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Nebulizer use in inner-city children with asthma: morbidity, medication use, and asthma management practices
A M Butz1, P Eggleston, K Huss
1Department of Pediatrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Baltimore, MD 21287-3144, USA. Abutz@jhmi.jhu.edu.
Insights
Nebulizer use is common in urban children with asthma but does not reduce symptoms. Many children with asthma are undertreated with inhaled corticosteroids, despite regular physician monitoring.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Public Health
Background:
- Nebulizer use is prevalent among urban children with asthma.
- Asthma management practices and medication administration patterns require further investigation.
Purpose of the Study:
- To assess nebulizer use frequency in children with asthma.
- To describe asthma morbidity and medication administration patterns.
- To examine the relationship between inhaled anti-inflammatory medication, asthma morbidity, and management in nebulizer users versus non-users.
Main Methods:
- Cross-sectional, descriptive survey of 686 children (aged 5-12) with persistent asthma.
- Data collected via telephone survey from caregivers regarding asthma morbidity, healthcare utilization, and medication use.
- Nebulizer use defined as usage ≥1 day/month in the past 6 months.
Main Results:
- 33% of children reported current nebulizer use.
- Nebulizer users experienced significantly higher hospital admissions and emergency department visits.
- Inhaled corticosteroid use was low in both groups (8% non-users, 15% users).
- Among nebulizer users, inhaled anti-inflammatory use correlated with increased asthma morbidity.
Conclusions:
- Nebulizer use in inner-city children with asthma is higher than expected but not linked to reduced morbidity.
- High-risk children with asthma are frequently undertreated with inhaled corticosteroids.
- Despite physician monitoring, long-term asthma control remains inadequate for this population.
Objective:
To assess the frequency of nebulizer use, describe morbidity and patterns of medication administration, and examine the potential relationships between inhaled anti-inflammatory medication administration, asthma morbidity, and asthma management practices in children with asthma using a nebulizer compared with children with asthma not using a nebulizer.
Research Design:
A cross-sectional, descriptive survey of previous events.
Setting:
Elementary schools and participants' homes in Baltimore, Md, and Washington, DC.
Participants:
Six hundred eighty-six families of children aged 5 to 12 years with a diagnosis of at least mild, persistent asthma.
Interventions:
None.
Measurements And Main Results:
Asthma morbidity, health care utilization, pattern of asthma medication administration, nebulizer use, and asthma management data were collected by telephone survey administered to caregivers. Nebulizer use was defined as use at least 1 or more days per month during the last 6 months. Of 686 children identified, 231 (33%) reported current nebulizer use. Nebulizer users had significantly increased lifetime hospital admissions, hospitalizations, and emergency department visits in the last 6 months compared with nonnebulizer users. Inhaled corticosteroid administration was low for both groups (nonnebulizer users, 8%; nebulizer users, 15%). In the nebulizer users group, administration of inhaled anti-inflammatory medications was associated with increased asthma morbidity (increased hospitalizations, days and nights with symptoms, and oral steroid use).
Conclusions:
Nebulizer use by inner-city children with asthma is higher than anticipated but is not associated with reduced asthma morbidity. This group of high-risk children was undertreated with inhaled corticosteroids for long-term control of asthma despite reports of adequate monitoring by a primary care physician.