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Among Latinos, Puerto Rican children less likely to use their asthma inhalers

February 08, 2019

Feb. 8, 2019-- Compared to Mexican American children, Puerto Rican children were more likely to have poor or decreasing use of inhaled medication needed to control their asthma, according to new research published online in the Annals of the American Thoracic Society.

The study also found that girls of both ethnic groups were more likely than boys to have poor or decreasing use of the asthma control medications.

In "Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Utilization," Kimberly J. Arcoleo, PhD, MPH, and co-authors report on what is believed to be the first study of adherence over time to inhaled corticosteroids (ICS) for asthma within Latino populations. To control asthma and prevent exacerbations, ICS need to be taken by those with persistent asthma even when their symptoms are not apparent.

The study followed 123 children, ages 5-12, with persistent asthma living in Phoenix, Arizona, and Bronx, New York, for one year. A device attached to their inhalers monitored their inhaler use, and the researchers categorized use as poor, moderate, declining adherence or increasing adherence. All of the children received their medication for free.

The study found:
  • Between 23 percent and 32 percent of all children had poor adherence (less than 50 percent of prescribed doses taken) at each three-month follow-up after enrollment.

  • Less than 15 percent had good adherence (more than 80 percent of prescribed doses taken) at each three-month follow-up after enrollment.

  • Puerto Rican children were more than five times as likely as Mexican American children to have their ICS use described as poor, and nearly three times as likely to have their ICS use described as decreasing.

  • Girls were five times as likely as boys to have their ICS use described as poor or decreasing.

  • Children with poor adherence were more likely to go to the ER or be hospitalized for an asthma attack throughout the study period.

Study limitations include the fact that the devices only stored data on ICS use for the most recent 30 days, so adherence was not continuous across the 12 months the children were followed.

Still, the authors believe their study may help focus intervention efforts on those who are least compliant with ICS use and those who are decreasing their use of the controller medications.

Dr. Arcoleo, who is an associate professor at the University of Rochester School of Nursing in New York, said that the study shows that there are naturally changing patterns of children's ICS adherence over time.

"As clinicians and researchers, we cannot assume that a child who demonstrates good adherence at one visit will remain adherent," she explained. "We need easy-to-use, validated methods of assessing adherence during the clinical visit, which is something our team is working on developing."
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About the Annals of the American Thoracic Society

The AnnalsATS is a peer-reviewed journal published by the American Thoracic Society. The Journal delivers up-to-date and authoritative coverage of adult and pediatric pulmonary and respiratory sleep medicine and adult critical care. The scope of the Journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists and the advancement of public health. In October 2018, the journal received its first impact factor with a ranking of 4.006.

Editor: David Lederer, MD, MS, associate professor of medicine and epidemiology and associate division chief for clinical and translational research at Columbia University.

About the American Thoracic Society

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society.

The ATS will hold its 2019 International Conference, May 17-22, in Dallas, Texas, where world-renowned experts will share the latest scientific research and clinical advances in pulmonary, critical care and sleep medicine.

American Thoracic Society

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