Smith LA, Bokhour B, Hohman KH, et al. Pediatrics. 2008;122(4):760–769
PURPOSE OF THE STUDY. There were 2 objectives for the study, (1) to define the rates of suboptimal control and underuse of controller medication in children with asthma and (2) to characterize how parental behaviors relate to these patterns.
STUDY POPULATION. The study included 754 children 2 to 13 years of age with persistent asthma in a Medicaid plan and a large provider group.
METHODS. Telephone interviews were conducted with parents of participants to determine rates of suboptimal control and controller underuse. Suboptimal control was defined as ≥4 symptom days, ≥1 symptom night, or ≥4 albuterol use days in the previous 2 weeks. Controller underuse was defined as suboptimal control and parental report of <6 days/week of inhaled steroid use.
RESULTS. There were 37% of children (280 of 754 children) with suboptimal control. This was more common in Hispanic children (51%) than in black (37%) or white (22%) children. Underuse of controller medication was documented for 133 children, 48% of those with suboptimal asthma control and 18% overall. Suboptimal control was related to modifiable factors, including low parental expectations for symptom control and concern about competing household responsibilities. Controller medication underuse was related to modifiable factors, including parental evaluation of asthma control in conflict with the National Heart, Lung, and Blood Institute guidelines and lack of a schedule for asthma medications.
CONCLUSIONS. The conclusion of the authors was that 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.
REVIEWER COMMENTS. This study population included only insured children, and the findings may not be generalizable to uninsured populations. Another limitation is that the study depended on parental reports and 2-week recall of symptoms and medications. However, the implications from the findings are very important, that improvement in asthma control requires sensitivity in addressing parental beliefs and household concerns.
- Copyright © 2009 by the American Academy of Pediatrics