Controlling childhood asthma: Study shows ‘mismatch’ between doctors’ instructions, parents’ understanding

Boston – A Harvard Medical School study of parents whose children have asthma shows roughly half don't know which type of asthma-control medication their child is taking and how often it should be used.

The researchers surveyed the parents and health care providers of 740 children with probable persistent asthma – defined as having asthma and using one or more controller medications.

Parents were given a list of brand and generic names for all asthma-control medications and asked to select their child’s medication and how often the child took it. Researchers then compared the parents’ answers to the physician’s instructions. Results showed that a “mismatch” between physicians’ instructions and the parents’ understanding was common: 49 percent of parents failed to identify both their child’s medication and the prescribed frequency.

According to the health care providers, the majority of children – 77 percent – had been prescribed an inhaled corticosteroid. However, 27 percent of the parents whose children were supposed to use the medication every day of the year said their children did not do so. That mismatch in understanding jumped to 54 percent among parents whose children were supposed to use the medication only on days when their asthma was active.

“Of course we need to improve provider-patient communication in the medical office … but providers may be unaware of their patient’s lack of adherence,” Dr. Ann Chen Wu, primary study author and associate professor at Harvard Pilgrim Health Care Institute, said in a press release. “A mismatch between parent and provider was more likely to happen if the parents felt that the medicine was not helping, or, conversely, if the parent believed their child did not need as much as prescribed.”

Researchers recommended increased focus on reducing misunderstanding between parents and health care providers regarding asthma-control medications. Wu also noted that a “substantial” number of health care providers’ instructions did not follow evidenced-based guidelines that call for daily use of asthma-control medication. “Adherence to the guidelines has demonstrated improved outcomes, decreased hospitalizations, emergency department visits and outpatient visits,” she said.

The study was published online May 17 in the Journal of Allergy and Clinical Immunology.