Asthma medication use and disease burden in children in a primary care population.
BACKGROUND
Children with persistent asthma underuse controller medications and overuse relievers. A better understanding of the appropriateness of regimens, medication adherence, and adequacy of asthma control is needed.


OBJECTIVE
To describe use of asthma medications and disease burden in children with persistent asthma, to determine whether use of controllers and relievers is consistent with national guidelines, and to estimate adequacy of asthma control.


METHODS
Cross-sectional cohort study.


METHODS
Forty-two primary care practices participating in 3 regions of the United States.


METHODS
Parents of 638 children aged 3 to 15 years with asthma.


METHODS
Asthma symptom-days, use of reliever and controller medications, and adequacy of asthma control, ascertained by face-to-face questionnaire.


RESULTS
The mean age was 9.4 years, and 59.9% were boys. In the preceding 2 weeks, two thirds (67.5%) of subjects had 0 to 4 symptom-days, 15.8% had 5 to 9 symptom-days, and 16.6% had 10 to 14 symptom-days (percentages do not total 100 because of rounding). One third (32.6%) of children using relievers had high levels of use. One third (34.3%) of children using controllers used them 4 or fewer days per week. Among children with some evidence of persistent disease (use of controllers, excess symptoms, or excess reliever use), almost two thirds (64.3%) were inadequately controlled. This group consisted both of children reportedly using controllers less than recommended and those reporting not receiving controller medication at all.


CONCLUSIONS
In this insured population, inappropriate reliance on relievers and nonadherence to controllers were common. Inadequate asthma control was common regardless of whether controllers were prescribed.
Lozano
Paula
P
Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. plozano@u.washington.edu
Finkelstein
Jonathan A
JA
Hecht
Julia
J
Shulruff
Reeva
R
Weiss
Kevin B
KB
D000293:Adolescent; D017677:Age Distribution; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000145:classification / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D018927:Anti-Asthmatic Agents