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Use of Inhaled Anti-inflammatory Medication in Children With Asthma in Managed Care Settings
Robert J. Adams, MBBS, MD;
Anne Fuhlbrigge, MD, MS;
Jonathan A. Finkelstein, MD, MPH;
Paula Lozano, MD, MPH;
James M. Livingston, MBA;
Kevin B. Weiss, MD;
Scott T. Weiss, MD, MS
Arch Pediatr Adolesc Med. 2001;155:501-507.
Background Many factors affect use of inhaled therapy in asthma. Relatively little
is known about current patterns of use of anti-inflammatory medication 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-inflammatory
(controller) asthma medication to children in 3 managed care organizations
(MCOs).
Methods Using automated databases, a 1-year cross-sectional study of children
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 13 352 children were studied. Significantly fewer children
aged 3 to 5 years were dispensed any ( 1) controller medication than older
children (P<.001). Among children dispensed 6
or more ß-agonists, only 39% also received 5 or more controller dispensings,
with adolescents significantly less likely than younger children to receive
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 ß-agonist dispensing and MCO, significantly lower dispensing of any
controller medication was seen for those aged 3 to 5 years (odds ratio [OR],
0.8; 95% confidence interval [CI], 0.7-0.9) and for girls (OR, 0.9; 95% CI,
0.8-0.96). In contrast, for repeated (5) controller dispensing there were
significantly fewer dispensings to adolescents (OR, 0.7; 95% CI, 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 medication
in children that are affected by age, sex, and health care organization. Few
children with frequent symptoms are using controllers regularly, as is recommended
by national guidelines.
From the Channing Laboratory, Brigham and Women's Hospital, Harvard
Medical School, Boston, Mass (Drs Adams, Fuhlbrigge, and S. T. Weiss and Mr
Livingston); Center for Healthcare Studies, Northwestern University, Chicago,
Ill (Dr K. B. Weiss); Department of Ambulatory Care and Prevention, Harvard
Medical School and Harvard Pilgrim Health Care, Boston (Dr Finkelstein); and
Center for Health Studies, Group Health Cooperative of Puget Sound and the
Department of Pediatrics, University of Washington, Seattle (Dr Lozano).
Corresponding author and reprints: Anne Fuhlbrigge, MD, MS, Channing
Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115
(e-mail: anne.fuhlbrigge{at}channing.harvard.edu).
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