Reported Medication Adherence Behaviour and Obstacles to Continued Asthma Care in Hospitalized Children

Abstract

Asthma is a chronic respiratory condition that significantly affects children worldwide, leading to recurrent hospitalizations, impaired quality of life, and increased healthcare costs. Despite the availability of effective pharmacological therapies, medication adherence remains a major challenge in paediatric asthma care. This study aimed to evaluate reported medication adherence behaviour and identify obstacles to continued asthma care among hospitalized children. A prospective observational study was conducted in Fortis Hospital Jaipur, India, enrolling 986 asthmatic children below 15 years of age and their caregivers. Data were collected using structured interviews, medical record reviews, and validated adherence scales, including the Morisky Medication Adherence Scale (MMAS). Baseline characteristics revealed that males constituted 59.5% of the study population, with the majority aged between 5–10 years. Urban residents accounted for 55.1% of cases, and fathers were the primary caregivers in 43.2% of instances. Most caregivers had secondary education, and private employment was the predominant occupation. The majority of children had asthma for 1–3 years, and two medications per day was the most common therapy pattern. Prescriptions predominantly included β‑agonists (74.3%), steroids (47.2%), cromolyn (17.7%), and xanthines (5.6%), with inhalers being the most frequently used formulation (51.2%). Adherence rates declined with longer disease duration, with only 7.4% adherence among children with asthma for 1–3 years. Reported barriers to adherence included therapy duration (80.4%), route of administration (77.4%), dosing frequency (61.1%), and sensory attributes such as taste, smell, and color. Caregivers additionally cited cost (73.4%), beliefs (68.0%), lack of immediate benefit (66.3%), frequent regimen modifications (63.6%), and fear of side effects (45.9%) as major obstacles. Concordance between prescribed medications and reported use was high for β‑agonists and xanthines but lower for steroids and cromolyn, indicating preventive therapies were more vulnerable to discontinuation. Children’s self‑reports revealed greater lapses than caregiver accounts, with 45% admitting to forgetting doses and nearly half intentionally avoiding medication. Appointment‑keeping was inadequate, with only 29.4% of parents receiving scheduled follow‑ups and 60% successfully keeping them. Structured pharmacist‑led health education significantly improved adherence, with 72.2% of children achieving medium/high MMAS scores post‑intervention. In conclusion, medication adherence in pediatric asthma is influenced by a constellation of behavioral, familial, and systemic factors. Hospitalization offers an opportunity to identify these barriers and implement corrective strategies. Strengthening caregiver education, reducing financial burdens, simplifying regimens, and reinforcing follow‑up systems are essential to improve adherence and long‑term outcomes in children with asthma.