Background - Previous studies have shown poor compliance with regular drug therapy in children and adults with asthma. In preschool children the parents supervise and are responsible for drug administration, but little is known of compliance in this group. In addition, there are few data on the patterns of drug use of inhaled prophylactic asthma therapy or of the relation between compliance and symptom control. A study was undertaken to address these issues with the hypothesis that parental supervision would result in good compliance.Methods - The subjects were 29 asthmatic children aged 15 months to five years already established on inhaled prophylactic medication delivered through a large volume spacer. The prescribed drug regimens varied between subjects. This was an observational study using an electronic inhaler timer device to record the date and time of each actuation of the aerosol canister. Diary cards were used for parallel recording of symptoms and parentally reported compliance with a drug regimen.Results - Variable and generally poor compliance was demonstrated with a median of 50% of study days with full compliance (subject range 0-94%) and an overall median of 77% of prescribed doses of therapy taken during the study period. No relation was found between frequency of prescribed regimen and good compliance. Day care was associated with poorer compliance. No relation between good compliance and low symptom scores was found.Conclusion - Compliance with inhaled prophylactic therapy is poor in preschool children with asthma whose medication is administered under parental supervision.

OBJECTIVE:To investigate how parents use bronchodilator treatment for relief of symptoms when treating their asthmatic preschool children.DESIGN:A commercial electromechanical timer device was attached to a large volume spacer to record the time and date of each use of inhaled bronchodilator over two months. The recorded time and dates were compared with symptoms noted in an asthma diary card.SETTING:Large paediatric teaching hospital in Glasgow.SUBJECTS:29 preschool children with moderately severe asthma attending a specialist paediatric asthma clinic.MAIN OUTCOME MEASURES:Inhaler use measured by the timer device; symptoms and inhaler use recorded by parents in a daily asthma diary.RESULTS:Satisfactory data were obtained in 22 of the 29 children; the median number of study days was 53 (range 18-77). Asthmatic symptoms were recorded on a median of 30 (3-77) days. Bronchodilator was used on a median of 19 (2-73) days, or on 63% (7-100%) of days when symptoms occurred. The median number of puffs used in a day was 1 (range 0-100) and was significantly related to symptom severity in only 14 of the 22 children. In only two of the 22 children was bronchodilator given more frequently than four hourly, and only five children ever used more than 12 puffs a day.CONCLUSIONS:The frequency of parental administration of bronchodilator treatment was variable and not closely related to the parent's record of symptom severity. Parents often recorded symptoms in their children but did not treat them.

Objective-To measure the prevalence of breast feeding and to examine the value of using information collected on Guthrie cards (used for detecting inherited metabolic disease and hypothyroidism when newborn infants are 7 days old) to calculate this prevalence.Design-Analysis, by geographical area and maternity unit, of information on breast feeding collected on Guthrie cards for 131 759 babies born 1990 and 1991, and comparison with prevalences from other sources.Setting-Scotland.Results-Of the 131 759 babies, only 46 949 (35.6%) were breast feeding on day 7. The prevalence of breast feeding ranged from 59.1% (376/636) in Shetland to 21.1% (1836/8719) in Lanarkshire and < 8% in some postcode districts of cities. Analysis of the data by hospital of birth showed that the prevalence ranged from 51.2% (2701/5275) to 16.4% (507/3090).Conclusion-The prevalence of breast feeding in Scotland is low and varies among areas and maternity units. Intervention to increase this prevalence is essential, and information collected on Guthrie cards is a useful indication of mothers' intentions to breast feed.