Longitudinal Adherence to Inhaled Corticosteroids in Pediatric Patients with Difficult to Control Asthma

The purpose of this study is to examine adherence to inhaled corticosteroids in children with difficult-to-treat (DTT) asthma, in whom poor adherence is known to lead to poor outcomes. Participants received multi-modal treatment strategy including a digital adherence intervention. Twenty children with moderate- to severe-persistent asthma aged 6-17 years (Mage = 12.2 years, 57.1% male) received multi-modal treatment including a digital adherence intervention and completed electronic adherence monitoring over a 12 month period. Baseline adherence was 39% with 5% of participants’ adherence >80%, 35% between 50-80% adherence, and 60% <50%adherence. ICS adherence during the self-management intervention (M=75.9%) was significantly improved compared to baseline adherence (IQR 59.2% - 83.3%; S=68, p<.0001) with 94% of participants having >50% adherence. Adherence at the end of the 1-year study (35.8%; IQR 12.9%-54.6%) was not significantly different from baseline (IQR 20.8%- 57.1%; S = -27, p = 0·17). When examining post-intervention patterns of adherence, 76% had >50% adherence during 1-month post-intervention and 29% had >50% during the 3-month post-intervention period. No significant associations were found between adherence and clinical outcomes. Participants benefited from the intervention, however adherence gains were not sustained over 1 year with participants demonstrating differing rates of decline in adherence post-intervention. These findings highlight that continued interventions may be required to sustain adherence. Further, identification of individual factors associated with adherence declines following an intervention is needed to determine individual patient needs regarding the timing of booster sessions.