Impact of knowledge, attitude and perceptions on medication adherence in children with asthma

Introduction: Poor medication adherence is a common cause of persistent poor control in children with asthma. Aim: To assess the impact of knowledge, attitude and perceptions about asthma, on medication adherence in children with asthma. Methods: In this prospective study, children aged 7-18 years with asthma had comprehensive clinical assessment and spirometry. A 31 item questionnaire to assess the knowledge, attitude and perceptions (KAP questionnaire) about asthma was administered. Medication adherence was assessed by a combination of self reporting, pharmacy records review, inhaler check, and tablet counting, as appropriate; and was classified into 3 groups (good, average and poor). Asthma control was assessed as controlled, partly controlled or uncontrolled based on the GINA criteria. Results: 180 children (mean [SD] age=11.4 [2.8] years, 59.4% males) were studied. Adherence was good in 101 (56.1%), average in 56 (31.1%) and poor in 23 (12.8) children. The proportion (mean [95% CI]) of appropriate responses on the KAP questionnaire in those with poor adherence (47.7 [41.2-54.2]%) was significantly lower compared to those with good (57.2 [53.4-60.9]%) and average (52.5 [49.1-55.8]%) adherence (p=0.0433). Asthma control was good in 47.5% with good adherence, compared to 33.8% with average or poor adherence (p=0.0031). Significant bronchodilator reversibility in FEV1 (≥12%) was observed in 23.7% with good adherence, compared to 39.2% with average or poor adherence (p=0.0338). Conclusions: Our data suggest that knowledge, attitudes, and perceptions about asthma affect medication adherence and asthma control. Hence, improving these should be a key focus in the management of asthma.