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Factors associated with poor controller medication use in children with high asthma emergency department use
Arlene Butz1, Tricia Morphew2, Cassia Lewis-Land3
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Controller medication use in children with high-risk asthma is linked to specialty care access and allergen sensitization. Addressing caregiver concerns and environmental factors can improve asthma management and reduce emergency department visits.
Area of Science:
- Pediatric Pulmonology
- Environmental Health
- Health Services Research
Background:
- Asthma medication adherence is crucial for managing high-risk pediatric asthma.
- Understanding factors influencing controller medication use is key for effective disease management.
- Previous research highlights the need to explore health and social determinants in pediatric asthma care.
Purpose of the Study:
- To investigate health and social factors associated with controller medication use in children with persistent asthma and frequent emergency department (ED) visits.
- To analyze the Asthma Medication Ratio (AMR) as a measure of guideline-based care.
- To identify predictors of appropriate controller medication use in a high-risk pediatric asthma population.
Main Methods:
- A randomized clinical trial involving 222 children with persistent asthma and frequent ED use.
- Data collection included questionnaires, allergen sensitization testing, salivary cotinine levels, and pharmacy records.
- Logistic regression analysis was employed to determine factors associated with an AMR greater than 0.50.
Main Results:
- Nearly half of the children (48%) had suboptimal controller medication use (AMR < 0.50).
- Specialty care, minimal caregiver worry about side effects, ragweed allergen sensitization, and lack of dust mite sensitization were significantly associated with appropriate controller medication use (AMR > 0.50).
- Factors such as African American race, Medicaid insurance, and uncontrolled asthma were prevalent in the study population.
Conclusions:
- Identifying environmental allergen sensitization is important for clinical decision-making in high-risk pediatric asthma.
- Addressing caregiver concerns regarding medication adverse effects can improve adherence.
- Increased referral to specialty care is recommended for optimizing asthma management in children.
Background:
Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community.
Objective:
To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use.
Methods:
Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention. Logistic regression was used to examine factors associated with an AMR greater than 0.50, reflecting appropriate controller medication use.
Results:
Most children were male (64%), African American (93%), Medicaid insured (93%), and classified as having uncontrolled asthma (44%). Almost half (48%) received non-guideline-based care or low controller medication use based on an AMR less than 0.50. The final regression model predicting an AMR greater than 0.50 indicated that children receiving specialty care (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.06-11.50), caregivers reporting minimal worry about medication adverse effects (OR, 0.50; 95% CI, 0.25-1.00), positive sensitization to ragweed allergen (OR, 3.82; 95% CI, 1.63-8.96), and negative specific IgE for dust mite (OR, 0.33; 95% CI, 0.15-0.76) were significantly associated with achieving an AMR greater than 0.50.
Conclusion:
Clinical decision making for high-risk children with asthma may be enhanced by identification of sensitization to environmental allergens, ascertaining caregiver's concerns about controller medication adverse effects and increased referral to specialty care.
Trial Registration:
ClinicalTrials.gov Identifier: NCT01981564.
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