Nebulizer use in inner-city children with asthma - Morbidity, medication use, and asthma management practices

Objective:To assess the frequency of nebulizer use, describe morbidity and patterns of medication administration, and examine the potential relationsh ips between inhaled anti-inflammatory medication administration, asthma mor bidity, and asthma management practices in children with asthma using a neb ulizer compared with children with asthma not using a nebulizer. Research Design: A cross-sectional, descriptive survey of previous events. Setting: Elementary schools and participants' homes in Baltimore, Md, and W ashington, DC. Participants: Six hundred eighty-six families of children aged 5 to 12 year s with a diagnosis of at least mild, persistent asthma. Interventions: None. Measurements and Main Results: Asthma morbidity, health care utilization, p attern of asthma medication administration, nebulizer use, and asthma manag ement data were collected by telephone survey administered to caregivers. N ebulizer use was defined as use at least 1 or more days per month during th e last 6 months. Of 686 children identified, 231 (33%) reported current neb ulizer use. Nebulizer users had significantly increased lifetime hospital a dmissions, hospitalizations, and emergency department visits in the last 6 months compared with nonnebulizer users. Inhaled corticosteroid administrat ion was low for both groups (nonnebulizer users, 8%; nebulizer users, 15%). In the nebulizer users group, administration of inhaled anti-inflammatory medications was associated with increased asthma morbidity (increased hospi talizations, days and nights with symptoms, and oral steroid use). Conclusions: Nebulizer use by inner-city children with asthma is higher tha n anticipated but is not associated with reduced asthma morbidity. This gro up of high-risk children was undertreated with inhaled corticosteroids for long-term control of asthma despite reports of adequate monitoring by a pri mary care physician.