Adesão à corticoterapia inalatória em crianças e adolescentes

Abstract

Methods used for measuring adherence to inhaled corticosteroids in children and adolescents, rates and implications to clinical practiceNoadherence with prescribed asthma therapy is common, and contributes to poor clinical outcomes, including greater morbidity, mortality and health care utilization costs. This is a review regarding methods to measuring adherence and it was conducted usingarticles, reviews, and meta-analysis published in MEDLINE, HIGHWIRE, LILACS and direct search, from 1992 to 2008. The methods to assess adherence, cited in order of less to more objective, include patient and/or family self-report, clinical judgment, medication measurement, medical/pharmacy records, electronic device monitors and biochemicalmonitoring of subjects. Biochemical monitoring is not used in clinical practice. The rates of adherence commonly range from 30 to 70%. Adherence is notoriously higher when determined by patient self-report and clinical judgment, compared to electronic monitors. Despite the inadequacies of clinical judgment, the physician needs to remember that real rates are always lower than patient self-report and this must be considered, when incident poor clinical control. Weighing inhaler canister can infer adherence but it can be influenced by discharging and sharing medication. Pharmacy databases provide information about medication dispensed and the timing of refill and can be applied more time. This strategy can be a valid means of assessing adherence. The electronic monitor is more accurate than other methods and provides date and time of each medication use event, but it is expensive. The results with electronic monitor demonstrated that adherence was lower. To increase physician education about patient adherence and to use accurate methods to assess adherence is a promise avenue.