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Inadequate therapy and poor symptom control among children with asthma: findings from a multistate sample
Jill S Halterman1, Peggy Auinger, Kelly M Conn
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Children's Hospital at Strong, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Insights
Many children with persistent asthma lack adequate therapy or effective symptom control. Factors like race, ethnicity, and insurance status impact treatment, highlighting a need for improved pediatric asthma management.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Epidemiology
Background:
- Asthma significantly impacts children's health and quality of life.
- Current treatment guidelines emphasize preventive medication use for persistent asthma.
- Suboptimal control and inadequate therapy remain prevalent challenges in pediatric asthma care.
Purpose of the Study:
- To assess preventive medication use in children with persistent asthma.
- To evaluate asthma control levels among children using preventive medications.
- To identify demographic and clinical factors associated with poor asthma control in children.
Main Methods:
- Utilized parent-reported data from the State and Local Area Integrated Telephone Survey (SLAITS) Asthma Survey.
- Analyzed data from 975 children aged under 18 with persistent asthma or using preventive medications.
- Defined inadequate therapy, suboptimal control, and optimal control based on symptom persistence, medication use, and exacerbation frequency.
Main Results:
- Only 20.1% of children with persistent asthma achieved optimal control.
- 37% had inadequate therapy, and 42.9% had suboptimal control.
- Black race, Hispanic ethnicity, and discontinuous insurance were linked to inadequate therapy.
Conclusions:
- Inadequate asthma therapy is a significant issue in pediatric populations.
- A substantial number of children experience poor symptom control despite using prescribed preventive medications.
- Addressing adherence, environmental triggers, and access to action plans is crucial for improving pediatric asthma outcomes.
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, < or = 1 attack, and reported using preventive medication. Demographic and asthma-related variables were compared across groups.
Results:
Among children with persistent asthma, 37 per cent had inadequate therapy, 42.9 per cent had suboptimal control, and only 20.1 per cent had optimal control. In multivariate regression, black race (odds ratio [OR], 2.0; 95 percent confidence interval [CI] 1.1-3.5), Hispanic ethnicity (OR, 1.8; 95 per cent CI, 1.1-2.9), and discontinuous insurance status (OR, 2.4; 95 per cent 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.
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