Determinants and clinical consequences of non-adherence to aerosol therapy in adolescents with asthma: a prospective observational study from eastern India

Background: Adolescents with asthma represent a high-risk group for poor disease control, largely due to suboptimal adherence to inhaled therapy. Despite advances in guideline-directed management, medication non-adherence remains a major barrier to optimal outcomes, particularly in resource-constrained settings. Aims and Objectives: The aim of the study was to determine the prevalence, determinants, and clinical consequences of non-adherence to aerosol therapy among adolescents with asthma attending a tertiary care center in Eastern India. Materials and Methods: This 12-month prospective observational study included consecutive 115 adolescents (10–19 years) diagnosed with moderate persistent asthma as per Global Initiative for Asthma (GINA) 2023 criteria. Medication adherence was assessed using the Morisky Medication Adherence Scale 8 (MMAS-8) and objective compliance ratio ≥80%. Asthma control was defined according to GINA criteria. Multivariate logistic regression was performed to identify predictors of poor adherence and uncontrolled asthma. Results: Poor adherence (MMAS-8 <6) was observed in 33.0% of participants. Uncontrolled asthma was present in 47.8%. Poor adherence independently predicted uncontrolled asthma (adjusted odds ratios [AOR] 2.86; 95% confidence interval [CI] 1.29–6.32; P=0.009). Independent predictors of poor adherence included lower parental education (AOR 3.12; P=0.011), improper inhaler technique (AOR 4.67; P=0.001), and lower socioeconomic status (AOR 2.94; P=0.020). Hospitalization rates were significantly higher among poorly adherent patients (36.8% vs. 18.2%, P=0.018). Conclusion: Suboptimal adherence remains common among Indian adolescents with asthma and is strongly associated with uncontrolled disease and increased healthcare utilization. Multidimensional interventions targeting education, inhaler technique, and socioeconomic barriers are essential.