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Medication use and health care contacts among symptomatic children with asthma
J S Halterman1, H L Yoos, K Sidora
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY 14642, USA. jill_halterman@urmc.rochester.edu
Insights
Many children with asthma symptoms receive inadequate treatment and have limited healthcare contact. This highlights a significant gap in managing pediatric asthma, leading to preventable suffering and illness.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Healthcare Management
Background:
- Childhood asthma remains a significant public health concern with increasing morbidity and mortality.
- Current understanding of medication and healthcare service utilization during symptomatic periods in pediatric asthma is limited.
Purpose of the Study:
- To prospectively document medication use and healthcare contacts among children experiencing active asthma symptoms.
- To identify patterns of care during symptomatic periods in pediatric asthma patients.
Main Methods:
- Prospective study involving 165 children aged 6-19 years with active asthma symptoms over a 3-month period.
- Data collected via biweekly phone interviews and daily diaries, assessing symptoms, medication use, and healthcare contacts.
- Statistical analyses included chi-square and regression to evaluate associations between symptom frequency and care utilization.
Main Results:
- A majority of children (65%) experienced persistent to severe asthma symptoms.
- Inadequate anti-inflammatory therapy was common, with only 19-25% receiving prednisone and 46-56% using maintenance medication, even among highly symptomatic children.
- Healthcare contact rates were low (≤50%), irrespective of symptom severity or demographic factors.
Conclusions:
- Significant under-treatment with anti-inflammatory medications and insufficient healthcare engagement observed in children with frequent asthma symptoms.
- Children with active asthma symptoms are likely experiencing preventable morbidity due to inadequate care.
- Urgent interventions are needed to improve asthma management in pediatric populations.
Objective:
Asthma morbidity and mortality continue to increase despite the availability of improved therapies. Little is known about the degree to which children with asthma use medications and health care services during symptomatic periods. This study documents prospectively the use of medications and health care contacts among children with active asthma symptoms.
Methods:
Children age 6--19 years from 11 primary care settings in upstate New York were eligible for this study if they had 3 or more asthma-related medical visits during the prior year. We collected extensive information on asthma symptoms, medication use, and contacts with health care providers from biweekly phone interviews and daily diaries during a 3-month period. Symptoms were evaluated as the average number of symptomatic days per week. We tabulated the proportion of children using anti-inflammatory medications and having health care contacts according to the frequency of their symptoms during this 3-month period. Chi-square and regression analyses were used.
Results:
One hundred sixty-five children participated (67% White, 24% Black, 9% Other). Sixty-five percent of the children in this sample had an average of more than 2 symptomatic days per week or more than 2 symptomatic nights per month during the 3-month study period and thus had mild persistent to severe asthma. Among these children, 25% received prednisone, and 46% reported the use of an inhaled maintenance medication during the monitoring period. Ten percent of children in this sample experienced an average of 6 or more symptomatic days per week during the study period. Among these highly symptomatic children, only 19% received prednisone, and 56% used a maintenance medication. Further, the proportion of children having contact with a health care provider during this 3-month period was 50% or less, even among the children experiencing the most frequent asthma symptoms. There were no differences in the proportion of children with health care contacts, prednisone use, or maintenance anti-inflammatory use among different gender or race categories or with different insurance types or places of residence.
Conclusions:
Even among children experiencing almost daily asthma symptoms, inadequate anti-inflammatory therapy is common, and few contacts with health care providers occur. These children are silently suffering at home and likely are experiencing preventable morbidity.