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Two-thirds of children with persistent asthma symptoms seen in primary care have uncontrolled asthma

Daily use of inhaled antiinflammatory medications such as corticosteroids (controllers) reduces airway obstruction and symptoms, such as labored breathing and coughing, among people who have persistent asthma. Inhaled beta agonists, so-called relievers, are adrenalin-like drugs that ideally are supposed to be used to quickly open up the airways to "rescue" a person during an asthma episode that occurs when symptoms break through despite use of controller medications.

Unfortunately, inappropriate reliance on relievers and nonadherence to controllers are common among children with persistent asthma who are seen by primary care doctors, according to a recent study from the Pediatric Asthma Care Patient Outcomes Research Team (PORT), which is supported in part by the Agency for Healthcare Research and Quality (HS08368). The PORT is led by Kevin B. Weiss, M.D., M.P.H., of Hines VA Hospital and Northwestern University's Feinberg School of Medicine.

The researchers used a face-to-face questionnaire to interview the parents of 638 children (ages 3 to 15) with asthma, who were cared for at one of 42 primary managed care practices in three U.S. regions. Symptoms included cough, wheeze, or limitation in activity. Overall, 64 percent of children with persistent asthma were inadequately controlled (excess symptoms or reliever use), including both children who used controllers less than recommended or who received no controller medication at all.

One-third of children had excessive symptoms, that is, 5 to 14 symptoms days in the preceding 2 weeks. One-third of children using relievers had high levels of use (inhaler use 3-4 days per week, five or more puffs per day, or inhaler or nebulizer use 5 or more days per week). One-third of children using controller medications used them only 4 or fewer days per week (underdosing).

Older age, minority race, and household poverty were significantly associated with inadequate control. Having seen an asthma specialist in the previous 6 months was significantly associated with a lower likelihood of inadequate asthma control.

See "Asthma medication use and disease burden in children in a primary care population," by Paula Lozano, M.D., M.P.H., Jonathan A. Finkelstein, M.D., M.P.H., Julia Hecht, Ph.D., and others, in the January 2003 Archives of Pediatric and Adolescent Medicine 157, pp. 81-88.

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