Electronic measurement of non-compliance to inhaled corticosteroids in a multicultural population of children with asthma in Amsterdam (Compliance Objectively measured in a Multicultural Population of children Living in Amsterdam Needing inhaled Corticosteroids for Effective asthma treatment; COMPLIANCE)

Objective: To study objectively, electronically measured non-compliance to inhaled corticosteroids (ICS) in a multicultural population of children with asthma in Amsterdam and to determine the association of determinants with non-compliance. Design: The study was designed as an observational, longitudinal study in which non-compliance to ICS and determinants for non-compliance to ICS were measured in a cohort of Moroccan, Turkish and native Dutch children with asthma. Methods: Electronic non-compliance measurements were performed for three months per patient using Real Time Medication Monitoring System (RTMMS) technology. Determinants included age, gender, ethnicity, language skills, parental level of education, family income, hospitalisation rates, frequency of visits to the paediatric outpatient clinic, housing and smoking habits and medication beliefs. Determinants were extracted from medical records and parent interviews. Data analysis was performed using univariate and multivariate linear regression. Results: 61 children (aged 1-11 years) were included, of which 22 Dutch and 37 Moroccan. The mean non-compliance rate found in this study was 51% (SD 32%). Children with Moroccan ethnicity showed higher non-compliance rates than children with Dutch ethnicity (58% vs 36%, p = 0.037). Non-compliance also differed with type of ICS (fluticason vs fluticason + salmeterol: 53% vs 24%, p = 0.001) and negative parental medication beliefs (BMQ concerns score >10 vs ≤10: 55% vs 34%, p = 0.009). Conclusion: Non-compliance to ICS is a major concern in asthma treatment, especially in ethnic minority children, children using ICS inhalers without long-acting beta-agonists and in children whose parents have concerns about medication side effects. Therefore new instruments are needed for improving compliance to ICS.