Family and insurance factors are linked to poorer control of children's asthma
Research Activities, July 2009, No. 347
Inhaled corticosteroids and montelukast (Singulair®) are typically prescribed to control children's asthma symptoms and to reduce the likelihood of acute asthma episodes that can land them in the emergency department. Despite substantial use of daily controller medication, more than half of the children in a new study continued to suffer from poorly controlled asthma. The result was missed school and work days for the family and poorer quality of life for parents and children. Competing family priorities and lack of asthma symptom awareness may underlie some of this poor asthma control, suggest the researchers. They surveyed parents of 362 children participating in a study to reduce asthma morbidity about asthma-related impairment (indicated by symptoms, activity limitations, and use of albuterol for acute asthma episodes), and the number of asthma exacerbations in a 1-year period.
The survey also addressed demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Based on parents' reports, 76 percent of children took daily controller medications. Yet asthma was well controlled for only 24 percent of children, partially controlled for 20 percent, and poorly controlled for 56 percent. The current level of asthma control suggested that 74 percent of children needed to intensify their use of medication. Both parents and children suffered significantly lower quality-of-life scores when children had poor control.
Medicaid insurance, presence of another family member with asthma, and maternal employment outside the home were significant factors associated with poor asthma control. These factors suggest competing priorities that may interfere with parental knowledge of a child's level of asthma control, daily use of controller medications, and opportunities for asthma monitoring visits. These families could benefit from more frequent asthma monitoring contacts and additional support and education to augment effective home management of their child's asthma, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS15378).
See "Socioeconomic, family, and pediatric practice factors that affect level of asthma control," by Gordon R. Bloomberg, M.D., Christina Banister, B.A., C.C.R.P., Randall Sterkel, M.D., and others in the March 2009 Pediatrics 123(3), pp. 829-835.