Inadequate Therapy and Poor Symptom Control among Children with Asthma: Findings from a Multistate Sample
ABSTRACT 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.
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, < or = 1 attack, and reported using preventive medication. Demographic and asthma-related variables were compared across groups.
Among children with persistent asthma, 37 per cent had inadequate therapy, 42.9 per cent had suboptimal control, and only 20.1 per cent had optimal control. In multivariate regression, black race (odds ratio [OR], 2.0; 95 percent confidence interval [CI] 1.1-3.5), Hispanic ethnicity (OR, 1.8; 95 per cent CI, 1.1-2.9), and discontinuous insurance status (OR, 2.4; 95 per cent 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.
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.
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- "Despite compelling evidence of efficacy and NAEPP-EPR3 recommendations, many children with persistent asthma are undertreated and poorly controlled (Butz, Tsoukleris, Donithan, Hsu, Mudd et al., 2006; Lozano et al., 2003; Warman, Silver, & Stein, 2001). Among 975 children meeting the persistent criteria, almost 40% were not receiving preventative medications, and only 20% of those on medication were well controlled (Halterman et al., 2007). "
ABSTRACT: To increase awareness among nurse practitioners (NPs) regarding diagnostic and treatment guidelines for asthma for the 5-11 year age group recently updated by the National Asthma Education Prevention Program-Expert Panel 3 (NAEPP-EPR3). NAEPP-EPR3 guidelines for the diagnosis and management of asthma released from the National Heart, Lung, and Blood Institute in August 2007, selected clinical trials, meta-analyses, and clinical reviews. Recent research has revealed that children suffering from asthma in the United States are underdiagnosed and their asthma is poorly controlled. Compelling evidence supports that children classified as having persistent asthma following NAEPP-EPR3 guidelines benefit from daily inhaled corticosteroid therapy, yet many are misclassified and undertreated. With application of current guidelines from NAEPP-EPR3, NPs can more effectively assess, diagnose, treat, and foster a collaborative self-management plan for children age 5-11 years. These interventions will result in an improved quality of life and decreased health risks for this young population.Journal of the American Academy of Nurse Practitioners 06/2009; 21(5):261-9. DOI:10.1111/j.1745-7599.2009.00403.x
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ABSTRACT: Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers. The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma. The National Survey of Children's Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured). Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population. Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.Ambulatory Pediatrics 01/2008; 8(1):43-9. DOI:10.1016/j.ambp.2007.10.005