The effects of maternal anxiety and attitudes on the adherence to inhaled corticosteroids in children with asthma

Main Article Content

Ozlem Sancakli
Asli Akin Aslan

Keywords

asthma, children, mothers, anxiety, attitude, adherence

Abstract

Objective: Long-term inhaled corticosteroid (ICS) use in children with asthma causes serious concerns in parents, leading to treatment non-adherence. This study aimed to investigate the effect of maternal anxiety and attitudes on adherence to ICS therapy in children with asthma.


Method: The patient group included the children with mild to moderate persistent asthma, aged 6–11 years. Healthy children in a similar age range were included as a control group. The patient group was divided into two categories (treatment adherent and non-adherent) according to the regularity of ICS use. All patients were assessed with Childhood-Asthma Control Test (C-ACT), and their mothers were assessed using Parent Attitude Research Instrument (PARI) and Beck’s Anxiety Inventory (BAI).


Results: A total of 156 children (age: 7.4 ± 1.4 years, F/M: 71/85) with persistent asthma and 60 healthy children (age: 7.5 ± 1.3 years, F/M:25/35) were included in the study. The rate of adherence in children with asthma was 52.6%. Mothers of non-adherent patients had significantly higher BAI scores than those of the adherent patients and controls (p < 0.001 and p < 0.001, respectively). The number of mothers who indicated that they did not have enough information about asthma and treatment was also higher in the non-adherent group. PARI subtest scores were not different between the adherent and non-adherent groups.


Conclusions: In our study, it was found that mothers’ anxiety levels and their knowledge about asthma and medications were associated with treatment adherence in children with asthma. Psychological and educational support to the families of children with asthma would improve their treatment adherence and efficacy.

Abstract 761 | PDF Downloads 544 HTML Downloads 341 XML Downloads 26

References

1. Lundback B, Backman H, Lotvall J, Ronmark E. Is asthma prevalence still increasing? Expert Rev Respir Med. 2016;10:39–51. 10.1586/17476348.2016.1114417

2. Morton RW, Everard ML, Elphick HE. Adherence in childhood asthma: the elephant in the room. Arch Dis Child. 2014;99:949–953. 10.1136/archdischild-2014-306243

3. Yawn BP, Rank MA, Cabana MD, Wollan PC, Juhn YJ. Adherence to asthma guidelines in children, tweens, and adults in primary care settings: a practice-based network assessment. Mayo Clin Proc. 2016;91(4):411–421. 10.1016/j.mayocp.2016.01.010

4. Drotar D, Bonner MS. Influences on adherence to pediatric asthma treatment: a review of correlates and predictors. J Dev Behav Pediatr. 2009;30:574–582. 10.1097/DBP.0b013e3181c3c3bb

5. Wijga AH, Zuidgeest MG, Kerkhof M, Koppelman GH, Smit HA, de Jongste JC. Guideline-recommended use of asthma medication by children is associated with parental information and knowledge: the PIAMA birth cohort. Pharmacoepidemiol Drug Saf. 2014;23(4):406–410. 10.1002/pds.3584

6. Deis JN, Spiro DM, Jenkins CA, Buckles TL, Arnold DH. Parental knowledge and use of preventive asthma care measures in two pediatric emergency departments. J Asthma. 2010;47(5):551–556. 10.3109/02770900903560225

7. Peters TE, Fritz GK. Psychological considerations of the child with asthma. Child Adolesc Psychiatr Clin N Am. 2010;19:319–333. 10.1016/j.chc.2010.01.006

8. Koster ES, Wijga AH, Koppelman GH, Postma DS, Brunekreef B, De Jongste JC, et al. Uncontrolled asthma at age 8: the importance of parental perception towards medication. Pediatr Allergy Immunol. 2011;22:462–468. 10.1111/j.1399-3038.2011.01150.x

9. Easter G, Sharpe L, Hunt CJ. Systematic review and meta-analysis of anxious and depressive symptoms in caregivers of children with asthma. J Pediatr Psychol. 2015;40:623–632. 10.1093/jpepsy/jsv012

10. Avcil S, Uysal P, Demir F, Erge D, Kurt Omurlu I, Yenigun A. Mothers’ emotional states and attitudes regarding their children with asthma. J Asthma. 2019;56:618–626. 10.1080/02770903.2018.1484130

11. Ozkaya E, Cetin M, Ugurad Z, Samanci N. Evaluation of family functioning and anxiety-depression parameters in mothers of children with asthma. Allergol Immunopathol (Madr). 2010;38:25–30. 10.1016/j.aller.2009.06.004

12. Yamamoto N, Nagano J. Parental stress and the onset and course of childhood asthma. Biopsychosoc Med. 2015;9:7. 10.1186/s13030-015-0034-4

13. Schaefer ES, Bell RQ. Development of a parental attitude research instrument. Child Develop. 1958;29:339–361. 10.1111/j.1467-8624.1958.tb04891.x

14. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2020. Available from: www.ginasthma.org

15. Santos Pde M, D’Oliveira A Jr, Noblat Lde A, Machado AS, Noblat AC, Cruz AA. Predictors of adherence to treatment in patients with severe asthma treated at a referral center in Bahia, Brazil. J Bras Pneumol. 2008;34:995–1002. 10.1590/S1806-37132008001200003

16. Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E, Saglani S, et al. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. Eur Respir J. 2017;50:1700910. 10.1183/13993003.00910-2017

17. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007;119:817–825. 10.1016/j.jaci.2006.12.662

18. Sekerel BE, Soyer OU, Keskin O, Uzuner N, Yazicioglu M, Kilic M, et al. The reliability and validity of Turkish version of Childhood Asthma Control Test. Qual Life Res. 2012;21:685–690. 10.1007/s11136-011-9970-z

19. Le Compte G LCA, Özer S Üç sosyoekonomik düzeyde Ankara’lı annelerin çocuk yetiştirme tutumları: Bir ölçek uyarlaması. Psikoloji Dergisi. 1978;1:5–8.

20. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897. 10.1037/0022-006X.56.6.893

21. Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck anxiety ınventory: psychometric properties, 1998. J Cogn Psychother. 1998;12:163–172.

22. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Meth. 2007;39:175–191. 10.3758/BF03193146

23. Klok T, Kaptein AA, Brand PLP. Non-adherence in children with asthma reviewed: the need for improvement of asthma care and medical education. Pediatr Allergy Immunol. 2015;26:197–205. 10.1111/pai.12362

24. Capo-Ramos DE, Duran C, Simon AE, Akinbami LJ, Schoendorf KC. Preventive asthma medication discontinuation among children enrolled in fee-for-service Medicaid. J Asthma. 2014;51:618–626. 10.3109/02770903.2014.895010

25. Coutts JA, Gibson NA, Paton JY. Measuring compliance with inhaled medication in asthma. Arch Dis Child. 1992;67:332–333. 10.1136/adc.67.3.332

26. Irvine L, Crombie IK, Alder EM, Neville RG, Clark RA. What predicts poor collection of medication among children with asthma? A case-control study. European Respir J. 2002;20:1464–1469. 10.1183/09031936.02.00302102

27. Zedan MM, Ezz El Regal M, A Osman E, E Fouda A. Steroid phobia among parents of asthmatic children: myths and truth. Iran J Allergy Asthma Immunol. 2010;9(3):163–168. PMid: 20952806

28. Yuksel H, Sogut A, Yilmaz O, Demet M, Ergin D, Kirmaz C. Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers. Respir Med. 2007;101:2550–2554. 10.1016/j.rmed.2007.07.025

29. Nagano J, Kakuta C, Motomura C, Odajima H, Sudo N, Nishima S, Kubo C. The parenting attitudes and the stress of mothers predict the asthmatic severity of their children: a prospective study. Biopsychosoc Med. 2010;4:12. 10.1186/1751-0759-4-12

30. Amaral SCO, Pimenta F, Marôco J, Sant’Anna CC. Stress reduction intervention with mothers of children/adolescents with asthma: a randomized controlled study in Brazil. Health Care Women Int. 2020;41:266–283. 10.1080/07399332.2019.1570201

31. Erdoğan F, Eliaçik M, Özahi Ipek İ, Arici N, Kadak MT, Ceran Ö. Is children’s Body Mass Index associated with their parents’ personality? A prospective controlled trial. Minerva Pediatr. 2017;69:281–287. 10.23736/S0026-4946.16.04241-9

32. Unal Yuksekgonul A, Aslan AT, Sismanlar Eyuboglu T, Soysal S, Budakoglu II. Evaluation of the psychological status of mothers of children with cystic fibrosis and the relationship between children’s clinical status. J Paediatr Child Health. 2020;56:1537–1543. 10.1111/jpc.14983

33. Çağan Appak Y, Yalın Sapmaz Ş, Doğan G, Herdem A, Özyurt BC, Kasırga E. Clinical findings, child and mother psychosocial status in functional constipation. Turk J Gastroenterol. 2017;28:465–470. 10.5152/tjg.2017.17216