The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children

Eur J Clin Pharmacol. 2013 Mar;69(3):683-90. doi: 10.1007/s00228-012-1380-9. Epub 2012 Sep 7.


Purpose: To investigate the association of ethnicity with objectively, electronically measured adherence to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in the city of Amsterdam.

Methods: The study was designed as a prospective, observational multicenter study in which adherence to ICS and potential risk factors for adherence to ICS were measured in a cohort of Moroccan and native Dutch children with asthma. Electronic adherence measurements were performed for 3 months per patient using a Real Time Medication Monitoring (RTMM) system. Ethnicity and other potential risk factors, such as socio-economic status, asthma control and parental medication beliefs, were extracted from medical records or parent interviews. The association between adherence and ethnicity was analysed using multivariate linear regression analysis.

Results: A total of 90 children (aged 1-11 years) were included in the study and data of 87 children were used for analysis. Average adherence to ICS was 49.3 %. Native Dutch children showed higher adherence to ICS than Moroccan children (55.9 vs. 42.5 %, respectively; p = 0.044, univariate analysis). After correction for confounders (>3 annual visits to the paediatric outpatient clinic, regular use of a spacer during inhalation), the final regression model showed that ethnicity was independently associated with adherence (p = 0.028).

Conclusions: In our Western European population of inner city children with asthma, poor adherence to ICS was a serious problem, and even somewhat more so in ethnic minorities. Paediatricians involved in asthma treatment should be aware of these cultural differences in medication-taking behaviour, but further studies are needed to elucidate the causal mechanism.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage*
  • Age Factors
  • Anti-Asthmatic Agents / administration & dosage*
  • Asthma / drug therapy*
  • Asthma / ethnology
  • Blacks / statistics & numerical data*
  • Child
  • Child Welfare
  • Child, Preschool
  • Cultural Characteristics
  • Equipment Design
  • Female
  • Health Knowledge, Attitudes, Practice / ethnology*
  • Humans
  • Infant
  • Linear Models
  • Male
  • Medication Adherence / ethnology*
  • Metered Dose Inhalers
  • Morocco / epidemiology
  • Multivariate Analysis
  • Netherlands / epidemiology
  • Parents / psychology
  • Prospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Time Factors
  • Urban Health
  • Whites / statistics & numerical data*


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents