Inadequate use of asthma medication in the united states: Results of the asthma in america national population survey

doi:10.1067/mai.2002.125489

Journal of Allergy and Clinical Immunology

Volume 110, Issue 1, July 2002, Pages 58-64

https://doi.org/10.1067/mai.2002.125489 Get rights and content

Abstract

Background: Studies of the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. Objective: We sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use. Methods: This study was based on a cross-sectional, national, random-digit-dial household telephone survey in 1998 designed to identify adult patients and parents of children with current asthma. Respondents were classified as having current asthma if they had a physician's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year. Results: One or more persons met the study criteria for current asthma in 3273 (7.8%) households in which a screening questionnaire was completed. Of these, 2509 persons (721 children <16 years) with current asthma were interviewed. Current use of anti-inflammatory medication was reported by 507 (20.1%). Of these, most were using inhaled corticosteroids (72.5%), with use of antileukotrienes reported by 11.4% and use of cromolyn-nedocromil reported by 18.6%. Of persons with persistent asthma symptoms in the past month, 26.2% reported current use of some form of anti-inflammatory medication. In bivariate analysis persons reporting lower income, less education, and present unemployment, as well as smokers, were significantly (P < .001) less likely to report current anti-inflammatory use than were other populations. In a multiple regression model nonsmokers and those of white, non-Hispanic ethnicity, as well as persons reporting less asthma control, were more likely to report current anti-inflammatory medication use. Conclusion: In the United States use of appropriate asthma therapy remains inadequate. Strategies to increase use of anti-inflammatory therapy among patients with asthma are needed. These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged. (J Allergy Clin Immunol 2002;110:58-64.)

Section snippets

Methods

The data for this study come from a national sample of adult patients and parents of children with current asthma. Eligible subjects were identified by means of telephone screening of a national random-digit-dialing sample of telephone-owning households. Sample weights were applied to correct the minor degree of disproportionate sampling when making estimates for the total population. Interviews were conducted by trained interviewers in 42,022 households with telephones in the United States and

Results

The survey yielded a national sample of 2509, with 721 children younger than age 16 years and 1788 adults with current asthma. The majority (58.2%) of persons in the sample were younger than 35 years of age, and the age range was less than 1 to 89 years. The demographic characteristics of the population are shown in Table I.

. Demographic characteristics of the sampled population (n = 2509)

Variable	Category	No. unweighted	% Weighted (± SD)
Age	<6 y	202	8.1 ± 0.5
	6-15 y	519	20.7 ± 0.8
	16-34 y	728	29.3 ± 0.9
	≥35

Discussion

The results from this representative national population study present a bleak picture of the status of asthma treatment in the United States. Reported use of anti-inflammatory asthma medications is low in persons for whom they are strongly indicated (ie, those with persistent asthma symptoms). It is even slightly lower in persons who describe asthma-related limitations in their lives, irrespective of their recent symptoms. Hence regardless of whether the criteria for judging the

Acknowledgements

We acknowledge the assistance of Patricia Vanderwolf and John Boyle of Schulman, Ronca & Bucuvalas for statistical analysis with this study.

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^☆: Supported by GlaxoSmithKline. Dr Adams is a recipient of the Thoracic Society of Australia and New Zealand/Allen and Hanbury's Respiratory Research Fellowship. Dr Fuhlbrigge is supported by a Mentored Clinical Scientist Development Award (1 KO8 HL03919-01) from the National Heart, Lung, and Blood Institute.

^☆☆: Reprint requests: Anne L. Fuhlbrigge, MD, MS, Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115.

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Asthma, Rhinitis, Other Respiratory DiseasesInadequate use of asthma medication in the united states: Results of the asthma in america national population survey☆,☆☆

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Lancet

Soc Sci Med

Efficacy and safety of inhaled corticosteroids in asthma

Am Rev Respir Dis

Effects of 6 weeks of therapy with oral doses of ICI 204,219, a leukotriene D4 receptor antagonist, in subjects with bronchial asthma

Am J Respir Crit Care Med

First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma

Thorax

Inhaled steroids and the risk of hospitalisation for asthma

JAMA

Expert panel report 2: guidelines for the diagnosis and management of asthma

Has asthma medication use in children become more frequent, more appropriate, or both?

Pediatrics

Inadequate therapy for asthma among children in the United States

Pediatrics

Guidelines and realities of asthma management. The Philadelphia story

Arch Intern Med

Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience

Arch Intern Med

The impact of socioeconomic status in the intensity of ambulatory treatment and health outcomes after hospital discharge for adults with asthma

J Gen Intern Med

Asthma, Rhinitis, Other Respiratory Diseases
Inadequate use of asthma medication in the united states: Results of the asthma in america national population survey☆,☆☆