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Uncontrolled asthma can lead to emergency room visits and hospitalizations. The increased use of antiinflammatory medications, especially inhaled corticosteroids (ICSs), has been linked to reduced asthma deaths and morbidity in many countries. Yet a decade after the release of U.S. guidelines recommending ICSs and other controllers (such as inhaled cromolyn sodium) for persistent asthma management, few children with persistent asthma symptoms (indicated by frequent use of beta agonists) use controllers regularly, according to a study of several managed care organizations (MCOs). This suggests that the group of young people with well-controlled persistent asthma is small, concludes Kevin B. Weiss, M.D., of Northwestern University Medical School. Dr. Weiss is principal investigator of the Pediatric Asthma Care Patient Outcomes Research Team (PAC-PORT), which is supported by the Agency for Healthcare Research and Quality (HS08368).
Controllers prevent or control lung inflammation that leads to asthma episodes. Beta agonists—adrenalin-like bronchodilators that quickly open up the airways—can help stop an asthma attack once begun, but they do not prevent an attack.
As part of the PAC-PORT, researchers conducted a 1-year study of 13,352 children with asthma who were cared for in three MCOs to identify age and other factors associated with controller medication use. Most children with frequent symptoms such as coughing or wheezing (judged by their frequent use of bronchodilators) received some medication to combat airway inflammation, but few were using sufficient controller medication to be considered "regular" users of preventive therapy, as recommended in national guidelines. Adolescents were most likely to have suboptimal asthma management.
Among children dispensed six or more beta agonist inhalers (indicating frequent breathing problems), only 39 percent also received five or more controller inhalers (indicating regular use) to prevent breathing problems. Adolescents were significantly less likely than younger children to receive five or more controllers (33 vs. 43 percent). Using 3- to 5-year-old children as the reference group, young people 12 to 15 years old were 40 percent less likely to receive five or more controller inhalers, and those 6 to 8 years old were 30 percent more likely to receive them. Fewer girls than boys received any controller therapy (37 vs. 41 percent).
More details are in "Use of inhaled anti-inflammatory medication in children with asthma in managed care settings," by Robert J. Adams, M.B.B.S., M.D., Anne Fuhlbrigge, M.D., M.S., Jonathan A. Finkelstein, M.D., M.P.H., and others, in the April 2001 Archives of Pediatric and Adolescent Medicine 155, pp. 501-507.
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