Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1174-e1181 (doi:10.1542/peds.2007-0206)
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ARTICLE

Does Current Asthma Control Predict Future Health Care Use Among Black Preschool-aged Inner-City Children?

Hemant P. Sharma, MDa, Elizabeth C. Matsui, MD, MHSa, Peyton A. Eggleston, MDa, Nadia N. Hansel, MD, MPHb, Jean Curtin-Brosnan, MAa and Gregory B. Diette, MD, MHSb

a Division of Pediatric Allergy and Immunology, Department of Pediatrics, and Division of Pulmonary and Critical Care Medicine
b Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

OBJECTIVES. Factors predictive of future asthma must be identified among young inner-city children, who suffer disproportionately from asthma. We investigated whether current asthma control predicts future asthma-related health care use among inner-city preschool-aged children with asthma.

METHODS. A total of 150 inner-city preschool-aged children with asthma were followed prospectively for 6 months. At baseline, symptom frequency and reliever-medication use were assessed to classify children into National Asthma Education and Prevention Program–derived control categories. Long-term controller-medication use was also assessed, as well as asthma-related health care use at baseline and at 3 and 6 months.

RESULTS. The mean age was 4.4 years, 92% were black, and 39% reported long-term controller use. At baseline, 37% were classified as having mild-intermittent, 17% had mild-persistent, 21% had moderate-persistent, and 25% had severe-persistent asthma control. Significant changes in asthma control were observed over time, including 46% of children originally categorized with mild-intermittent asthma who had worsened asthma control by 3 months. Asthma control significantly predicted future health care use 3 months later but not 6 months later. Multivariate analyses showed that, once control status was known, reported use of long-term controller medication added little additional predictive value.

CONCLUSIONS. Among inner-city preschool-aged children, significant fluctuations in asthma control occur as early as 3 months after assessment. Poor control but not long-term controller-medication use is an independent predictor of future asthma-related health care use at 3 months but is not significantly predictive of 6-month outcomes. Therefore, clinicians caring for inner-city children with asthma should consider reassessing asthma control at least every 3 months to identify those at highest future risk and to provide early interventions.

Key Words: asthma • severity • control • health care use • prediction • risk • children • inner city

Abbreviations: HCU—health care use • GINA—Global Initiative for Asthma • NAEPP—National Asthma Education and Prevention Program • LTC—long-term controller • UD—unscheduled doctor • ED—emergency department • OR—odds ratio

Accepted Apr 17, 2007.


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