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Randomized Controlled Trial
. 2018 May-Jun;6(3):844-852.
doi: 10.1016/j.jaip.2017.08.007. Epub 2017 Sep 22.

Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned

Arlene M Butz  1 , Melissa Bellin  2 , Mona Tsoukleris  3 , Shawna S Mudd  4 , Joan Kub  4 , Jean Ogborn  5 , Tricia Morphew  6 , Cassia Lewis-Land  7 , Mary Elizabeth Bollinger  8
Affiliations
Randomized Controlled Trial

Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned

Arlene M Butz et al. J Allergy Clin Immunol Pract. 2018 May-Jun.

Abstract

Background: Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied.

Objective: To examine the risk factors associated with VPC asthma in urban minority children.

Methods: This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months.

Results: At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14).

Conclusions: Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.

Trial registration: ClinicalTrials.gov NCT01981564.

Keywords: Asthma control; Children; Stepwise therapy; Very poorly controlled asthma.

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Figures

Figure 1
Figure 1
Recruitment and Retention Flow Diagram
Figure 2
Figure 2
Change in Asthma Control from Baseline to Six Month Follow-up (N=212). *At baseline, no child participant was categorized with Well-controlled asthma.
See this image and copyright information in PMC

Comment in

  • Rethinking Access to Care.
    Gergen PJ. Gergen PJ. J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):853-854. doi: 10.1016/j.jaip.2017.10.013. J Allergy Clin Immunol Pract. 2018. PMID: 29747988 No abstract available.

References

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