| Abstract |
Introduction: Asthma is a chronic respiratory disease that significantly affects children and adolescents worldwide. Effective asthma management requires strict adherence to prescribed medication regimens. However, non-compliance remains a significant barrier to asthma control, particularly in childhood.
Purpose: The purpose of this study was to assess the degree of adherence to asthma therapy among children and adolescents attending the pediatric pulmonary clinic at the University General Hospital of Heraklion (PAGNI), investigate the factors influencing adherence, and correlate adherence with asthma control.
Methodology: Our study was a cross-sectional observational study using standardized questionnaires and open-ended questions to collect qualitative characteristics. The study sample was a convenience sample consisting of 105 children and adolescents aged 6 to 16 years with diagnosed asthma who visited the pediatric pulmonary clinic of the University General Hospital of Heraklion (PAGNI) on Mondays, Thursdays, and Fridays. Data collection was conducted from March to April 2024. Participants were required to be informed about the study's purpose and sign a consent form for voluntary participation. The questionnaires included demographic characteristics, the Childhood Asthma Control Test (C-ACT), the Asthma Control Test (ACT), and the Morisky Medication Adherence Scale (MMAS-8). Statistical analysis was performed using IBM SPSS Statistics 28.0. Finally, semi-structured interviews with 5 open-ended questions were conducted with 20 out of the 105 children and adolescents to evaluate factors affecting non-adherence to asthma therapy.
Results: Of the 105 children and adolescents in the study, the majority were 60 boys (57.1%), while 45 were girls (42.9%). More than half of the participants (55.2%) showed low adherence to their medication regimen, while significantly more than half of the children and adolescents (67.6%) had well-controlled asthma (p<0.05). Conversely, significantly fewer than half of the children and adolescents (13.3%) had high medication adherence (p<0.05). Additionally, the chi-square test showed no significant correlation between asthma control (ACT/C-ACT scores) and medication adherence (MMAS-8 scores) in children (p=0.607, p>0.05). However, better asthma control was significantly associated with a higher age of asthma symptom onset (r=0.238, p<0.05) or a lower number of asthma exacerbations in the past year (r=-0.228, p<0.05). Finally, better medication adherence was associated with children and adolescents who had a lower body mass index (β=-0.09, p=0.032) or a higher age of asthma symptom onset (β=0.16, p=0.031). The main reasons for non-adherence reported in the open-ended questions were practical difficulties in proper inhalation technique, engagement in play/activities, lack of reminders from parents, lack of organization/planning, and the belief that medication was not necessary.
Conclusions: The study population shows inadequate adherence to asthma treatment, highlighting the need for targeted interventions to improve adherence to asthma therapy among pediatric patients. Characteristics of children and adolescents, such as gender, place of residence, comorbidities, as well as demographic factors of their parents, such as education level, smoking habits, and history of asthma or atopy, did not significantly affect asthma control and adherence to medication. However, it was found that children and adolescents with a higher age of asthma symptom onset or fewer asthma exacerbations in the past year had better asthma control. Similarly, better adherence to medication was observed in children and adolescents with a lower body mass index or those who first exhibited asthma symptoms at an older age. Additionally, the level of asthma control in children was not significantly influenced by their adherence to medication. According to the qualitative research results, factors such as difficulty in inhalation technique, lack of reminders from parents, and not taking medication due to engagement in play/activities negatively impacted adherence. Therefore, interventions such as educational programs for patients and their caregivers are essential to enhance adherence and achieve better asthma control.
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