Underuse of controller medications in Egyptian asthmatic children

Abstract

Background: International guidelines recommend daily use of controller medications for children with persistent asthma. Several studies from different regions of the world have reported low asthma control among children. Objectives: To assess the frequency of underuse of controller medications in Egyptian children and to clarify the causes and predictors for this underuse. Methods: This observational cross-sectional study was held over a 12-month-period in Zagazig University Hospitals, including 460 children with persistent asthma. All studied patients were submitted to careful history taking, proper medical examination and subsequent sharing, with their parents, in filling a previously designated Arabic asthma interview format concerning the disease course, medications, parents' beliefs about asthma, and causes of underuse. Results: Of 460 children who have persistent asthma, 84.4% were underusers of controller therapy, with 63.5% reporting no controller use at all and 21.3% reporting improper use. More than half of the studied patients received their medications in emergency department (52.8%), and follow up with a general practitioner (52.2%) with less attendance to our outpatient asthma clinic (15.2%). The most important causes of underuse are non-prescription of controller drugs by managing physician (45%) and financial cost (28%). Furthermore, predictors of this underuse include false beliefs about asthma (OR = 56.2; 95% CI: 13.5-232, P < 0.05), negative family history of atopy (OR = 2.4; 95% CI: 1.10-5.18, P < 0.05), younger age of the patients (P < 0.05), and general practitioner as the treating physician (OR = 3.5; 95% CI: 1.99-6.16, P < 0.05). Conclusion: There is high frequency of underuse of controller medications among Egyptian asthmatic children. Non-prescription of controller medications by managing physician and financial cost remain the most important direct causes of underuse.

Keywords: underuse; controller medications; bronchial asthma; children

Egypt J Pediatr Allergy Immunol 2013;11(1):29-34