title: Factors associated with poor controller medication use in children with high asthma emergency department use.
abstract: Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community.
  
  
  
  To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use.
  
  
  
  Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention. Logistic regression was used to examine factors associated with an AMR greater than 0.50, reflecting appropriate controller medication use.
  
  
  
  Most children were male (64%), African American (93%), Medicaid insured (93%), and classified as having uncontrolled asthma (44%). Almost half (48%) received non-guideline-based care or low controller medication use based on an AMR less than 0.50. The final regression model predicting an AMR greater than 0.50 indicated that children receiving specialty care (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.06-11.50), caregivers reporting minimal worry about medication adverse effects (OR, 0.50; 95% CI, 0.25-1.00), positive sensitization to ragweed allergen (OR, 3.82; 95% CI, 1.63-8.96), and negative specific IgE for dust mite (OR, 0.33; 95% CI, 0.15-0.76) were significantly associated with achieving an AMR greater than 0.50.
  
  
  
  Clinical decision making for high-risk children with asthma may be enhanced by identification of sensitization to environmental allergens, ascertaining caregiver's concerns about controller medication adverse effects and increased referral to specialty care.
  
  
  
  ClinicalTrials.gov Identifier: NCT01981564.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: abutz@jhmi.edu.
authors.forename: Arlene
authors.initials: A
authors.lastname: Butz
authors.affiliation: Morphew Consulting LLC, Bothell, Washington.
authors.forename: Tricia
authors.initials: T
authors.lastname: Morphew
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Cassia
authors.initials: C
authors.lastname: Lewis-Land
authors.affiliation: School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joan
authors.initials: J
authors.lastname: Kub
authors.affiliation: School of Social Work, University of Maryland, Baltimore, Maryland.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bellin
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jean
authors.initials: J
authors.lastname: Ogborn
authors.affiliation: School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Shawna S
authors.initials: SS
authors.lastname: Mudd
authors.affiliation: Department of Pediatric Pulmonary and Allergy, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Bollinger
authors.affiliation: School of Pharmacy, University of Maryland, Baltimore, Maryland.
authors.forename: Mona
authors.initials: M
authors.lastname: Tsoukleris
mesh_terms: D000485:Allergens / Q000145:classification / Q000276:immunology; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004781:Environmental Exposure; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D057566:Self Report; D012698:Serologic Tests; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D018927:Anti-Asthmatic Agents