Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 760-769 (doi:10.1542/peds.2007-2750)
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ARTICLE

Modifiable Risk Factors for Suboptimal Control and Controller Medication Underuse Among Children With Asthma

Lauren A. Smith, MD, MPHa, Barbara Bokhour, PhDb,c, Katherine H. Hohman, MPHd, Irina Miroshnik, MSd, Kenneth P. Kleinman, ScDd, Ellen Cohn, ScDe, Dharma E. Cortés, PhDf, Alison Galbraith, MD, MPHd, Cynthia Rand, PhDg and Tracy A. Lieu, MD, MPHd,h

a Department of Pediatrics, School of Medicine
b Department of Health Policy and Management Department, School of Public Health
e Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
c Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, Massachusetts
d Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
f Department of Psychiatry, Cambridge Hospital and Harvard Medical School, Cambridge, Massachusetts
g Department of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
h Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVES. Our aims were (1) to describe rates of suboptimal control and controller medication underuse in a diverse population of children with asthma and (2) to identify potentially modifiable parental behaviors and beliefs associated with these outcomes.

METHODS. We conducted telephone interviews with parents of 2- to 12-year-old children with persistent asthma, in a Medicaid plan and a large provider group. Suboptimal control was defined as ≥4 symptom days, ≥1 symptom night, or ≥4 albuterol use days in the previous 2 weeks. Controller medication underuse was defined as suboptimal control and parent report of <6 days/week of inhaled steroid use. Multivariate analyses identified factors that were independently associated with suboptimal control and controller medication underuse.

RESULTS. Of the 754 study children, 280 (37%) had suboptimal asthma control; this problem was more common in Hispanic children (51%) than in black (37%) or white (32%) children. Controller medication underuse was present for 133 children (48% of those with suboptimal asthma control and 18% overall). Controller medication underuse was more common among Hispanic (44%) and black (34%) children than white (22%) children. In multivariate analyses, suboptimal control was associated with potentially modifiable factors including low parental expectations for symptom control and high levels of worry about competing household priorities. Controller medication underuse was associated with potentially modifiable factors including parental estimation of asthma control that was discordant with national guidelines and no set time to administer asthma medications.

CONCLUSIONS. Deficiencies in asthma control and controller medication use are associated with potentially modifiable parental beliefs, which seem to mediate racial/ethnic and socioeconomic disparities in suboptimal control and controller medication underuse.

Key Words: suboptimal asthma control • controller medication use • barriers to asthma control • asthma disparities

Accepted Dec 21, 2007.


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