Non-adherence with asthma therapy: more than just forgetting.

T he ubiquity of non-adherence with medication regimens is well-known to clinicians and has been extensively documented in the literature. Research that has quantified the frequency of pediatric non-adherence across a range of chronic illnesses such as diabetes, rheumatoid arthritis, and cystic fibrosis has found that adherence levels #50% of prescribed dosage are common. Studies of children’s adherence with asthma therapy have reported similarly poor average rates of adherence. Non-adherence with treatment regimens has been repeatedly implicated as a contributor to sub-optimal clinical control in chronic pediatric illnesses. Although the consequences of periodic non-adherence with therapy among children with mild asthma may be insignificant, for some children drug holidays or chronic under-use of controller medications can result in persistant asthma symptoms, increased missed days of school, unnecessary urgent healthcare visits, and increased risk of fatal or near fatal asthma attacks. Understanding those factors that contribute to non-adherence with asthma therapy has the potential to help families more effectively manage their child’s asthma and reduce asthma morbidity. As reported in this issue ofThe Journal,Fiese,Wamboldt, and Anbar sought to develop a reliable measure of asthma management routines and to evaluate its association with adherence with therapy, as well as parent and child quality-oflife and healthcare utilization. The investigators based the development of this instrument on their previous work, which suggested that family routines might be instrumental in assisting families manage asthma and adhere with therapy. Factor analysis of the eight-item Asthma Routine Questionnaire resulted in the identification of two factors; the first factor was labeled ‘‘Medication Routines’’ because these four question dealt primarily with medication-taking activities, and the second factor was labeled ‘‘Routine Burden’’ because these three questions primarily measured whether asthma care was considered a burden. After controlling for SES and asthma severity, Routine Burden was found to be associated with reports of lower quality-of-life by both parents and children, however Routine Burden was not associated with