Arlene M Butz1, Melissa Bellin2, Mona Tsoukleris3, Shawna S Mudd4, Joan Kub4, Jean Ogborn5, Tricia Morphew6, Cassia Lewis-Land7, Mary Elizabeth Bollinger8. 1. Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: abutz@jhmi.edu. 2. School of Social Work, The University of Maryland, Baltimore, Md. 3. The School of Pharmacy, The University of Maryland, Baltimore, Md. 4. The Johns Hopkins University School of Nursing, Baltimore, Md. 5. Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md. 6. Morphew Consulting LLC, Bothell, Wash. 7. Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md. 8. Department of Pediatrics, School of Medicine, The University of Maryland, Baltimore, Md.
Abstract
BACKGROUND: Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied. OBJECTIVE: To examine the risk factors associated with VPC asthma in urban minority children. METHODS: This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months. RESULTS: At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14). CONCLUSIONS: Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.
RCT Entities:
BACKGROUND: Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied. OBJECTIVE: To examine the risk factors associated with VPC asthma in urban minority children. METHODS: This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months. RESULTS: At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14). CONCLUSIONS: Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.
Authors: Bradley E Chipps; Jonathan Corren; Elliot Israel; Rohit Katial; David M Lang; Reynold A Panettieri; Stephen P Peters; Judith R Farrar Journal: Ann Allergy Asthma Immunol Date: 2017-02 Impact factor: 6.347
Authors: Jason E Lang; Allen J Dozor; Janet T Holbrook; Edward Mougey; Sankaran Krishnan; Shawn Sweeten; Robert A Wise; W Gerald Teague; Christine Y Wei; David Shade; John J Lima Journal: J Allergy Clin Immunol Pract Date: 2013-01-12
Authors: Melissa H Bellin; Cassie Land; Angelica Newsome; Joan Kub; Shawna S Mudd; Mary Elizabeth Bollinger; Arlene M Butz Journal: J Asthma Date: 2016-06-15 Impact factor: 2.515
Authors: Arlene M Butz; Mona Tsoukleris; Mary Elizabeth Bollinger; Mandeep Jassal; Melissa H Bellin; Joan Kub; Shawna Mudd; C Jean Ogborn; Cassia Lewis-Land; Richard E Thompson Journal: J Asthma Date: 2018-10-11 Impact factor: 2.515