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Antiinflammatory medications for the long-term treatment of childhood asthma are underused

Antiinflammatory medications control the chronic airway inflammation that causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing in children with asthma. Underuse of these medications often results in emergency department (ED) visits for children with asthma, particularly disadvantaged and minority children.

The view among many parents—especially poor, minority parents—that asthma is uncontrollable, as well as their negative attitudes toward inhaled antiinflammatory medications may contribute to suboptimal asthma care for their children, according to the results of this study, which was supported by the Agency for Healthcare Research and Quality (HS10689). The study was conducted by researchers at the University of Rochester Medical Center and School of Nursing.

The investigators developed and administered a questionnaire to parents of children with asthma to explore their understanding of and attitudes about the nature of asthma, its cause, medications, treatment expectations, and health care provider relationship. Of the 109 children whose parents were surveyed, 27 had an appropriate medication regimen, 31 had mild intermittent asthma, and 34 had a suboptimal regimen (parents reported antiinflammatory medication use, but the child was still symptomatic). Seventeen parents reported no antiinflammatory medication use, despite moderate to severe asthma. Parental responses to eight questions were significantly correlated with a child's suboptimal medication regimen. This questionnaire may be a useful way for health care providers to screen for nonadherence to asthma medication.

Parents who believed that there was little they could do to control their child's symptoms; that using inhaled steroids should be a last resort in treating asthma; that after a child has taken inhaled steroids for awhile, they won't work when they are really needed; and that their child thinks taking daily medicine is a hassle were more likely to have the child on a suboptimal or inadequate regimen. These parents also had lower expectations than health care providers about their child's ability to lead a normal life. The parents felt that their children could not be symptom-free most of the time nor participate fully in gym, that asthma would affect school attendance, and that they would probably have asthma-related ED visits or hospitalizations.

Details are in "Barriers to anti-inflammatory medication use in childhood asthma," by H. Lorrie Yoos, Ph.D., Harriet Kitzman, Ph.D., and Ann McMullen, M.S., in the July 2003 Ambulatory Pediatrics 3, pp. 181-190.

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