Asthma therapy may be underused in children

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The use of controller medications before an ER visit for Asthma may not affect whether a child is admitted to the hospital or given oral steroids, according to the results of a study presented this weekend at the annual meeting of the American College of Allergy, Asthma, and Immunology in Anaheim, California.

While this runs counter to previous reports suggesting that controller medications do have a beneficial effect on patient outcomes, the authors believe these findings may stem from compliance issues and other factors rather than from an actual lack of efficacy.

The study involved a review of the medical records of 354 children with Asthma who were seen at an ER for an Asthma attack between 2000 and 2003. 

The children consisted of 127 who reported using controller medications, such as inhaled corticosteroids and long-acting beta-agonists like salmeterol, and 227 children who did not.

Demographically, the groups were similar, but controller users were significantly older than nonusers: 6.9 vs. 4.7 years, lead author Dr. Helen C. Wang and colleagues, from Thomas Jefferson University in Philadelphia, note.

Fifty-eight percent of children who used controller medications had a previous hospitalization compared with 35 percent of nonusers. Similarly, the rates of hospitalizations requiring ICU admission and intubation were significantly higher in the controller group.

As noted, the ER outcomes of the two groups did not differ significantly. About 17 percent of patients in each group were admitted to the hospital and about 78 percent were given oral steroids in the ER. Lastly, new controller prescription rates were similar in the groups, hovering around 2 percent.

Rather than concluding that there is no benefit to controller use, Wang said the findings suggest poor compliance with treatment and overreporting of medication usage.

“I actually wasn’t really surprised by the findings,” she told Reuters Health. “The hypothesis I went into the study with was that there is probably a lot of overreporting of controller medication use. Ineffective technique is also a possible explanation.”

“The rates of controller usage in the study were reported rates,” Wang emphasized. “We, as physicians, need to take a step back and question how often are patients really taking their medication. We need to take time to educate them about controller usage, making sure they are complying with the treatment and using the proper technique.”

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