Inadequate Therapy and Poor Symptom Control among Children with Asthma: Findings from a Multistate Sample

• Published in: Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association Vol. 7; no. 2; pp. 153 - 159
• Main Authors: Halterman, Jill S., MD, MPH, Auinger, Peggy, MS, Conn, Kelly M., MPH, Lynch, Kathleen, BA, Yoos, H. Lorrie, PhD, Szilagyi, Peter G., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2007; Elsevier Science Ltd
• Subjects: Adolescent; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - prevention & control; Child; Child, Preschool; children; Children & youth; Communication; control; Disease control; Disease management; Female; Health care; Humans; Insurance coverage; Male; Morbidity; Odds Ratio; Patient Compliance; Pediatrics; Preventive medicine; preventive therapy; Risk Factors; Socioeconomic Factors; symptoms; Treatment Failure; Treatment Outcome; United States; United States; symptoms; asthma; control; children; preventive therapy
• ISSN: 1530-1567; 1876-2859; 1539-4409; 1876-2867
• DOI: 10.1016/j.ambp.2006.11.007

Objectives Asthma continues to cause significant morbidity in children. We hypothesized that many children still do not use recommended preventive medications, or they have ineffective symptom control despite preventive medication use. The aim of this study was 1) to describe the use of preventive medications among children with persistent asthma, 2) to determine whether children using preventive medications have adequate asthma control, and 3) to identify factors associated with poor control. Methods The State and Local Area Integrated Telephone Survey (SLAITS) Asthma Survey provided parent-reported data for children aged <18 years with asthma from a random-digit dial survey implemented in Alabama, California, Illinois, and Texas. We focused this analysis on children with persistent symptoms and/or children using preventive asthma medications (N = 975). Children with inadequate therapy had persistent symptoms and no preventive medication use. Children with suboptimal control had persistent symptoms or >1 attack in the previous 3 months despite preventive medication use; children in optimal control had intermittent symptoms, ≤1 attack, and reported using preventive medication. Demographic and asthma-related variables were compared across groups. Results Among children with persistent asthma, 37% had inadequate therapy, 42.9% had suboptimal control, and only 20.1% had optimal control. In multivariate regression, black race (odds ratio [OR], 2.0; 95% confidence interval [CI] 1.1–3.5), Hispanic ethnicity (OR, 1.8; 95% CI, 1.1–2.9), and discontinuous insurance status (OR, 2.4; 95% CI, 1.4–4.3) were associated with inadequate therapy. Potential explanations for poor control included poor adherence, exposure to smoke and other triggers, and lack of written action plans. Conclusions Inadequate asthma therapy remains a significant problem. A newly highlighted concern is the substantial number of children experiencing poor symptom control despite reported use of preventive medications.