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Socioeconomic, family, and pediatric practice factors that affect level of asthma control
Gordon R Bloomberg1, Christina Banister, Randall Sterkel
1St Louis Children's Hospital, Washington University School of Medicine, Department of Pediatrics, Division of Allergy and Pulmonary Medicine, One Children's Place, St Louis, MO 63110, USA. bloomberg@kids.wustl.edu
Insights
Many children have poorly controlled asthma despite medication use. Factors like Medicaid insurance and family structure impact asthma control and quality of life in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Asthma Management
Background:
- Effective control of childhood asthma is multifactorial.
- Numerous issues influence asthma management in children.
- Understanding these factors is key to improving pediatric asthma outcomes.
Purpose of the Study:
- To identify factors associated with asthma control levels in children managed by community pediatricians.
- To investigate the relationship between demographic, clinical, and management factors and pediatric asthma control.
Main Methods:
- A telephone-administered questionnaire collected data from 362 children in an asthma morbidity intervention study.
- Asthma control was categorized as well, partially, or poorly controlled based on impairment and exacerbations.
- Statistical analyses (univariable and multivariable) identified factors linked to poor asthma control and medication use.
Main Results:
- 56% of children experienced poorly controlled asthma, despite 76% reporting daily controller medication use.
- Medicaid insurance, family history of asthma, and maternal employment were linked to poor control.
- Inadequate controller medication escalation was noted for 74% of children; poor control correlated with lower quality of life.
Conclusions:
- Poor asthma control and reduced quality of life persist in children despite significant controller medication use.
- Medicaid insurance and family structure elements are associated with poor asthma control.
- Optimizing controller medication and monitoring quality of life are crucial for reducing pediatric asthma morbidity.
Background:
Multiple issues play a role in the effective control of childhood asthma.
Objective:
To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians.
Patients And Methods:
Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications.
Results:
Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control.
Conclusions:
Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.
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