Introduction
In China, the prevalence of paediatric asthma has increased over the past 20 years and is now approximately 3%. The long-term goals of asthma management according to the Global Initiative for Asthma (GINA) 2020 update are to improve and individualize the care of patients with asthma so that patients are able to achieve good control of symptoms and maintain normal activity levels, and have minimized risk of: asthma-related death, exacerbations, persistent airflow limitation and side effects. The 2020 GINA guidelines suggest that poor adherence can be identified in clinical practice by empathic questioning that encourages open discussion, and acknowledges the probability of incomplete adherence. For optimal control of chronic diseases such as asthma, long-term adherence to treatment is required. If symptom control is poor and/or exacerbations persist despite 3 months of controller therapy, before considering a step-up of controller treatment, the relationship of symptoms to asthma should be confirmed, inhaler technique checked, good adherence confirmed or for children under 5-years old, an alternative treatment considered.
Methods:
The study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers).
Results:
The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit . Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control.
Discussion: