title: Risk factors hindering asthma symptom control in Saudi children and adolescents.
abstract: BACKGROUND
  Maintaining good control of asthma symptoms can help to prevent exacerbations and its associated complications. The Asthma Control Test (ACT) can rapidly assess the effectiveness of asthma management plan and therapy. The aim of this study was therefore to identify risk factors associated with uncontrolled asthma symptoms in young Saudi asthmatic children (3-17 years old).
  
  
  METHODS
  In this cross-sectional hospital-based survey, the ACT was administered to 297 asthmatic children/adolescents, recruited at the emergency department (ED) of two major hospitals.
  
  
  RESULTS
  Most recruited patients had intermittent (63.5%) and mild persistent (27.6%) asthma; few had moderate persistent (8.9%) and none had severe asthma. These patients visited the ED four times (3.9 ± 3.2), on average. Almost half of the patients stated that they had not received education about asthma (47%) or education about medication use (43%). Most patients (60.3%) had uncontrolled symptoms (ACT score ≤19), of whom the intermittent asthma patients had better scores than those with more severe symptoms. Children ≤6 years old, with symptoms diagnosed <5 years previously and who were not attending school, had significantly worse control than older patients. Poor medication compliance and inappropriate inhaler device use were ascribed to younger patients (<12 years old) and worse scores; particularly in relation to stopping inhaled corticosteroid therapy when their symptoms improve. Patients with poor control also stated that they had not received education about inhaler device use.
  
  
  CONCLUSIONS
  Most Saudi asthmatic children/adolescents visiting the ED had poor control of symptoms; indeed, none achieved complete control, which is related to deficient medication compliance and improper medication inhaler device use; deficient knowledge about asthma was also another factor hindering control.
authors.affiliation: Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia.|Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Rabih
authors.identifier: http://orcid.org/0000-0002-6516-7771
authors.initials: R
authors.lastname: Halwani
authors.affiliation: Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Vazquez-Tello
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Nour
authors.initials: N
authors.lastname: Horanieh
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Said
authors.initials: S
authors.lastname: Dulgom
authors.affiliation: Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.|Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Zohair
authors.initials: Z
authors.lastname: Al-Aseri
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Nouf
authors.initials: N
authors.lastname: Al-Khamis
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Zubaida
authors.initials: Z
authors.lastname: Al-Sum
authors.affiliation: Department of Medicine, Pulmonary Division-ICU, King Saud University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Hamdan
authors.initials: H
authors.lastname: Al-Jahdali
authors.affiliation: Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia.|Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Muhsen
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers; D012307:Risk Factors; D012529:Saudi Arabia; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Saudi Arabia; asthma control test; dry powder inhaler; inhaler; medication compliance; metered dose inhaler; pediatric asthma; risk factor