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Non-adherence to inhaled corticosteroids and the risk of asthma exacerbations in children

机译：儿童不坚持吸入糖皮质激素和哮喘发作的风险

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Background: Non-adherence to inhaled corticosteroids (ICSs) is a major risk factor for poor asthma control in children. However, little is known about the effect of adherence to ICS on the incidence of asthma exacerbations. The objective of this study was to examine the effect of poor adherence to ICS on the risk of exacerbations in children with asthma. Methods: In this nested case–control study using data from the Dutch PHARMO Record Linkage System, children aged 5–12?years who had an asthma exacerbation needing oral corticosteroids or hospital admission were matched to patients without exacerbations. Refill adherence was calculated as medication possession ratio from ICS-dispensing records. Data were analyzed using a multivariable multiplicative intensity regression model. Results: A total of 646 children were included, of whom 36 had one or more asthma exacerbations. The medication possession ratio was 67.9% (standard deviation [SD] 30.2%) in children with an exacerbation versus 54.2% (SD 35.6%) in the control group. In children using long-acting beta-agonist, good adherence to ICS was associated with a higher risk of asthma exacerbations: relative risk 4.34 (95% confidence interval: 1.20–15.64). Conclusion: In children with persistent asthma needing long-acting beta-agonist, good adherence to ICS was associated with an increased risk of asthma exacerbations. Possible explanations include better motivation for adherence to ICS in children with more severe asthma, and reduced susceptibility to the consequences of non-adherence to ICS due to overprescription of ICS to children who are in clinical remission. Further study into the background of the complex interaction between asthma and medication adherence is needed.
机译：背景：不坚持吸入糖皮质激素（ICSs）是儿童哮喘控制不良的主要危险因素。但是，对于ICS依从性对哮喘加重发生率的影响知之甚少。这项研究的目的是检查对ICS依从性较差对哮喘患儿加重风险的影响。方法：在这项基于荷兰PHARMO记录链接系统数据的嵌套病例对照研究中，将5-12岁的哮喘急性加重需要口服皮质类固醇或住院的儿童与无急性加重的患者进行匹配。从ICS分配记录中计算出笔芯的依从性，作为药物占有率。使用多变量乘法强度回归模型分析数据。结果：共纳入646名儿童，其中36名患有一种或多种哮喘急性发作。加重儿童的药物拥有率为67.9％（标准差[SD] 30.2％），而对照组为54.2％（SD 35.6％）。在使用长效β-激动剂的儿童中，对ICS的良好依从性与哮喘急性发作的较高风险相关：相对风险为4.34（95％置信区间：1.20-15.64）。结论：对于需要长效β-激动剂的持续性哮喘患儿，对ICS的良好依从性会增加哮喘急性发作的风险。可能的解释包括：患有更严重哮喘的儿童有更好的动机接受ICS，由于对临床缓解儿童过量使用ICS导致对不遵守ICS后果的敏感性降低。需要进一步研究哮喘与药物依从性之间复杂相互作用的背景。

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