A new study by specialists at the
Johns Hopkins
Children's Center and elsewhere suggests that only one
in five inner-city children with chronic asthma gets enough
medicine to control dangerous flare-ups of the disease.
The findings, reported in December's
Pediatrics, are disturbing, the researchers say,
because preventive therapy failure leads to overreliance on
fast-acting "rescue" drugs after an asthma attack strikes
and to more complications and increased risk of death.
The scientists interviewed parents of 180 Baltimore
City children 2 to 9 years of age diagnosed with persistent
asthma and studied pharmacy records. Overall, only 20
percent of the 180 children got the recommended amount of
daily controller medication, which is six or more refills
in a 12-month period. Sixty percent got too little therapy
to fully prevent flare-ups, and 20 percent either got no
medication at all or relied solely on quick-relief rescue
drugs, which stop an asthma attack from progressing.
Current guidelines call for any child asthmatic with
wheezing, coughing and shortness of breath two or more
times a week, or with night-time symptoms two or more times
a month, to use inhaled corticosteroids as controller drugs
to curb inflammation and prevent acute attacks.
"It's clear that kids who need preventive drugs aren't
getting them," said lead author Arlene Butz, an associate
professor at the School of Medicine and an
asthma
specialist at the Children's Center. Previous research
indicates that inner-city children are at special risk
because their living conditions include asthma triggers
such as exposure to secondhand smoke and to mouse and
cockroach allergens.
The survey also showed that children cared for by
asthma specialists in or out of the hospital were more
likely to follow a proper drug regimen than those who were
not.
Butz and colleagues said that training primary care
pediatricians to check pharmacy records will help them
monitor their patients' adherence to the prescribed drug
regimen.
Asthma is the country's leading pediatric chronic
illness, affecting 6.2 million children under the age of
18.
Other Johns Hopkins researchers in the study were Kim
Mudd, of the Children's Center; and Michele Donithan, of
the Bloomberg School of Public Health. The University of
Maryland also participated in the study, which was funded
by the National Institute of Nursing Research.
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