Study: Many Low-Income Caregivers Need Help With Asthma Control For Their Preschoolers

Michelle N. Eakin, PhD

In a study evaluating a home and community education program to improve asthma management among Head Start students with asthma, investigators found that a majority of families have insufficient availability of asthma medications in the home.

According to the American College of Allergy, Asthma and Immunology (ACAAI), 26 million Americans have asthma. Of that number, 7 million are children. Asthma symptoms are one of the leading causes of missed work for adults and school days for children.

The US Department of Health and Human Services Office of Minority Health states that African-American children are 4 times more likely to be admitted to the hospital for asthma, compared to non-Hispanic whites.

“African-American children are at greater risk for poor asthma outcomes,” lead researcher Michelle N. Eakin, PhD, assistant professor in the Pulmonary and Critical Care Medicine Department at John Hopkins University told MD Magazine^®. “It’s very important to develop tailored interventions for at-risk populations that will help families learn to manage their asthma.”

For their study, the investigators recruited participants from the Baltimore City Head Start programs from April 2011 to November 2016. Caregivers were eligible for the study if they were the parent or legal guardian of a child between the ages of 2 and 6, reported a physician diagnosis of asthma for their child, and spoke English.

The investigators conducted 2-hour home visits to 288 families for the study and reported all asthma medications prescribed and all asthma medications and devices currently in the home. Ninety-two percent of participants were African-American and 94% had state insurance coverage.

Medication readiness criteria included being able to locate each medication/device, unexpired medication, inhalers with counters that were filled with medicine, the caregiver knowing which medication was a rescue and which was a controller, and the caregiver being able to state dosing instructions.

Caregiver beliefs about medicine were evaluated using the Pediatric Asthma Medication Beliefs Assessment.

Although 96% of caregivers reported a rescue medication, only 79% had the medication inside the home, and 60% met all 5 medication readiness criteria. Of the 161 children prescribed a controller medication, 79% had it in the home and 49% met all 5 readiness criteria. There was an association between caregivers having fewer worries/concerns and higher odds of meeting all 5 readiness criteria for controller medications.

“We were definitely surprised by how many families did not have the medication in the home,” Eakin said. “Among those that did, many were expired or empty and the families were not aware since inhalers can still dispense propellant without active medication which looks like there is medicine being delivered when there is none.”

Eakin said that pediatric health care providers need to focus on interventions that will help families understand the importance of both rescue and controller medications in managing asthma. In addition, although this was one of the first studies to verify that families had medications in the home (and not rely on caregiver reporting), the investigators did not follow-up with families who said their medication was in another location.

“We need studies looking at what specific interventions will help families refill medications regularly and evaluate the impact on asthma outcomes, including asthma control, emergency room visits, and overall health-related quality of life,” concluded Eakin.

The study, “Home Medication Readiness for Preschool Children with Asthma,” was published online in Pediatrics.