Inadequate therapy for asthma among children in the United States

Objective. Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number o f children with moderate to severe asthma are not taking the maintenance me dications recommended by national guidelines. The objective of this study w as to describe medication use among US children with asthma and determine r isk factors for inadequate therapy. Methods. The National Health and Nutrition Examination Survey (NHANES) III 1988-1994 provided cross-sectional, parent-reported data for children 2 mon ths to 16 years of age. Analysis focused on children with moderate to sever e asthma (defined as having any hospitalization for wheezing, greater than or equal to 2 acute visits for wheezing, or greater than or equal to 3 epis odes of wheezing over the past year). We defined these children as adequate ly treated if they had taken a maintenance medication (inhaled corticostero id, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampl ing design. Results. A total of 1025 children (9.4%) had physician- diagnosed asthma. O f those with moderate to severe asthma (n = 524), only 26% had taken a main tenance medication during the past month. Even among children with 2 or mor e hospitalizations over the previous year, only 32% had taken maintenance m edications. In a logistic regression analysis, factors significantly associ ated with inadequate therapy included: age less than or equal to 5 years. M edicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more l ikely to have taken maintenance medications than children surveyed before 1 991. Conclusion. Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable mo rbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.