Non-compliance in asthmatic children. A study of theophylline levels in pediatric emergency room population
ABSTRACT Sub-therapeutic theophylline levels due to patient (parent) non-compliance is a significant cause of outpatient treatment failure in childhood asthma. In a study of 50 known asthmatic children with acute asthmatic episodes, 98% had sub-therapeutic theophylline levels less than 10 mcg/ml with 75.5% due to inadequate patient (parent) compliance.
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- "Our conclusions are at variance from those of two previous reported studies. Sublett et al. (1979) concluded that 75% of 50 asthmatic children were non-compliant because they had sub-therapeutic plasma concentrations, despite the fact that each patient was receiving a theophylline dose of only 5-6 mg kg-' 6 h-'. In contrast to the results from this present study, Eney & Goldstein (1976) found that monitoring patients caused more to attain therapeutic concentrations without a change in dose. "
ABSTRACT: Day-to-day variations in plasma theophylline concentrations at steady-state have been assessed in 29 hospital inpatients who required theophylline for obstructive airways disease. Plasma concentrations were measured at 09.00h and 14.00h for four consecutive days in the equilibrium state in 13 patients taking 350 mg/day and 16 patients taking 700 mg/day. Analysis of variance gave 95% confidence limits for day-to-day variation of +/- 2.9 micrograms/ml at 350 mg/day and +/- 4.8 micrograms/ml at 700 mg/day. In a separate study, compliance with sustained-release theophylline therapy has been assessed in a group of 63 patients receiving the drug in general practice but not attending hospital. Compliance was estimated by comparing plasma theophylline concentrations before and after a 7-day period of measured theophylline consumption and by tablet counting. Of the 63 patients, 16 had discontinued their theophylline prior to being contacted and two did so during the first week: these were considered non-compliant. Three patients had plasma concentrations which increased by more than the day-to-day variation for their dose level during monitored intake and one other took less than 80% of his tablets. These patients were also considered non-compliant. A further four patients in whom plasma theophylline levels were zero on at least one occasion during the study were also adjudged non-compliant. Thus non-compliance with prescribed theophylline dosage occurred in 26 (41.3%) of the patients studied. In the majority of these, treatment had been discontinued and the non-compliance was gross.(ABSTRACT TRUNCATED AT 250 WORDS)British Journal of Clinical Pharmacology 02/1984; 17(1):15-20. DOI:10.1111/j.1365-2125.1984.tb04992.x · 3.69 Impact Factor
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ABSTRACT: Compliance with medical regimens is as poor or poorer in childhood asthma than it is for other chronic illnesses. A spate of self-management programs for childhood asthma has been developed to counteract nonadherence and to enable patients to be more confident and competent in their ability to prevent or control asthmatic episodes. The programs offer promise and report some encouraging results, but the programs are still unproven, and they are neither widely available nor widely used. The individual physician remains the key player in mounting effective self-management programs; but if the physician is to function effectively in this role, drastic changes are called for in the way that both medical practice is conducted and patient-health care provider relationships are managed. Steps and strategies that would help providers establish effective individual self-management programs for asthmatic patients are outlined.Clinical Reviews in Allergy & Immunology 5(3):231-247. DOI:10.1007/BF02991197 · 4.73 Impact Factor