Developmental Trajectories and Influencing Factors of Inhaled Corticosteroid (ICS) Adherence in Pediatric Asthma Under a Remote Collaborative Management model—Latent Class Growth Analysis

Wenqi Li,1,* Xialian Yu,1,2,* Yan Gao,2 Yi Qin,2 Jianing Lu,2 Tao Li,1 Xiaoyin Hu,2 Caifeng Zhang2 1School of Nursing Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Caifeng Zhang, Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China, Email [email protected] Xiaoyin Hu, Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China, Email [email protected]: This study aimed to explore the developmental trajectories and influencing factors of inhaled corticosteroid (ICS) medication adherence among pediatric asthma patients managed through the remote collaborative model based on the China Childhood Asthma Action Plan (CCAAP).Methods: A total of 249 pediatric asthma patients who were followed up at a respiratory specialty outpatient clinic between January 2022 and November 2024 were recruited using convenience sampling. The instruments consisted of a general information questionnaire, the Chinese version of the Bronchial Asthma Medication Adherence Scale, an asthma knowledge questionnaire, and an inhaled medication error rate assessment form. Medication adherence was evaluated at baseline and at 1, 3, and 6 months. Latent Category Growth Analysis (LCGA) was employed to identify adherence trajectories, and unordered multinomial logistic regression was conducted to examine the influencing factors.Results: Four distinct adherence trajectories were identified, including the Declining Adherence group (6.02%), the Rapid Improvement group (8.03%), the Persistent Adherence group (71.08%), and the Gradual Improvement group (14.86%). The groups differed significantly in parental education, peak flow meter usage, concerns regarding steroid medication, history of severe exacerbations, asthma knowledge level, and 6-month medication error rate. Multivariate analysis indicated that pre-visit asthma knowledge, 6-month medication error rate, peak flow meter usage, concerns about steroid medication, and parental education were significant determinants of the Rapid Improvement group. Severe exacerbations at 3 months were related to the Gradual Improvement group, whereas recent severe exacerbations and the 6-month medication error rate were associated with the Declining Adherence group.Conclusion: ICS adherence within the CCAAP telemedicine-based management model demonstrates substantial heterogeneity. Identifying distinct trajectories enables early detection of non-adherence risk and supports personalized intervention strategies, which may significantly improve asthma control and resource allocation in remote care settings. Implementing stratified management based on these findings can enhance long-term treatment efficacy and pediatric asthma outcomes.Keywords: childhood asthma management program, telemedicine-based collaborative management model, asthma, pediatric patients, medication adherence, latent class growth model