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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ABSTRACT: A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care.JAMA Pediatrics 10/2014; 168(10):e141983. DOI:10.1001/jamapediatrics.2014.1983 · 4.25 Impact Factor
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ABSTRACT: ABSTRACT Background: The goal of asthma management is to attain optimal control of symptoms with minimal treatmentrelated side effects. Several factors contribute to poor asthma control: such as poor adherence to medications, or inappropriate inhaler technique, in addition to home circumstances that trigger asthma attacks. Objective: To determine the level of asthma control and any home circumstances that may contribute toward poor asthma control in children seen at the Asthma and Allergy clinic at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: A prospective cross sectional study was conducted in 115 asthmatic children, aged between 5 and 18 years, from July to October 2012. Children >12 years filled in the asthma control test, while those <12 years filled in the childhood asthma control test. A questionnaire on home circumstances was filled in by the parent or legal guardian or the patient. Adherence to medications was assessed and inhaler technique observed. All study participants underwent a full medical examination relevant to allergy and asthma, followed by the performance of a lung function test. Results: A total of 115 patients were enrolled of which 59 (51.3%) patients were male. Ninety nine (86.1%) patients were black and 55.7% of the patients had controlled asthma (ACT or C-ACT > 19). None of the home circumstances were found to be associated with poor asthma control. Good adherence to medications was found to be associated with good asthma control; however good inhaler technique did not contribute to the overall level of control. Conclusion: Taking the time to educate our asthma patients about the importance of adherence to medications is the most effective measure to achieve optimal asthma control. Home circumstances did not contribute to the overall level of asthma control.Current Allergy and Clinical Immunology 09/2014; 27(3):182. · 0.15 Impact Factor
Pediatric Allergy, Immunology, and Pulmonology 09/2010; 23(3):191-200. DOI:10.1089/ped.2010.0013 · 0.56 Impact Factor