The mean age of the children was 8.8 years, ranging from five to 13 years (). The majority were boys (59%), had parents with postsecondary education (62% of mothers and 70% of fathers) and were Caucasian (78%). Approximately two-thirds (64%) of the children were rated by their parents as having mild asthma, which was described as infrequent interference with normal lifestyle. Less than one-half (43%) stated that they had received any ‘special asthma education’ in the past, and greater than one-half (55%) of those received it more than four years ago. No significant difference was found in demographics, including differences in height, weight and age of diagnosis between the acceptable and poor control groups.
Demographics of children with an acceptable or poor level of asthma control
Of the 153 eligible respondents, 115 (75%) children had poor asthma control, whereas 38 (25%) children had acceptable control. The most commonly cited indicator of poor control was limitation in the amount or kind of play because of asthma symptoms (67%). Exacerbations (52%) and daytime asthma symptoms (49%) were also commonly reported indicators. Of those in the poor control group, 26% visited the emergency department an average of 1.8 times in the past year due to asthma. Sixty-eight per cent of poorly controlled participants had unscheduled physician visits (mean 3.1 visits) in the past year, but this was not significantly different from those with acceptable control (61%, mean 2.2 visits) (P=0.056 for mean visits). Significantly more children with poorly controlled asthma (81.4%) missed one or more school days due to asthma (mean 6.5 days) in the past school year compared with those with acceptable control (53%, mean 3.1 days) (P<0.05). Children who missed any school days due to asthma were 3.8 times (95% CI 1.55 to 9.41) more likely to have poor asthma control.
Inhaled corticosteroid and β2-agonist use
Data on medication use were available for 136 of 153 children (). Eighty-three (62%) of these children used inhaled corticosteroids. No significant difference was found between the use of inhaled steroids in the acceptable control group (55%) and the poor control group (64%). For children with poorly controlled asthma using inhaled corticosteroids, the majority reported ‘daily use’ (65%) as opposed to ‘as needed’ dosing (35%). Interestingly, the reverse was true for the acceptable control group, with 61% using inhaled corticosteroids as needed (P=0.05 versus poor control group). Inhaled corticosteroids were used by 42 of 59 (71%) children with prior asthma education and 41 of 77 (53%) children without prior asthma education (OR 2.17, 95% CI 1.06 to 4.45).
Use of medication in children with an acceptable or poor level of asthma control
Ninety-three (81%) children currently used β2-agonists in the poor control group compared with 71% in the acceptable control group (P=0.2). Data collected on the frequency of β2-agonist use was difficult to interpret because the responses contained insufficient information. In the poor control group, 17 (18%) children reported regular daily use of β2-agonists and seven (6%) children were currently using oral steroids.
Forty-one (28%) children reported receiving an action plan designed to guide treatment for symptomatic asthma (). Among those in the poor control group, 31 (28%) children had an action plan and 29 (93%) reported using it. These percentages did not significantly differ from those in the acceptable control group (26% had an action plan and 100% used it). Of the children without action plans, 52% (50 of 95 children) used inhaled corticosteroids, whereas of those with action plans, 81% (30 of 37) used inhaled corticosteroids (OR 3.86, 95% CI 1.54 to 9.64). Interestingly, significantly more parents in the poor control group reported that their child tried to avoid triggers some to most of the time (85%) compared with the acceptable control group (70%, P=0.04).
Self-management practices of children with an acceptable or poor level of asthma control
Exposure to smoking in the household
Sixty-seven (44%) households reported having smoke exposure in the home. Fifty-nine (51%) of the children in households with smokers (occasional and regular) were in the poor asthma control group compared with eight (21%) in the acceptable control group (P<0.001) (). Children exposed to cigarette smoke were 4.0 times (95% CI 1.67 to 9.35) more likely to have poor control. Each hour of smoke exposure per week increased the risk of having poor control by 33% (OR 1.33, 95% CI 1.02 to 1.74). Using a multivariate logistical regression analysis of all significant variables, the only variable that remained a significant predictor of poor control was cigarette smoke exposure (). Of those taking inhaled corticosteroids, a significantly higher percentage were from nonsmoking homes (65% [54 of 83 children], P=0.021).
Odds ratios on significant variables for poor asthma control after multivariate analysis
Children with poorly controlled asthma had significantly worse mean parental perception scores on a scale of one (strongly disagree) to five (strongly agree) (). The poor control group scored significantly worse than the acceptable control group on the child’s confidence level in daily asthma management (3.6 versus 4.1, P=0.009), interference with social life (2.3 versus 1.5, P<0.001), interference with school performance (2.4 versus 1.4, P<0.001), active participation in sports (3.7 versus 4.2, P=0.01) and fears that asthma may cause death (2.0 versus 1.6, P<0.05).
Parent perceptions of the psychosocial impact of asthma on their child in acceptable and poor asthma control groups