Use of inhaled anti-inflammatory medication in children with asthma in managed care settings

Background: Many factors affect use of inhaled therapy in asthma. Relativel y little is known about current patterns of use of anti-inflammatory medica tion in children with asthma and whether variations occur with age and use of bronchodilator medication. Objective: To study the factors associated with dispensing of anti-inflamma tory (controller) asthma medication to children in 3 managed care organizat ions (MCOs). Methods: Using automated databases, a 1-year cross-sectional study of child ren with asthma aged 3 to 15 years cared for in 3 MCOs was used to evaluate the association of age and other factors with controller medication use. Results: A total of 13352 children were studied. Significantly fewer childr en aged 3 to 5 years were dispensed any (greater than or equal to1) control ler medication than older children (P<.001). Among children dispensed 6 or more <beta>-agonists, only 39% also received 5 or more controller dispensin gs, with adolescents significantly less likely than younger children to rec eive 5 or more controllers (33%; P<.001). Significant differences were seen among MCOs in proportions of patients dispensed controller medication. In a multiple logistic regression model, controlling for frequency of P-agonis t dispensing and MCO, significantly lower dispensing of any controller medi cation was seen for those aged 3 to 5 years (odds ratio [OR], 0.8; 95% conf idence interval [CI], 0.7-0.9) and for girls (OR, 0.9; 95% CI, 0.8-0.96). I n contrast, for repeated (<greater than or equal to>5) controller dispensin g there were significantly fewer dispensings to adolescents (OR, 0.7; 95% C I, 0.6-0.9) and girls (OR, 0.8; 95% CI, 0.7-0.9). Conclusions: There may be differences in the use of preventive asthma medic ation in children that are affected by age, sex, and health care organizati on. Few children with frequent symptoms are using controllers regularly, as is recommended by national guidelines.