Factors associated with poor controller medication use in children with high asthma emergency department use

Publication date: Available online 21 February 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Arlene Butz, Tricia Morphew, Cassia Lewis-Land, Joan Kub, Melissa Bellin, Jean Ogborn, Shawna S. Mudd, Mary Elizabeth Bollinger, Mona Tsoukleris
BackgroundUnderstanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community. Objective: 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.MethodsStudy 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.ResultsMost 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.ConclusionClinical 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.Trial Registrationclinicaltrials.gov Identifier: NCT01981564.



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