Children and asthma in America 2004 survey

What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

BACKGROUND

Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes.

OBJECTIVE

The objective of this study was to describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population.

METHODS

Baseline data from 2 cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children's asthma medications and inhaler technique.

RESULTS

The sample contained 175 mainly Latino youth (85.6%) ranging from 5 to 18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine, and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. A better medication technique was associated with having a controller (b = 12.2, SE = 3.0, P < .0001), quick reliever (b = 8.05, SE = 3.5, P = .023), and a spacer (b = 9.3, SE = 3.54, P = .009).

CONCLUSIONS

This rigorous evaluation of the home medication environment of high-risk youth demonstrated that many families lack critical medications, devices, and a technique for proper management of asthma.

Comparison of the efficacy and safety of ciclesonide 160 microg once daily vs. budesonide 400 microg once daily in children with asthma

Ciclesonide is an onsite-activated inhaled corticosteroid (ICS) for the treatment of asthma. This study compared the efficacy, safety and effect on quality of life (QOL) of ciclesonide 160 microg (ex-actuator; nominal dose 200 microg) vs. budesonide 400 microg (nominal dose) in children with asthma. Six hundred and twenty-one children (aged 6-11 yr) with asthma were randomized to receive ciclesonide 160 microg (ex-actuator) once daily (via hydrofluoroalkane metered-dose inhaler and AeroChamber Plus spacer) or budesonide 400 microg once daily (via Turbohaler) both given in the evening for 12 wk. The primary efficacy end-point was change in forced expiratory volume in 1 s (FEV1). Additional measurements included change in daily peak expiratory flow (PEF), change in asthma symptom score sum, change in use of rescue medication, paediatric and caregiver asthma QOL questionnaire [PAQLQ(S) and PACQLQ, respectively] scores, change in body height assessed by stadiometry, change in 24-h urinary cortisol adjusted for creatinine and adverse events. Both ciclesonide and budesonide increased FEV1, morning PEF and PAQLQ(S) and PACQLQ scores, and improved asthma symptom score sums and the need for rescue medication after 12 wk vs. baseline. The non-inferiority of ciclesonide vs. budesonide was demonstrated for the change in FEV1 (95% confidence interval: -75, 10 ml, p = 0.0009, one-sided non-inferiority, per-protocol). In addition, ciclesonide and budesonide showed similar efficacy in improving asthma symptoms, morning PEF, use of rescue medication and QOL. Ciclesonide was superior to budesonide with regard to increases in body height (p = 0.003, two-sided). The effect on the hypothalamic-pituitary-adrenal axis was significantly different in favor of ciclesonide treatment (p < 0.001, one-sided). Both ciclesonide and budesonide were well tolerated. Ciclesonide 160 microg once daily and budesonide 400 microg once daily were effective in children with asthma. In addition, in children treated with ciclesonide there was significantly less reduction in body height and suppression of 24-h urinary cortisol excretion compared with children treated with budesonide after 12 wk.

Pharmacy fill patterns in young urban children with persistent asthma

BACKGROUND

Medication adherence impacts healthcare utilization. Pharmacy records are useful to establish fill patterns.

OBJECTIVE

Use pharmacy records to establish medication patterns fill patterns for comparison to healthcare utilization. Methods. Pharmacy records of 175 children with persistent asthma were collected and compared to healthcare utilization.

RESULTS

Majority of subjects had significant healthcare utilization, low numbers of rescue medications, and poor controller medication fill rates. Those with more rescue medications had more healthcare utilization and more controller medications.

CONCLUSIONS

Pharmacy fill patterns demonstrate few rescue and/or controller medication fills. Those with more rescue medications reported increased healthcare utilization despite controller medications.