Published Online: May 9, 2016
Asthma is the most common chronic illness in children and many children suffer asthma flares despite the availability of effective medications for asthma. Many children with persistent asthma do not take daily controller medicines as recommended by national guidelines. Possible reasons include that providers do not recommend controller medicines, parents do not understand their child’s physician recommendation on how asthma medications should be taken, or other reasons.
The goals of the study led by Wu and colleagues were to assess provider prescribing patterns for asthma controller medications and to assess how frequently parents’ reports of their child’s asthma controller medicine use were mismatched with their provider’s recommendations. In this study, Wu et al asked similar questions to parents and their providers and linked the surveys of parents and providers. The study included providers and parents of children with probable persistent asthma in a Medicaid program and four commercial health plans in 2011. Probable persistent asthma was defined as a diagnosis of asthma and at least one controller medication dispensing. Controller medications include inhaled corticosteroids, leukotriene antagonists, or combination inhaled corticosteroids/long acting beta agonists.
The study included 740 children and their providers. The average age of the child was 8.6 years. The study found that providers do not recommend that inhaled steroids be used according to national guidelines. Providers for half of the children reported prescribing controller medications for daily year-round use, 41% for daily use during active asthma months, and 9% for intermittent use for relief. Among parents, 72% knew which class of controller medication the provider prescribed and 49% knew the administration frequency and the medication class. Parents were less likely to report the same controller medication type as the provider, irrespective of dose and frequency, if they were Latino, there was a smoker in the home, or they believed the controller medicine was not helping. Wu et al suggest that efforts to increase use of controller medicines for asthma should focus on ways to align provider decision-making with national guidelines and ways to reduce mismatches between parent and provider intentions regarding controller medication use.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.