Monitoring adherence to ICS in asthmatic children: simple measurements by canister weight as good as electronic devices

Suboptimal adherence to inhaled steroids (ICS) is a known problem in children and adolescents, even when medications are administered under parental supervision. Poor adherence to asthma medications (less than 80%) was seen in 75% of children (JACI, 2011).

In this cohort study, 102 randomly selected asthmatic children and adolescents aged 3-14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser(R); Meditrack Products, Hudson, MA, USA) monitor, and canister weight.

Adherence rates to beclomethasone (BDP) by:

- self and/or parent report - 97.9%
- pharmacy records - 70.0%
- Doser electronic device - 51.5%
- canister weight - 46.3%

Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76.

Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records.

Measurements by canister weight are less costly compared with currently available electronic devices and should be considered as an alternative method of monitoring adherence to ICS.


Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods. Jentzsch NS, Camargos PA, Colosimo EA, Bousquet J. Allergy. 2009 Mar 28.
Concepts have changed: “compliance” has been replaced by “adherence” but meaning remains the same: 50% of asthmatic patients are poorly adherent to therapy (
Image source: Metered-dose inhaler, ProAir-HFA, Albuterol Sulfate(US) - not the medication in this study. Wikipedia, public domain.

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