Asthmatic children whose parents have high expectations for their ability to function normally are less likely to have symptoms than other children dealing with the condition, according to a new study. Children also are more likely to use asthma controller medications appropriately if they have a routine for taking medicine and if their parents clearly understand how well symptoms can be controlled.

The study, which appears in the Oct. 2008 issue of Pediatrics, was led by researchers from the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care and Boston University.

“Our findings suggest that parents’ expectations and perceptions are key factors influencing how well their children’s asthma is controlled, and how effectively they use medications,” said Dr. Tracy Lieu, the study’s senior author.

Asthma is one of the most common childhood chronic illnesses and the most frequent cause of children’s hospitalization. Racial and ethnic minorities and families of low socioeconomic status are at increased risk of having poorly controlled asthma.

For this study, the investigators surveyed more than 700 parents of children aged 2 to 12 years with persistent asthma who received care at Neighborhood Health Plan and Harvard Vanguard Medical Associates in Boston. Parents were asked how well they believed their child’s symptoms could be controlled, how asthma would or would not limit their child’s activities and health, and about their child’s actual asthma symptoms. In addition, parents were asked about other competing family priorities such as financial and job concerns, neighborhood safety, family relationships and their own health.

Children were more likely to have troublesome symptoms if their parents had low expectations for how well their asthma could be controlled. They were also more likely to have poorly controlled symptoms if there was no set time or routine for taking asthma medication.

Concerns about other family issues and lack of parental knowledge about asthma were also related to worse asthma control. Some parents mistakenly thought asthma is an intermittent rather than chronic condition, that two days of symptoms per week was adequate control, and that medication use was necessary only when their child had symptoms or not at all. (Daily medication use is recommended for children with persistent asthma.)

The investigators believe it is important that clinicians identify and work with parents who have low expectations about asthma control and educate them about treatments that can improve their child’s condition.

“Raising parents’ expectations for how well their children can be doing with asthma may be one of the keys to reducing racial/ethnic disparities in asthma outcomes,” Lieu observed.

This researcher was funded by the National Institute of Child Health and Human Development. The funding and data sources for this study had no role in study design; in the collection, analysis, and interpretation of data; or in the writing of the report.

CITATION:

Pediatrics. Vol. 122, No. 4, Oct. 2008.

“Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma.”

Lauren A. Smith (1), Barbara Bokhour (2,3), Katherine H. Hohman (4), Irina Miroshnik (4), Kenneth Kleinman (4), Ellen Cohn (5), Dharma E. Cortés (6), Alison Galbraith (4), Cynthia Rand (7), Tracy Lieu (4,8)

(1)Department of Pediatrics, School of Medicine, Boston University, Boston, MA
(2) School of Public Health, Boston University, Boston, MA
(3) Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Boston, MA
(4) Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA
(5) Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
(6) Cambridge Hospital and Harvard Medical School, Cambridge, MA
(7) Department of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
(8) Children’s Hospital Boston, MA

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School’s Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Cambridge Health Alliance, Children’s Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Source: Harvard Medical School