| Background: International guidelines recommend daily use of controller
medications for children with persistent asthma. Several studies from
different regions of the world have reported low asthma control among
children.
Objectives: To assess the frequency of underuse of controller
medications in Egyptian children and to clarify the causes and predictors
for this underuse.
Methods: This observational cross-sectional study was held over a 12-
month-period in Zagazig University Hospitals, including 460 children
with persistent asthma. All studied patients were submitted to careful
history taking, proper medical examination and subsequent sharing, with
their parents, in filling a previously designated Arabic asthma interview
format concerning the disease course, medications, parents' beliefs about
asthma, and causes of underuse.
Results: Of 460 children who have persistent asthma, 84.4% were
underusers of controller therapy, with 63.5% reporting no controller use
at all and 21.3% reporting improper use. More than half of the studied
patients received their medications in emergency department (52.8%),
and follow up with a general practitioner (52.2%) with less attendance to
our outpatient asthma clinic (15.2%). The most important causes of
underuse are non-prescription of controller drugs by managing
physician (45%) and financial cost (28%). Furthermore, predictors of
this underuse include false beliefs about asthma (OR = 56.2; 95% CI:
13.5-232, P<0.05), negative family history of atopy (OR = 2.4; 95% CI:
1.10-5.18, P<0.05), younger age of the patients (P< 0.05), and general
practitioner as the treating physician (OR = 3.5; 95% CI: 1.99-6.16,
P<0.05).
Conclusion: There is high frequency of underuse of controller
medications among Egyptian asthmatic children. Non-prescription of
controller medications by managing physician and financial cost remain
the most important direct causes of underuse. |