Many young people with asthma are not taking their prescribed medicine

Young people are not using inhalers prescribed to prevent asthma, and many children and parents know little about their asthma medications, say two studies.

PROVIDENCE, R.I. -- Asthmatic older children and teens take only 40 percent of their inhaler doses prescribed to prevent asthma, often skipping their daily medication entirely. The findings from a new study indicate that young people may be taught how to use inhalers to prevent asthma but that training doesn't mean they'll take the prescribed puffs.

Unlike the inhalers prescribed to arrest asthma attacks, preventive medications do not provide an immediate effect, but offer long-term control of symptoms. "If young people do not sense that immediate effect, they may lose their motivation to use the preventive medications," said Elizabeth McQuaid, who led the study.

"Expecting adolescents with asthma to follow strategies of preventive management on their own is a set-up for problems," she said. Adolescence is when young people become responsible for taking their own medication, but research shows that adolescence is also the time when they are the least likely to follow a doctor's advice.

The study of 57 asthmatic young people, ages 10 to 16, was presented recently at the Seventh Annual Conference on Child Health Psychology. McQuaid and colleagues measured adherence to medication over four weeks, using a computer chip attached to inhalers to record the date and time of each use and whether the dose was inhaled.

McQuaid and colleagues suggest that, when possible, physicians prescribe medicines that call for fewer daily doses for older children and teens or adopt other behavioral approaches. Physicians may want to begin new asthma treatments for young people by helping families anticipate potential barriers to effective prescription adherence, she said.

An assistant professor of psychiatry and human behavior in the Brown University School of Medicine, McQuaid is a pediatric psychologist at Rhode Island Hospital and works with asthmatic youngsters.

The researchers presented a second study showing that many of the 57 young people and their parents did not know whether their medication was designed to prevent or to treat asthma attacks. In addition, when asked how to prevent asthma episodes, 36 percent of children and 44 percent of adults did not list preventive medication, even though all of the children were prescribed medication to prevent asthma attacks. Sixteen percent of children and 15 percent of parents did not know of any strategies to prevent asthma episodes.

"These studies are one indication of how little families understand what their physicians are recommending and more importantly how hard it is for them to follow through," McQuaid said. She expects the findings will be used to establish guidelines for when children are best able to start managing their own asthma medication regimen. McQuaid is also using the data to design interventions to help young people and their parents with this transition.

Both studies were conducted by researchers from Brown University School of Medicine and Rhode Island Hospital and supported by grants from the American Lung Association and the National Institute of Children's Health and Human Development.

For moderate to severe asthma, taking inhaled medications on a preventive basis is a cornerstone of treatment. Common types of asthma medications include anti-inflammatories, which help prevent asthma attacks, and bronchodilators, which help stop asthma attacks underway. Doctors usually prescribe two to three puffs of an anti-inflammatory to be taken two-to-three times daily.

"We need to show kids that if they take their preventive medication each day, they won't need to take their inhalers to rescue them from asthma attacks in progress," McQuaid said. "If children took preventive medicines exactly as prescribed, asthma-related illness would decrease and quality of life would increase."

Asthma prevalence among children increased almost 87 percent between 1982 and 1995. About 14.9 million people in the United States have asthma, more than one-third of them children. Despite effective medical treatments, the incidence of asthma and the economic costs remain high.