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Inadequate therapy for asthma among children in the United States
J S Halterman1, C A Aligne, P Auinger
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Children's Hospital at Strong, Rochester, New York, USA. jill_halterman@urmc.rochester.edu
Insights
Most children with moderate to severe asthma are undertreated, lacking essential maintenance medications. Young children, those with Medicaid, and Spanish-speaking families face higher risks for inadequate asthma therapy, increasing preventable illness.
Area of Science:
- Pediatrics
- Pulmonology
- Public Health
Background:
- Childhood asthma morbidity and mortality are rising despite therapeutic advancements.
- A significant number of children with moderate to severe asthma may not be adhering to recommended maintenance therapies.
- National asthma management guidelines exist, yet treatment gaps persist.
Purpose of the Study:
- To assess medication use patterns in US children with asthma.
- To identify risk factors associated with inadequate asthma therapy among children.
- To describe the prevalence of maintenance medication use in children with moderate to severe asthma.
Main Methods:
- Utilized cross-sectional, parent-reported data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994).
- Focused on children aged 2 months to 16 years with moderate to severe asthma, defined by specific wheezing-related healthcare utilization criteria.
- Defined adequate treatment as the use of maintenance medications (inhaled corticosteroid, cromolyn, theophylline) in the past month; analyzed demographic associations with inadequate therapy using SUDAAN software.
Main Results:
- Out of 1025 children with asthma, 524 had moderate to severe asthma.
- Only 26% of children with moderate to severe asthma used maintenance medications in the past month; this was 32% even for those with multiple hospitalizations.
- Inadequate therapy was linked to younger age (
Conclusions:
- A majority of children with moderate to severe asthma, including those frequently hospitalized, receive inadequate treatment.
- Young children, those from low-income households (Medicaid recipients), and Spanish-speaking families are disproportionately affected by undertreatment.
- Inadequate asthma therapy in children can lead to preventable morbidity and mortality, highlighting a critical need for improved care access and adherence.
Objective:
Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy.
Methods:
The National Health and Nutrition Examination Survey (NHANES) III 1988-1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, >/=2 acute visits for wheezing, or >/=3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design.
Results:
A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age
Conclusion:
Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.