Study results published this May in the Journal of Allergy and Clinical Immunology revealed many parents may not completely understand their providers’ directions regarding the maintenance of asthma in their children.
Study authors concluded 72% of parents were aware of which class of controller medicine their provider prescribed and only 49% of the parents surveyed knew what kind of medication their children was supposed to be using and how often.
According to information provided by an American Academy of Allergy, Asthma & Immunology (AAAAI) May 20 press release, the study sample was comprised of 740 children with probable persistent asthma – which was defined by researchers as a diagnosis of asthma and a prescription of one or more controller medications. Both the parents and healthcare providers of these children were surveyed by mail, telephone, or in person.1
For the parent survey, a research assistant mentioned several brand and generic names for all asthma controller medications and then asked the parent to identify the medication his or her child was taking, as well as how regularly the child took the medication. The child’s physicians were asked similar questions and were invited to refer to the child’s electronic medical record when answering, if necessary. The parents’ responses were then compared to the instructions given by the child’s physician.1
Mismatches
Providers shared that 77% (572) of children were to be taking inhaled corticosteroids, 22% (224) were to be taking leukotriene antagonists and 10% (76) were to be taking a combination of inhaled corticosteroids/long-acting beta agonists.1
However, when compared with the parents’ responses, a discrepancy occurred for 29% (168) of children who were supposed to be taking inhaled corticosteroids, 10% (20) of children who were supposed to be taking leukotriene antagonists and 16% (14) of children who were supposed to be using a combination of controller medications.1
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Additional major discrepancies were identified when parents responded to questions regarding the rate of use.
For the 202 children who were supposed to be using the inhaled corticosteroids on a daily basis, year round, there were 27% of parents who answered differently. Likewise, in the 263 children who were supposed to be using inhaled corticosteroids every day when asthma is active, there was a discrepancy in understanding for 54%.1
Parents were not as likely to name the same controller medication type as the provider, regardless of dose and frequency, if they were Latino, had a smoker in the household, or believed that the controller medicine was not effective, the study said.2
Additionally, it was found that a considerable number of providers were prescribing asthma controllers less often than directed by evidence-based guidelines. Controller medications should be used on a daily basis with persistent asthma; however, the provider surveys revealed that only 50% of those sampled were given instructions to use their controller medications on a daily basis.1
The reason why many providers were prescribing controllers less regularly than called for by evidence-based guidelines is complicated, said lead author Ann Chen Wu, MD, MPH, associate professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.
“I think most providers understand what the national guidelines are, but it’s possible that a subset do not remember or know exactly what the guidelines are,” Wu said. “More likely, I think a lot of physicians probably do not believe patients can take controller medications as recommended by national guidelines. Remembering to take a controller medication daily – when you have no symptoms – can be difficult.”
Asthma controller medication guidelines have been developed because many studies demonstrate a significant decrease in asthma symptoms, hospitalizations, and emergency department visits when the medications are taken daily, Wu said.
“I think it’s very clear that the controller medications are efficacious, but the reality is, it’s very hard to take the medications as recommended,” she continued. “So I think many people adjust the recommendation.”
A Need for Improved Communication
Study authors concluded that efforts should concentrate on ways to diminish the discrepancies between parent and provider instructions relating to controller medication use. “I think efforts need to be made from all directions,” Wu said. “I think patients and parents could be more proactive about asking the provider which medications they should be taking.”
Another way that patients and parents could be more proactive is by letting their providers know which medications they’ve stopped taking and the reasons for this discontinuation, as well as any concerns they may have about medications. “I think sometimes providers assume that if their patients come in for another visit and they haven’t mentioned their asthma medication, they think that they’re still taking it, when maybe the patient decided to stop taking it,” Wu noted.
Patients could also ask for the asthma action plan, which is a written plan that lists all of the medications they should be taking while they’re well, sick, or very sick.
“I think that would help,” Wu said. “But on the flip side, it’s not all about the patients being more proactive. I think that providers also could remember to review the asthma medications at every visit, explain the importance of each of the controller medications they may be taking, and to provide the asthma action plan,” she added.
Additional Research
Another reason that patients might not take their controller medications as prescribed is because they don’t believe that it works, Wu mentioned. “I think that is actually true for 20% of patients – that specific medications don’t work for them – and I think this is based on genetics,” she said.
Therefore, Wu’s future research will involve working to develop genetic tests that will help predict which patient will respond to certain medications.
Kirsten Malenke is a staff writer at ADVANCE. Contact: [email protected]
References
1. The American Academy of Allergy Asthma & Immunology. JACI Study Finds Around Half of Parents May Not Understand Their Children’s Asthma Controller Medications. http://www.aaaai.org/about-aaaai/newsroom/news-releases/understand-asthma-meds
2. Wu, AC, et al. Mismatching Among Guidelines, Providers, and Parents on controller Medication Use in Children With Asthma. Journal Allergy Clin Immunol.
