. Naimi received the American Academy of Allergy, Asthma & Immunology Sepracor Research Excellence Award. D. Bogen received grant support from the National Institutes of Health. C. S. Rand is on the advisory board for the Merck Foundation/HCAN and on the leadership council for Schering-Plough. A. J. Apter received grant support from the National Institutes of Health/National Heart Lung Blood Institute. The rest of the authors have declared that they have no conflict of interest.
ABSTRACT