ASTHMA: DIAGNOSIS AND MANAGEMENT |
Use of Inhaled Antiinflammatory Medication in Children with Asthma in Managed Care Settings
Boston, MA
Purpose of Study. To study the factors associated with dispensing of antiinflammatory (controller) asthma medication to children in 3 managed care organizations (MCOs).
Study Population. A total of 13 352 children aged 3 to 15 years with at least 1 diagnosis of asthma.
Methods. Using automated databases, a 1-year cross-sectional study of children with asthma aged 3 to 15 years, cared for in 3 MCOs was used to evaluate the association of age and other factors with controller medication use.
Results. A total of 13 352 children were studied. Significantly fewer children aged 3 to 5 years were dispensed any (
1) controller medication than older children (P < .001). Among children dispensed 6 or more ß-agonists, only 39% also received 5 or more controller dispensings, with adolescents significantly less likely than younger children to receive 5 or more controllers (33%; P < .001). Significant differences were observed among MCOs in proportions of patients dispensed controller medication. In a multiple logistic regression model, controlling for frequency of ß-agonist-dispensing and MCOs, significantly lower dispensing of any controller medication was seen for those aged 3 to 5 years (odds ratio [OR]: 0.8; 95% confidence interval [CI]: 0.7–0.9) and for girls (OR: 0.9; 95% CI: 0.8–0.96). In contrast, for repeated (5) controller dispensing there were significantly fewer dispensings to adolescents (OR: 0.7; 95% CI: 0.6–0.9) and girls (OR: 0.8; 95% CI: 0.7–0.9).
Conclusions. There may be differences in the use of preventive asthma medication in children that are affected by age, sex, and health care organization. Few children with frequent symptoms are using controllers regularly, as is recommended by national guidelines.
Reviewers’ Comments. It has been a decade since the National Asthma Education and Prevention Program asthma management guidelines were first published in which the use of preventive medications were strongly encouraged and emphasized. This study reviews the dispensing of antiinflammatory medications in 3 diverse managed care settings and clearly demonstrates that those patients with a high requirement for ß-agonists seemed to receive inadequate "controller’ medication. Preschool-aged children in particular were less likely to be started on controller medications whereas adolescents were less likely to take the medications. New therapies recently approved specifically for preschool children, such as nebulized budesonide and oral montelukast, may result in greater prescribing of controller medications for this age group. Partnering with adolescents to manage their asthma and monitoring of ß-agonist refills may help to increase adherence with controller medications in this age group. There was also a difference between the sexes with less use of controllers in girls compared with boys. Both physiologic and psychosocial differences may be factors and more research will be needed to clarify this. Although this study suffers with the inherent weaknesses associated with database analysis, it serves as a timely reminder of the importance of providing preventive medications for children with asthma.
REFERENCES
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Adams RJ, Fuhlbrigge A, Finkelstein JA, et al.
Arch Pediatr Adolesc Med.2001; 155
:501
–507
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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