Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits

Pediatr Pulmonol. 2015 Nov;50(11):1060-4. doi: 10.1002/ppul.23138. Epub 2014 Dec 2.


Objective: To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.

Study design: One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).

Results: Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).

Conclusions: There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.

Keywords: adherence; asthma and early wheeze; inhaled corticosteroids; self management; white coat adherence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Ambulatory Care*
  • Asthma / drug therapy*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medication Adherence*
  • Prospective Studies


  • Adrenal Cortex Hormones