Patterns of inhaled corticosteroid use and asthma control in the Childhood Asthma Management Program Continuation Study.
BACKGROUND
Daily controller medication use is recommended for children with persistent asthma to achieve asthma control.


OBJECTIVE
To examine patterns of inhaled corticosteroid (ICS) use and asthma control in an observational study of children and adolescents with mild-to-moderate asthma (the Childhood Asthma Management Program Continuation Study).


METHODS
We assessed patterns of ICS use during a 12-month period (consistent, intermittent, and none) and asthma control (well controlled vs poorly controlled). Multivariate logistic regression examined the association between pattern of ICS use and asthma control.


RESULTS
Of 914 patients enrolled, 425 were recommended to continue receiving ICS therapy in the Childhood Asthma Management Program Continuation Study. Of these patients, 46% reported consistent ICS use and 20% reported no ICS use during year 1. By year 4, consistent ICS use decreased to 20%, whereas no ICS use increased to 57%; poorly controlled asthma was reported in 18% of encounters. In multivariate models controlling for age, sex, forced expiratory volume in 1 second, and asthma severity assessment, patients reporting consistent ICS use during a 12-month period were more likely to report poor asthma control (odds ratio, 1.6; 95% confidence interval, 1.2-2.1) compared with those reporting no ICS use.


CONCLUSIONS
In this observational study of children and adolescents with mild-to-moderate asthma, most did not report continued use of ICS. Patients recommended to continue receiving ICS therapy and reporting consistent ICS use were less likely to report well-controlled asthma even after controlling for markers of asthma severity. Although residual confounding by severity cannot be ruled out, many children and adolescents may not achieve well-controlled asthma despite consistent use of ICS.
Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. gregory.sawicki@childrens.harvard.edu
Gregory S
GS
Sawicki
Robert C
RC
Strunk
Brooke
B
Schuemann
Robert
R
Annett
Scott
S
Weiss
Anne L
AL
Fuhlbrigge
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D001239:Inhalation; D054539:Medication Therapy Management; D010349:Patient Compliance
D000305:Adrenal Cortex Hormones