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  Table of Contents    
Year : 2020  |  Volume : 37  |  Issue : 4  |  Page : 355-356  

Medication adherence in pediatric asthma

Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission21-Nov-2019
Date of Acceptance10-Mar-2020
Date of Web Publication01-Jul-2020

Correspondence Address:
Prawin Kumar
Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_516_19

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How to cite this article:
Kumar P, Goyal JP. Medication adherence in pediatric asthma. Lung India 2020;37:355-6

How to cite this URL:
Kumar P, Goyal JP. Medication adherence in pediatric asthma. Lung India [serial online] 2020 [cited 2021 Jun 23];37:355-6. Available from: https://www.lungindia.com/text.asp?2020/37/4/355/288753


We read with interest the recent article published in your journal by Sinha et al.[1] We would like to congratulate the authors for highlighting the issue of medication adherence in asthma, which is a cornerstone of asthma management. However, we have few concerns related to this article.

The authors have used compliance ratio for medication adherence, and they assumed good compliance when the CR% >80, i.e., >80% of the prescribed number of doses were taken. However, it does not provide information about medication use on a daily basis, which is crucial for long-term asthma control. Moreover, measuring the number of medication dosages taken does not guarantee that one has taken the medication; these are vulnerable to parents/patients manipulation.[2] Furthermore, many of the studies have used Test of Adherence to Inhaler (TAI), a validated questionnaire to assess adherence or medication possession rate as a measure of adherence, which is the number of days of medication supplied divided by the number of days between the first and the last refill.[3],[4]

The authors have stated that they have taken a prevalidated questionnaire to check the compliance, but neither had they mentioned any details of questionnaire nor had given a reference for this. The authors have also described in methodology that they have only included children with mild-to-moderate asthma as per the GINA guideline; however, most of the children (67.9%) were on combination of inhaled corticosteroid (ICS) and leukotriene receptor antagonist (LTRA), which is actually not a preferred controller therapy, instead an optional controller therapy for asthma management as per the recent GINA guideline.[5] It needs further elucidation why the authors had not considered preferred instead an optional controller therapy for long-term control of asthma symptoms, which might also have an impact on compliance to therapy? Furthermore, the author did not mention about the dose of ICS (low/moderate/high dose) on which LTRA was added.

It is quite surprising that the median (IQR) number of emergency visits in the follow-up period was 0.6 (0.2–1.0), but none of the patient received oral corticosteroid (OCS). On the other hand, ≥50% of the patient was either partly or uncontrolled asthma; however, the author had mentioned that none of them required long-acting beta-2-agonists (LABA) or OCS.

The authors have also described major factors responsible for poor compliance in this study, in which economic restriction was present in 17.5% of the defaulter. However, in spite of medications provided free of cost, what were the other economic restrictions, which were responsible for poor compliance in this study? It requires further explanation.

Finally, the authors have mentioned in the merit of study that it was a large population-based cohort, but as far as we understand after a careful reading of this study, it was a hospital-based, not a population-based cohort study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Sinha R, Lahiry S, Ghosh S. Suboptimal compliance to aerosol therapy in pediatric asthma: A prospective cohort study from Eastern India. Lung India 2019;36:512-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: A systematic review. Eur Respir J 2015;45:396-407.  Back to cited text no. 2
Ayele AA, Tegegn HG. Non adherence to inhalational medications and associated factors among patients with asthma in a referral hospital in Ethiopia, using validated tool TAI. Asthma Res Pract 2017;3:7.  Back to cited text no. 3
van Dellen QM, Stronks K, Bindels PJ, Ory FG, van Aalderen WM, PEACE Study Group. Adherence to inhaled corticosteroids in children with asthma and their parents. Respir Med 2008;102:755-63.  Back to cited text no. 4
Global Strategy for Asthma Management and Prevention Global Initiative for Asthma. Available from: https://ginasthma. org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms. pdf. [Last updated on 2019 Nov 20].  Back to cited text no. 5


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