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Factors associated with medication self-administration in children with asthma
M L Winkelstein1, K Huss, A Butz
1Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
Insights
Most minority children with asthma self-administer inhaled medications early, often without supervision. This is linked to parental employment and child independence, despite poor inhaler technique and medication report discrepancies.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Child Health Outcomes
Background:
- Early self-administration of inhaled asthma medications is prevalent among minority children.
- Factors influencing this behavior and its impact on adherence and technique require investigation.
Purpose of the Study:
- To identify factors associated with early self-administration of inhaled asthma medications in minority children.
- To assess parental reasons, associated childhood activities, and perceived/actual metered-dose inhaler (MDI) skills.
- To evaluate concordance between physician, parent, and child reports of asthma medication use.
Main Methods:
- Cross-sectional study involving minority children with asthma.
- Data collection included parent interviews on medication administration reasons, childhood behaviors, and perceived child MDI skills.
- Objective assessment of child MDI technique and comparison of medication reports from physicians, parents, and children.
Main Results:
- 93% of children self-administered inhaled asthma medications without adult supervision.
- Early self-administration correlated with parental employment and child's independent behaviors.
- Only 7% of children demonstrated effective MDI skills, though 60% of parents rated skills as excellent.
- Significant discordance existed between physician prescriptions and parent/child reports for various asthma medications.
Conclusions:
- Parental employment and child's independent behaviors are associated with early self-administration of asthma medications.
- A significant gap exists between perceived and actual MDI proficiency in children.
- Discrepancies in medication reporting highlight the need for improved communication and education for effective asthma management.
Abstract:
This study investigated factors associated with early self-administration of inhaled asthma medications by minority children. Specifically, the study evaluated: (1) the reasons parents allow early administration of inhaled medications, (2) childhood activities associated with early medication administration, (3) parent's perception of the child's ability to use a metered-dose inhaler (MDI), (4) the child's actual ability to use an MDI, and (5) concordance/discordance between physician-parent reports and parent-child reports of asthma medications. Study results indicated that 93% of the children were taking inhaled asthma medications without adult supervision. Early self-administration of asthma medications was related to the parent's employment status and the performance of other childhood behaviors such as completion of homework independently and crossing the street alone. Only 7% of the children had effective MDI skills, but 60% of the parents rated their child's MDI skills as excellent. Twenty percent, 67%, and 50%, respectively, of the parents' reports of beta-agonists, daily inhaled steroids, and cromolyn were discordant with the physician's actual prescriptions. Sixty-two percent, 57%, and 79%, respectively, of the children's reports for inhaled beta-agonists, daily inhaled steroids, and cromolyn were discordant with their parents' reports. Implications for anticipatory guidance, future educational strategies, and supervision of MDI technique are provided.