MILWAUKEE — An article published in the Journal of Allergy and Clinical Immunology shows that many caregivers, like parents, may not fully understand their providers’ instructions when it comes to keeping their children’s asthma under control. Overall, only 72% of parents knew which class of controller medicine their provider prescribed, and about half of the parents knew neither the medicine class nor its recommended frequency.
The study included 740 children with probable persistent asthma. Those with severe asthma were excluded. Their parents and healthcare providers were surveyed by mail, by telephone, or in person. During the parent survey, a research assistant shared a list of brand and generic names for all asthma-controller medications, and the parent was asked to select the medicine his or her child was taking and indicate how often the child used it. The responses were then compared against the physician’s instructions.
Providers reported that 77% of children were supposed to be taking inhaled corticosteroids, 22% were to be using leukotriene antagonists, and 10% were to be taking a combination of inhaled corticosteroids/long-acting beta agonists. When compared against the parents’ responses, however, a mismatch occurred for 29% of children who were supposed to be taking inhaled corticosteroids, 10% of children who were supposed to be taking leukotriene antagonists, and 16% of children who were supposed to be using a combination of controller medications.
“Of course, we need to improve provider-patient communication in the medical office, especially for controller medications for children with asthma, but providers may be unaware of their patient’s lack of adherence,” said primary author Dr. Ann Chen Wu of Harvard Pilgrim Health Care Institute.
Other significant mismatches were discovered when parents answered questions about frequency of use. For the 202 children who were supposed to be using the inhaled corticosteroids every day, year round, there were 27% of parents who reported otherwise. Similarly, in the 263 children who were supposed to be using inhaled corticosteroids every day when asthma is active, there was a mismatch in understanding for 54%.
“A mismatch between parent and provider was more likely to happen if the parents felt that the medicine was not helping or, conversely, if the parent believed their child did not need as much as prescribed,” Wu explained. “In addition, while only two of the five locations were able to offer the survey in Spanish, we noticed parents who self-identified as Latino were also more likely to have a mismatch.”
Wu also noted that a substantial number of providers were prescribing asthma controllers less regularly than called for by evidence-based guidelines. Controller medicines should be recommended for use on a daily basis with persistent asthma, but the provider surveys showed only 50% of these candidates were instructed to use their controller medication every day.
“Adherence to the guidelines has demonstrated improved outcomes: decreased hospitalizations, emergency-department visits, and outpatient visits,” Wu said. “However, we found that half of our pediatric providers recommended seasonal, periodic, or as-needed use of inhaled corticosteroids, which may not be in line with the guidelines.”