Socioeconomic, Family, and Pediatric Practice Factors That Affect Level of Asthma Control

• Published in: Pediatrics (Evanston) 2009-03, Vol.123 (3), p.829-835
• Main Authors: Bloomberg, Gordon R, Banister, Christina, Sterkel, Randall, Epstein, Jay, Bruns, Julie, Swerczek, Lisa, Wells, Suzanne, Yan, Yan, Garbutt, Jane M
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - therapeutic use; Albuterol - therapeutic use; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - epidemiology; Asthma - genetics; Asthma - psychology; Asthma in children; Biological and medical sciences; Child; Child, Preschool; Childhood asthma; Children & youth; Chronic obstructive pulmonary disease, asthma; Control; Demographic aspects; Drug therapy; Emergency Service, Hospital - statistics & numerical data; Families & family life; Family; Family Characteristics; Female; General aspects; Guideline Adherence - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Influence; Male; Medicaid; Medical sciences; Morbidity; Multivariate Analysis; Patient Compliance - statistics & numerical data; Patient outcomes; Pediatrics; Pediatrics - statistics & numerical data; Pneumology; Prognosis; Quality of life; Quality of Life - psychology; Risk Factors; Social economics; Socioeconomic Factors; Socioeconomics; United States; Utilization Review - statistics & numerical data; Women, Working
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2008-0504

Multiple issues play a role in the effective control of childhood asthma. To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians. Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications. Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control. Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.