Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2504-2513 (doi:10.1542/10.1542/peds.2006-1630)
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ARTICLE

Patterns of Inhaled Antiinflammatory Medication Use in Young Underserved Children With Asthma

Arlene M. Butz, ScD, MSNa, Mona Tsoukleris, PharmD, BCPSb, Michele Donithan, MHSc, Van Doren Hsu, PharmDd, Kim Mudd, MSNa, Ilene H. Zuckerman, PharmD, PhDd and Mary E. Bollinger, DOe

a Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
b Departments of Pharmacy Practice and Science
d Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
c Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
e Division of Pediatric Pulmonology and Allergy, University of Maryland School of Medicine, Baltimore, Maryland

BACKGROUND. Asthma guidelines advocate inhaled corticosteroids as the cornerstone treatment of persistent asthma, yet several studies report underuse of inhaled corticosteroids in children with persistent asthma. Moreover, few studies use objective pharmacy data as a measure of drug availability of asthma medications. We examined factors associated with the use of inhaled corticosteroids in young underserved children with persistent asthma using pharmacy records as their source of asthma medications.

METHODS. This was a cross-sectional analysis of questionnaire and pharmacy record data over a 12-month period from participants enrolled in a randomized clinical trial of a nebulizer educational intervention.

RESULTS. Although exposure to ≥1 inhaled corticosteroids refill was high at 72%, 1 of 5 children with persistent asthma had either no medication or only short-acting ß agonist fills for 12 months. Only 20% of children obtained ≥6 inhaled corticosteroids fills over 12 months. Obtaining ≥3 inhaled corticosteroids fills over 12 months was significantly associated with an increase in short-acting ß agonist fills and receiving specialty care in the regression models while controlling for child age, asthma severity, number of emergency department visits, having an asthma action plan, and seeking preventive care for the child's asthma.

CONCLUSIONS. Overreliance on short-acting ß agonist and underuse of inhaled corticosteroid medications was common in this group of young children with persistent asthma. Only one fifth of children obtained sufficient controller medication fills.

Key Words: asthma • children • preventive care • antiinflammatory

Abbreviations: ED—emergency department • ICS—inhaled corticosteroid • SAB—short-acting ß-agonist • OCS—oral corticosteroid • CI—confidence interval

Accepted Aug 1, 2006.


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