Background: Asthma is the most common chronic illness in children. However,
adherence to asthma treatment guidelines In children is poor. The factors
associated with this nonadherence are not well understood.
Objectives: The purpose of this study was to assess adherence to national a
sthma treatment guidelines in pediatric Medicaid enrollees in Maryland. Fac
tors associated with nonadherence and with short-term persistence in nonadh
erence were studied.
Methods: Adherence was assessed by applying 7 criteria to Maryland Medicaid
claims data for children with asthma between the ages of 5 and 18 years. T
hese criteria were based on the National Heart, Lung, and Blood Institute's
National Asthma Education and Prevention Program (NAEPP). To examine patte
rns of nonadherence to guidelines, each patient's asthma medication use was
compared over 2 consecutive 6-month periods.
Results: The most frequently failed treatment criterion was lack of use of
anti-inflammatory inhalers in persistent asthma (20.2%). Compared with youn
ger children (5-8 years) older children (9-18 years) were at higher risk of
failing several of the criteria, including overuse of beta(2)-agonist inha
lers, inappropriate use of salmeterol, and lack of use of inhaled anti-infl
ammatory drugs. Prevalence of nonadherence was significantly different duri
ng the 2 periods (31.2% vs 18.9%; P <0.001), with adherence in 1 period hav
ing poor agreement with adherence in the second (<kappa> = 0.26).
Conclusions: Based on this study of Maryland Medicaid claims data, approxim
ately one third of children with asthma are not being treated in accordance
with current treatment guidelines. Older children are at higher risk than
younger children for nonadherence to NAEPP guidelines. Adherence to asthma
treatment guidelines varies over time, suggesting that patients' regimens s
hould be monitored frequently.