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

doi:10.1016/j.ambp.2006.11.007

Ambulatory Pediatrics

Volume 7, Issue 2, 1 March 2007, Pages 153-159

Presented in part at the Pediatric Academic Societie’s Annual Meeting in San Francisco, Calif, April 29-May 2, 2006.

https://doi.org/10.1016/j.ambp.2006.11.007 Get rights and content

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.

Section snippets

Population and Sampling

We obtained data for this study from the 2003 State and Local Area Integrated Telephone Survey (SLAITS) National Asthma Survey 4-state sample, which provides parent-reported data for asthmatic children from a random-digit dial survey implemented in Alabama, California, Illinois, and Texas. This survey was conducted by the Center for Disease Control’s National Center for Health Statistics SLAITS survey mechanism. Details regarding the questionnaire design and methodology are available through

Results

The SLAITS National Asthma Survey included 1622 children aged <18 years with current asthma. Nine hundred seventy-five children had persistent asthma symptoms and/or were using preventive asthma medications and thus were included in this analysis (57.4% of the children with current asthma). Table I shows demographic characteristics, health care utilization, and asthma-related characteristics for the children in this sample. Most of the children were aged ≥5 years (78.7%), 55% were nonwhite, and

Discussion

This study shows that inadequate therapy for asthma remains a significant problem. A large number of children with asthma are experiencing persistent symptoms and report no use of preventive anti-inflammatory medications. These children likely are experiencing preventable morbidity. A newly highlighted and important concern is the substantial number of children who are experiencing poor symptom control despite reported use of preventive medications. We identified several potential reasons for

Acknowledgment

The research for this article was funded by grants from the Halcyon Hill Foundation and the Generalist Physician Faculty Scholars Program of the Robert Wood Johnson Foundation (045441), both awarded to Dr. Jill Halterman. We thank George B. Segel, MD, and Kathy O’Connor, MPH, for their insightful review of the manuscript.

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

Objectives

Methods

Results

Conclusions

Section snippets

Population and Sampling

Results

Discussion

Acknowledgment

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

J Pediatr

Ambul Pediatr

Ambul Pediatr

Ambul Pediatr

Am J Prev Med

Addict Behav

J Pediatr

Prevalence, impact, and trends in childhood disability due to asthma

Arch Pediatr Adolesc Med

Surveillance for asthma–United States, 1980-1999

MMWR Surveill Summ

Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma

NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002

The British Guidelines on Asthma Management: 1995 review and position statement

Thorax

Effects of 22 months of treatment with inhaled corticosteroids and/or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma

Am Rev Respir Dis

Inhaled steroids and the risk of hospitalization for asthma

JAMA

Global Strategy for Asthma Management and Prevention: NHLBI/WHO Workshop Report

Assessment of asthma control and severity

Ann Allergy Asthma Immunol

Asthma severity and asthma control: symptoms, pulmonary function, and inflammatory markers

Curr Opin Pulm Med

Development and validation of a questionnaire to measure asthma control

Eur Respir J

Association of asthma control with health care utilization and quality of life

Am J Respir Crit Care Med

Association of asthma control with health care utilization: a prospective evaluation

Am J Respir Crit Care Med

Measuring asthma controlClinic questionnaire or daily diary?

Am J Respir Crit Care Med

The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents

Dis Manag

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