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Factors associated with high short-acting β2-agonist use in urban children with asthma
Arlene M Butz1, Jean Ogborn2, Shawna Mudd3
1Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Inner-city children with asthma often overuse short-acting beta-2 agonist (SABA) medications. Cockroach sensitization and controller medication use are linked to high SABA use in these children.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Public Health
Background:
- Guideline-based asthma therapy aims to minimize short-acting beta-2 agonist (SABA) use.
- Inner-city children with asthma exhibit high SABA utilization rates.
- Persistent asthma management in pediatric populations presents unique challenges.
Purpose of the Study:
- To identify factors associated with elevated SABA use in inner-city children diagnosed with persistent asthma.
- To inform targeted interventions for improving asthma control in vulnerable pediatric groups.
Main Methods:
- A randomized controlled trial enrolled 100 inner-city children with persistent asthma.
- Data collected included serologic allergen-specific IgE, salivary cotinine, and pharmacy records for SABA and inhaled corticosteroid fills over 12 months.
- Regression models analyzed associations between high SABA use and clinical factors, including allergen sensitization and prior healthcare utilization.
Main Results:
- High SABA users were significantly more likely to have experienced asthma hospitalizations and intensive care unit admissions.
- Positive cockroach sensitization was strongly associated with high SABA use.
- Increased use of inhaled corticosteroids was paradoxically linked to higher SABA fills, suggesting potential adherence or treatment challenges.
Conclusions:
- Close monitoring of SABA and controller medication use is crucial for children with persistent asthma.
- Assessing allergen sensitization, particularly to cockroaches, and environmental exposures is vital for effective asthma management.
- Healthcare providers should consider these factors to optimize treatment strategies and reduce SABA reliance.
Background:
One goal of guideline-based asthma therapy is minimal use of short-acting β₂ agonist (SABA) medications. Inner-city children with asthma are known to have high SABA use.
Objective:
To examine factors associated with high SABA use in inner-city children with asthma.
Methods:
One hundred inner-city children with persistent asthma were enrolled into a randomized controlled trial of an emergency department (ED) and home intervention. All children underwent serologic allergen specific IgE and salivary cotinine testing at the ED enrollment visit. Pharmacy records for the past 12 months were obtained. Number of SABA fills during the past 12 months was categorized into low- to moderate- vs high-use groups. SABA groups were compared by the number of symptom days and nights, allergen sensitization, and exposures. Regression models were used to predict high SABA use.
Results:
Mean number of SABA fills over 12 months was 3.12. Unadjusted bivariate analysis showed that high SABA users were more than 5 times more likely to have an asthma hospitalization, almost 3 times more likely to have an asthma intensive care unit admission, and more than 3 times more likely to have prior specialty asthma care or positive cockroach sensitization than low to moderate SABA users. In the final regression model, for every additional inhaled corticosteroid fill, a child was 1.4 times more likely and a child with positive cockroach sensitization was almost 7 times more likely to have high SABA use when controlling for prior intensive care unit admission, receipt of specialty care, child age, and income.
Conclusion:
Providers should closely monitor SABA and controller medication use, allergen sensitization, and exposures in children with persistent asthma.
Trial Registration:
ClinicalTrials.gov, identifier NCT01981564.
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