What Affects Asthma Medicine Use in Children? Australian Asthma Educator Perspectives

Abstract

The global burden of childhood asthma is significant. Health care systems are faced with increasing financial costs, while children with asthma and their caretakers are faced with poorer physical health, emotional health, and quality of life. Despite the availability of effective treatment, the quality use of asthma medicines in children remains suboptimal. An investigation was conducted to explore issues related to children's asthma medicine usage from the perspective of the health care professional. Although current literature has elicited the views of caretakers and children, the health care professional viewpoint has been relatively unexplored. Semi-structured qualitative interviews were conducted with a convenience sample of 21 Australian asthma educators. Interviews were audiotaped and transcribed, and transcripts were thematically analyzed with the assistance of NVivo 7. Emergent themes associated with health care professionals, parents, medicines, children, and educational resources were found. Major issues included a lack of information provided to parents, poor parental understanding of medicines, the high cost of medicines and devices, child self-image, the need for more child responsibility over asthma management, and the lack of standardization, access to, and funding for educational resources on childhood asthma. There are multitudes of key issues that may affect asthma medicines usage in children. This research will help inform the development of educational tools on the use of medicines in childhood asthma that can be evaluated for their effectiveness in getting key messages to target audiences such as children, caretakers, and teachers.

Medication Use in Children with Asthma: Not a Child Size Problem

“…Parental fear of ICS ("steroid phobia") is reported extensively as a major barrier to the use of and adherence to asthma medications ( 45,48,(64)(65)(66)(67)(68). Interestingly, an emerging trend is the high use of CAM.…”

“…One of the key themes to emerge from our review was that parental knowledge, attitudes, beliefs, socioeconomic characteristics, and family interaction patterns can all contribute to inappropriate use of medications (29,45,62,63). Parental fear of ICS ("steroid phobia") is reported extensively as a major barrier to the use of and adherence to asthma medications ( 45,48,(64)(65)(66)(67)(68).…”

“…Physician nonadherence to prescribing guidelines was frequently identified (43)(44)(45). Other prescribing concerns included "off-label" prescribing, for example, use of combination inhalers containing ICS and LABA in children under 6 years old.…”

“…Other prescribing concerns included "off-label" prescribing, for example, use of combination inhalers containing ICS and LABA in children under 6 years old. Over/underdiagnosis of asthma by physicians was also identified to be a problem (43)(44)(45)(46)(47)(48)(49)(50)(51)(52). In some studies, working with patients (and parents) from different ethnic backgrounds was associated with a lack of active communication about medications (53).…”

PACE: Pharmacists use the power of communication in paediatric asthma

“…A recent study by Grover and colleagues identified a key barrier to the management of paediatric asthma in primary care to be the inability of health care professionals to effectively communicate with the patient/ carer [5,9]. In further support of this point, 38 % of Australian parents feel they do not have enough information about their child's asthma [8].…”