Clark Noreen M, Dodge Julia A, Shah Smita, Thomas Lara J, Andridge Rebecca R, Awad Daniel
Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan, USA.
J Asthma. 2010 Mar;47(2):150-5. doi: 10.3109/02770900903483824.
Asthma severity, control, type of medical regimen provided, and compliance with it are not well understood in minority patients at the transition stage from childhood to adolescence.
Describe the level of asthma severity and control and the clinical regimens provided to a large population of low-income, African American children at this developmentally significant period.
Parents of 1292 children with asthma among 6827 preteens in 19 middle schools in predominantly African American (94%), low-income neighborhoods in Detroit, Michigan, were enrolled in the study. Data were collected through self-administered survey and telephone interviews and were useable for 936 participants. Study queries related to demographics, asthma symptoms, and medication use. Mixed effects models with a random intercept for school were used to determine severity and control and the association of medical regimens to these.
Sixty-seven percent of children with probable asthma had received a physician's diagnosis. Being female was associated with being undiagnosed (p = .02). Forty-seven with no diagnosis had persistent asthma and 10% of these were classified as severe. Sixty-eight percent with a diagnosis and asthma medicine prescriptions were not controlled. Compliant use of controller medicine was associated with poorer asthma control compared to noncompliant controller users (p = .04) and reliever-only users (p < .001). Thirty-nine percent of children had controller medicine; of those 40% were not compliant with controller use; 9% nebulized their controller medicine.
Care provided low-income minority children at an important stage in their development was not consistent with guidelines for asthma control. Therapy choices for treatment did not account for the actual level of their symptoms. Lack of an asthma diagnosis was significant in the population. Adolescent girls were at risk for not receiving a diagnosis. Patient compliance with asthma regimens was limited. Both clinician and patient education regarding effective asthma management appears needed regarding preteens in low-income minority communities.
在从儿童期向青春期过渡阶段的少数族裔患者中，哮喘的严重程度、控制情况、所采用的医疗方案类型及其依从性尚未得到充分了解。
描述在这一具有重要发育意义的时期，为大量低收入非裔美国儿童提供的哮喘严重程度和控制水平以及临床方案。
在密歇根州底特律市以非裔美国人为主（94%）的低收入社区的19所中学的6827名青少年中，选取1292名哮喘患儿的家长参与研究。通过自行填写调查问卷和电话访谈收集数据，936名参与者的数据可用。研究问题涉及人口统计学、哮喘症状和药物使用情况。采用具有学校随机截距的混合效应模型来确定严重程度和控制情况以及医疗方案与这些情况的关联。
67%可能患有哮喘的儿童已得到医生诊断。女性未被诊断的可能性更大（p = 0.02）。47名未被诊断的儿童患有持续性哮喘，其中10%被归类为重度。68%已被诊断并开具哮喘药物处方的儿童病情未得到控制。与不依从控制药物使用者相比，依从使用控制药物与更差的哮喘控制相关（p = 0.04），与仅使用缓解药物使用者相比也是如此（p < 0.001）。39%的儿童使用控制药物；其中40%不依从控制药物的使用；9%对控制药物进行雾化吸入。
在低收入少数族裔儿童发育的重要阶段所提供的护理与哮喘控制指南不一致。治疗选择未考虑他们实际的症状水平。在该人群中，未进行哮喘诊断的情况较为显著。青春期女孩有未被诊断的风险。患者对哮喘治疗方案的依从性有限。对于低收入少数族裔社区的青少年，临床医生和患者关于有效哮喘管理的教育似乎都很有必要。
