Reviews and feature article
Negative affect, medication adherence, and asthma control in children

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Background

Negative affect including depression is known to be associated with asthma control, but whether and how it influences control in children with asthma is not understood.

Objective

The objective of this investigation was to evaluate whether negative affect and medication nonadherence each predict decreased symptom control, and whether the relationship between negative affect and disease control is explained by children's adherence to asthma medications.

Methods

Participants included 104 children 8 to 18 years old being treated with an inhaled corticosteroid delivered by metered-dose inhaler for asthma diagnosed by their health care providers. Children and parents independently rated asthma symptoms and completed questionnaires assessing sad and anxious affect. Electronic devices were attached to each participant's metered-dose inhaler to measure adherence. At study completion, records were collected to confirm reports of health events.

Results

Both child and parent negative affect scores predicted symptom scores, whether reported by child or parent, and child negative affect scores predicted school absence because of asthma. In a lagged analysis taking into account time sequence, medication adherence predicted prednisone bursts but not subjective symptom scores. Nonadherence did not explain the relationship between negative affect and symptom scores, but parent negative affect predicted prednisone bursts even when controlling for level of adherence.

Conclusion

Although both negative affect and adherence were predictive of asthma control, the relationship of each to asthma control was distinctly different. Accuracy of symptom perception may be influenced by patient and parent affect characteristics.

Section snippets

Patient visits

One hundred four participants were recruited through advertising and referrals from multiple practices and clinics in the Denver area and met the following inclusion criteria: age 8 to 18 years with a current diagnosis of asthma by a health care provider who prescribed an inhaled corticosteroid (ICS) delivered by metered-dose inhaler (MDI), otherwise in good general health including no significant learning or psychological problems that might interfere with study participation. One parent from

Demographic and adherence profile of participants

Age, sex, race, and smoking household frequencies and their associated medication adherence levels are seen in Table I. Mean adherence rates did not differ significantly by age, sex, or race, although trends suggested that white and other participants were more adherent than black or Hispanic participants. Mean adherence was significantly lower for children in households with a smoking adult in contrast with nonsmoking households. The average rate of adherence across all participants was 40%

Discussion

On average, participants in this study used less than 40% of their prescribed ICS. Although this finding is consistent with other studies using an objective measure of adherence in pediatric patients with asthma,41, 42, 43, 44, 45, 46, 47, 48 most studies of adherence in children with asthma have not tested whether adherence predicts control, and none have directly tested whether an association between affect and control exists and is explained by level of adherence. Recognizing both that

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  • Cited by (0)

    Supported by General Clinical Research Centers grant M01-RR00051 and National Heart, Lung, and Blood Institute grant 5R01HL64199.

    Disclosure of potential conflict of interest: B. Bender has received research support from the National Heart, Lung, and Blood Institute, AstraZeneca, and Sepracor. L. Zhang has declared that she has no conflict of interest.

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