Don't Rely on Asthma Steroid Use Reporting


DENVER – Physicians can't rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it's best to have parents bring the canister into the office and check the dose counter, according to pediatrician Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters' dose counters.

They visited families' homes as part of an asthma education study, and the parents didn't know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

“Now we know what the reality is. They are not using the pump as they are supposed to,” Dr. Reznik said at the meeting.

Poor ICS adherence is nothing new, but the phenomenon hasn't been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2–9 years and were patients at a Bronx community health center. The parents' average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don't quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It's not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn't find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures.

The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children's Hospital at Montefiore in the Bronx.

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