Lozano PA, Finkelstein JA, Hecht J, et al. Arch Pediatr Adolesc Med. 2003;157:81–88
Purpose of the Study.
To describe the use of asthma medications and the disease burden among children with persistent asthma and to estimate asthma control.
A total of 638 children (3–15 years of age) with persistent asthma, drawn from private insurance claims and pharmacy databases, who were recruited for the Pediatric Asthma Care Patient Outcomes Research Team II study from 42 primary care practices in 3 urban locales were studied.
A single telephone interview with parents of eligible children was used to assess 1) classes of medications (controller and reliever) in use and frequency of use in the previous 4 weeks; 2) asthma symptoms during days, but not nights, in the previous 2 weeks; 3) visits to specialists, outpatient doctors, or emergency departments or hospitalizations; and 4) the existence and use of a written action plan.
Of the children who participated, 68% had 0 to 4 symptom days in the previous 2 weeks, 16% had 5 to 9 symptom days, and 16% had 10 to 14 symptom days. Sixty-five percent had a health care visit in the previous 1 year; 23% went to an emergency department, 14% saw an asthma specialist, and 4% were hospitalized. Most children with frequent symptom days were receiving controller medicines and used reliever medicines. Poor adherence to controller medicines was common (40%), especially among those with few symptom days. Sixty-four percent of children with persistent asthma had excessive symptoms or high reliever medication use and were considered to have inadequately controlled conditions. Approximately one-third of these patients had not been prescribed controllers. Written care plans were received by 21% of patients, and the existence of a plan was not protective against inadequate control.
Inadequate asthma control, defined as frequent symptoms or high reliever medication use, was common even when controller medications were prescribed. Nonadherence to controller medications and over-reliance on reliever medications were common.
This is an important study emphasizing that asthma control remains a significant problem for children. This study highlights 2 factors that contribute to poor asthma control, namely, lack of adherence to controller medications and lack of appropriate prescription of controllers. Younger age and being treated by an asthma specialist were associated with better asthma control. The study excluded important groups, including children <3 of age, children treated by a specialist, and patients with intermittent or severe persistent asthma. Patients themselves were not interviewed (only the parents were interviewed), which is a known limitation in adolescent studies. Surveyed controller and reliever use was not compared with actual prescription refills or mechanical dose-counting results. Nonetheless, this is another study suggesting that asthma among children is not well controlled and that we need to assist our patients with medication adherence and to make sure that patients with persistent asthma are prescribed controller medications.