Parental attitude and knowledge towards asthma care measures for their children in Saudi Arabia

Abstract

Background: Appropriate asthma management in children reduces emergency department visits, hospitalization, and improves the quality of life. We aim to assess the level of children asthma control and its association with parental knowledge. Methods: A prospective study conducted to measure childhood asthma control with a validated childhood asthma control test (C-ACT), and to assess asthma knowledge among the parents of children aged 4-11 years and their parents upon asthma clinic visits. C-ACT score ≤ 19 is considered as uncontrolled child asthma. Results: We have invited 238 parents to participate in the study; 177 (74.4%) completed the survey. The mean age of the parents and their children were 38.8 ± 7.6 and 7.8 ± 2.7 years, respectively; 28.2% of parents were smokers, and 46.3% of them were college graduated. Nearly 61.6% of the parents and children scored ≤ 19 on C-ACT; 54.2% and 37.9% of parents knew how inhaled salbutamol and corticosteroids work, respectively. A quarter of the parents received an asthma action plan. Multinomial logistic regression analysis showed that parents who did not know their children's medications name (OR, 6.1; 95% CI, 2.15-17.29), and when to use inhaled corticosteroid (OR, 2.1; 95% CI, 1.32-3.45) were independent factors predicting uncontrolled asthma in children with score ≤ 19. Conclusions: The study indicated that there is an association between poor asthma control (scored ≤ 19 on C-ACT) and parental knowledge of asthma medications. The parents should be educated thoroughly on asthma care, including medications used to minimize asthma exacerbations in their children. K E Y W O R D S bronchial diseases, lung diseases, pediatric asthma 1 | INTRODUCTION Asthma is a common chronic respiratory disease in children. Uncontrolled asthma increases mortality, morbidity, emergency department (ED) visits, hospitalization, reduces the quality of life as well as increases health care costs. 1 An overall prevalence of asthma in children from Saudi Arabia ranged from 8% to 25%, depending on studies conducted over the past three decades. A recent study in Saudi Arabia reported prevalence of 45% of uncontrolled asthma in children. 2,3 In western countries, the reported prevalence of asthma in children was 8.6% in the United States (uncontrolled asthma 46%, 2010), and 11% in France (uncontrolled asthma 37.6%, 2013). 4-7

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

“…As observed by Ho et al [ 14 ], asthma knowledge is a multifaceted phenomenon, affected by complex sociodemographic and contextual factors, and the construction of a self-report asthma knowledge instrument to predict asthma outcomes may be an unfeasible task. Indeed, whereas some studies [ 3 , 4 , 5 , 6 ] reported an association between parental asthma knowledge and disease control as in our study, other studies did not [ 10 , 12 ]. This may also be ascribed to the general tendency of parents with poorer knowledge to underestimate the severity of asthma in their children and to report fewer symptoms [ 10 ].…”

“…Current evidence shows that the parental level of asthma-related knowledge may influence asthma management practices [ 2 ] and affect children’s disease control [ 3 , 4 , 5 , 6 ]. Much of the existing literature studying the impact of parental knowledge on childhood asthma outcomes focuses on mothers as the primary caregivers [ 5 , 7 , 8 , 9 , 10 , 11 ], suggesting that asthma in children is majorly managed by mothers.…”

Uncontrolled Asthma Among Children and Its Association With Parents’ Asthma Knowledge and Other Socioeconomic and Environmental Factors

“…In 2017, a study from two major hospitals in Riyadh, which included 297 physician-diagnosed asthmatic children aged 3-11 years, found that 60.3% of the participants had uncontrolled asthma symptoms [ 28 ]. In 2020, two cross-sectional studies, one from Al Madinah Al Munawarah (n=278) [ 29 ] and the other from Riyadh (n=177), revealed that 62.6% and 61.6% of the participants were not adequately controlled, respectively [ 30 ]. Although our study showed less concerning figures, these observations from local studies indicate alarming levels of uncontrolled asthma among the pediatric population.…”

“…A lack of adequate parental perceptions about asthma was more noticeable in another Saudi study (n=600), by Abu-Shaheen et al, where 53.5% of the respondents believed that asthma is solely a hereditary disorder, and 60.3% and 32% worried about the adverse effects of inhaled corticosteroids and the risk of drug dependency, respectively [ 33 ]. Moreover, Alhammad et al reported that a high percentage of parents were using asthma medications inadequately, as only 54.2% of the respondents were knowledgeable that salbutamol should be inhaled and only 37.9% knew the correct way to inhale corticosteroids [ 30 ]. Internationally, a recent systematic review of eight studies from different countries (three from Saudi Arabia) covering a total of 3,701 parents concluded that the levels of parental awareness and knowledge about asthma care are generally low [ 34 ].…”

“…Reportedly, poor parental knowledge about asthma was shown to be an independent factor for uncontrolled asthma [ 30 , 44 ]. For instance, a local study showed that unawareness among parents about their child’s medications’ names increased the odds of uncontrolled asthma by six-fold, whereas parental misconceptions regarding inhaled corticosteroid use increased the odds by two-fold [ 30 ].…”