Are preschoolers and their families prepared to treat asthma?

Michelle Eakin, PhD

Roughly 8% of children aged younger than 18 years have asthma, and the chronic disease is a contributor to a number of other health concerns. According to a new report published in Pediatrics, many children are diagnosed with the condition in the early preschool years, and this age group is 3 times more likely to visit the emergency department (ED) or be hospitalized for the disease compared with older children.¹ However, their parents might not be getting the preparation they need to manage their child’s condition at home.

Michelle Eakin, PhD, associate professor in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University School of Medicine, Baltimore, Maryland, and coauthor of the report, says it’s important for pediatricians to realize that only 60% of caregivers had medications at home for their children that were not expired or empty.

“This is a concern because if the child starts to have asthma symptoms they need immediate access to this medication to help them breathe. In addition, less than half of the families had the controller medication available that was not expired or empty,” Eakin says. “The controller medication should be taken every day to prevent asthma symptoms. We know that many families do not take this medication as prescribed, but if it is not even in the home then the children have no opportunity to take it at all.”

The goal of the study, which involved interviews and a home visit with the parents and caregivers of more than 300 children aged 2 to 6 years, was to assess how prepared parents-particularly those in low-income and minority populations-were in providing medication and other treatments to their children.

During the home visits, a research assistant assessed 5 criteria-the availability of medications; whether the medications caregivers had on hand were expired; whether the medications included counters to indicate the number of remaining doses; whether medications used at home were “rescue” or controller medications; and whether caregivers fully understood dosing and administration instructions for these medications.

The study population-which was 92% African American-primarily used public health insurance with minimal copays for medications. Researchers found, however, that of the 96% of caregivers whose children used rescue medications, just 79% had the medication in their homes and only 60% met all 5 readiness criteria assessed by the research team. Of the children prescribed controller medications, the study team found that just 79% had those medications in the home and 49% met the 5 readiness criteria. Overall, researchers found that caregivers with fewer concerns about the medications their children were prescribed were more likely to meet all 5 criteria assessed for controller medication readiness.

Eakin says the research team was surprised at how many families didn’t have the medications they needed in their home, and how many had expired medications that might not provide the child the therapy they need during an exacerbation.

“Among those who did have some medications in the home, many were expired or empty, and the families were not aware because inhalers can still dispense propellant without active medication, which looks like there is medicine being delivered when there is none,” Eakin explains.

Pediatricians must be vigilant in educating parents and caregivers on medication administration and guide them to resources that can help them obtain those medications.

“We need to focus on educating families to understand the importance of both rescue and controller medications in managing asthma. Families need to be taught how to check expiration dates and when an inhaler is empty using the attached counter,” Eakin says. “Pediatric health providers may want to check to see if families report having the medicine in the home and school. They may have to work with pharmacies to ensure families pick up refills when needed. Finally, policy changes in pharmacy benefits may be helpful to allow families to pick up more than 1 inhaler at a time to have the medications available in multiple locations such as home and school.”

Although the study did not assess how medication administration or availability in these cases did or did not contribute to ED visits or hospitalizations for asthma exacerbations, Eakin says medication availability does pose a problem.

“The lack of availability of the rescue medication puts the child at significant risk for an asthma exacerbation requiring an ED visit because the family will not be able to administer the medication when symptoms first start, which could escalate the child’s symptoms,” Eakin says.

The hope is that the study will motivate clinicians to follow up with families on medication needs and education on the use of those medications.

“I hope that this research will motivate healthcare providers to work with families to overcome barriers to having medications available including educating them on the role of medications, teaching them how to check for expiration dates and if it is empty. and working with insurance companies to fill multiple inhalers if needed,” Eakin says. “In addition, I hope that insurance companies review their policies for only filling 1 inhaler at a time to allow families to have medications available in multiple locations.”

References:

1. Callaghan-Koru JA, Riekert KA, Ruvalcaba E, Rand CS, Eakin MN. Home medication readiness for preschool children with asthma. Pediatrics. 2018;142(3):e20180829.