# Analysis of key obstacles affecting long-term inhalation therapy compliance in children with bronchial asthma at primary hospitals

## TL;DR

This study identifies factors that hinder children with asthma from following long-term inhalation therapy, especially in primary hospitals.

## Contribution

The study highlights modifiable barriers like frequent asthma flare-ups and household smoking affecting therapy adherence in children.

## Key findings

- 60.4% of children showed poor adherence to inhalation therapy.
- Frequent exacerbations, uncontrolled asthma, and family smoking were key risk factors for poor adherence.
- Lower household income and worse lung function were also associated with poor adherence.

## Abstract

Bronchial asthma is a prevalent chronic respiratory disease in children, with long-term inhalation therapy being essential for disease control; however, adherence remains a significant challenge, particularly in primary care settings. This study aimed to identify the key obstacles affecting long-term inhalation therapy compliance among pediatric asthma patients managed at primary hospitals.

A retrospective analysis was conducted on 268 children aged 4–16 years with bronchial asthma who were treated between January 2024 and January 2025. Patients were divided into poor adherence [Morisky Medication Adherence Scale-8 (MMAS-8) score <6] and good adherence (MMAS-8 score 6–8) groups. Data on demographic characteristics, disease-related features, asthma control level, pulmonary function indices, and health-related quality of life (HRQoL) were collected and compared between the two groups.

Among the 268 children, 162 (60.4%) were in the poor adherence group and 106 (39.6%) in the good adherence group. The poor adherence group had a lower mean age (7.83 ± 1.72 vs. 8.47 ± 1.68 years), higher proportion of lower household income (10.49% vs. 4.72% with income <10,000 yuan), more frequent exacerbations in the past year (4.12 ± 1.24 vs. 2.53 ± 1.07), worse asthma control (30.25% vs. 10.38% uncontrolled), lower forced expiratory volume in 1 s (FEV₁: 75.34 ± 7.12% vs. 82.45 ± 6.34%), and lower total HRQoL score (69.36 ± 5.23 vs. 73.69 ± 5.12) (all P < 0.05). Multivariate analysis identified higher exacerbation frequency, uncontrolled asthma, hospitalization history, and family smoking as independent risk factors for poor adherence (all P < 0.05).

Key modifiable barriers to inhalation therapy adherence in children with asthma at primary hospitals include frequent exacerbations, poor disease control, prior hospitalizations, and household smoking, highlighting the need for multifaceted interventions targeting these factors.