Noncompliance and Prevalence

Despite these disadvantages patient reports have certain advantages com- 

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Over the past 10 years, electronic inhaler monitoring devices have been developed which record the date and time of actuations and can then be downloaded onto a computer. A record can then be printed which reflects a patient s pattern of inhaler use over a period of time. Electronic peak flow meters are also available which record and store peak flow values, along with date and time information. While these devices have generally been utilized exclusively for research, improved technologies are increasingly making their clinical application feasible. 

Research with electronic inhalers has examined both prophylactic and bronchodilator use. In one study of prophylactic medicine use (23), only 50% of patients complied as defined by within 10% of recommended twice daily dosing, 50% underused and 10% overused. Electronic monitoring of inhaler use has documented widespread underuse of anti-inflammatory medications in both children and adults. Mawhinney et al. reported that patients used their medication as prescribed on average for 37% of the days in the 3 to 4 weeks monitoring period (24). Underuse was observed for over 38% of the monitored days. Coutts et al. monitored school-age children and observed underuse of the inhaled steroids was observed on 55% of the study days (16). Similar results on the underuse of anti-inflammatory medications have been reported elsewhere (25-27). 

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