Abstract
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.
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Acknowledgements
We are indebted to Loes Thomaes, Chaled Abdel Gawad, Marloes van Hest, Sander Borgsteede, Fatma Karapinar, Marjo Janssen, Svetlana Belitser, Hein van Onzenoort, Inge Berger, Caroline Dijkstra, Karin Geutjes, Fatima Antar, Sufian Alariachi, Saidan Karaman and Mahmut Yilmaz for their comments on the study protocol and for collection of the data, and to the colleagues of the paediatric outpatient clinics of the participating hospitals for their contribution to this study.
Financial disclosure
The study was supported by a non-conditional grant from the health insurance company Agis and partially sponsored by the manufacturer of the RTMM-devices, Evalan BV.
Conflict of interest
The manufacturer of the RTMM-devices, Evalan BV, partially sponsored the study by providing devices at cost price. Both AGIS and Evalan BV did not have any role in the study design, nor in the analysis and interpretation of the data, nor in the writing of this manuscript.
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Netherlands Trial Registry (NTR)
Identification code: NTR1373 (www.trialregister.nl)
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Vasbinder, E., Dahhan, N., Wolf, B. et al. The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children. Eur J Clin Pharmacol 69, 683–690 (2013). https://doi.org/10.1007/s00228-012-1380-9
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DOI: https://doi.org/10.1007/s00228-012-1380-9