To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient.
Poor adherence to inhaled corticosteroids (ICSs) may contribute to the recent rise in asthma morbidity. In general, appropriate adherence to ICSs is a complex process that is influenced by various determinants. The purpose of this study was to identify factors that were associated with adherence to ICSs in children with asthma and their parents in a multi-ethnic population in Amsterdam, the Netherlands. Two hundred and thirty-two children, aged 7-17 years, with paediatrician diagnosed asthma and their parents completed questionnaires examining socio-demographics, asthma control, knowledge of asthma and other determinants of adherence. Adherence to ICSs was assessed by self-report and pharmacy record data. We used logistic regression analyses to identify factors associated with adherence to ICSs in children and parents separately. We found no differences in adherence between the different ethnic groups. In the multivariate analysis for children, well-controlled asthma (OR: 4.12; CI: 1.50-11.3) was associated with poorer adherence, whereas positive subjective view of parents (OR: 0.45; CI:0.25-0.81) and self-efficacy (OR:0.51; CI: 0.35-0.75) were inversely associated with poorer adherence. A consistent result with the multivariate models for parents was the inversely significant association between poorer adherence and positive subjective view of parents to use ICSs (OR: 0.39; CI:0.19-0.77). Regardless of ethnic background, children positively stimulated by their parents to use ICSs showed a better adherence than children who experienced less positive influences. These results emphasise the importance of involving parents in the treatment of their child's asthma in order to enhance adherence to ICSs.
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