Trends in Preventive Asthma Medication Use Among Children and Adolescents, 1988–2008

Abstract

To examine the trends in preventive asthma medication use among asthmatic children in the United States from 1988 to 2008.Asthmatic individuals aged 1 to 19 years with current asthma as part of the National Health and Nutrition Examination Survey during 3 time periods: 1988 to 1994, 1999 to 2002, and 2005 to 2008.Cross-sectional analysis of the study population for use of preventive asthma medication (PAM), including inhaled corticosteroids, leukotriene receptor antagonists, long-acting β-agonists, mast-cell stabilizers, and methylxanthines.In children with current asthma, there was an increase in the use of PAMs from 17.8% (SE: 3.3) in 1988 to 1994, to 34.9% (SE: 3.3) in 2005 to 2008 (P < .001). Adjusting for age, gender, race/ethnicity, and health insurance status, the odds of PAM use were higher in 2005 to 2008 compared with 1988 to 1994 (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI]: 1.5–4.5). A multivariate analysis over all 3 time periods showed lower use of PAMs among non-Hispanic black (aOR = 0.5, 95% CI: 0.4–0.7) and Mexican American (aOR = 0.6, 95% CI: 0.4–0.9) children compared with non-Hispanic white children. PAM use was lower in 12- to 19-year-olds compared with 1- to 5-year-olds and also in children who did not have health insurance compared with those who did have health insurance.Between 1988 and 2008, the use of PAM increased among children with current asthma. Non-Hispanic black and Mexican American adolescents aged 12 to 19 years, and uninsured children with current asthma had lower use of PAM.This study demonstrates an increased use of PAMs in asthmatic children in 2008 vs 1988. Although several factors are likely at work, it seems likely that the National Asthma Education and Prevention Program asthma treatment guidelines, initially released in 1991, are a major reason for this result. These guidelines, and subsequent updates in 1997 and 2007, emphasize the importance of inflammation in the pathophysiology of asthma and the value of preventive medications in reducing adverse outcomes (eg, emergency room visits, hospitalizations, and the use of systemic corticosteroids). It is plausible that the growth of direct-to-consumer pharmaceutical advertising may also have augmented the use of PAMs. The authors also point out that the lower use of PAMs in non-Hispanic black and Mexican American asthmatic children may partially explain the increased risk for adverse outcomes in these patient groups.