Just 60% of low-income urban preschoolers with asthma have the medications they need available at home, new findings from the U.S. show.

"Forty percent of families not having that available really puts them at risk for some bad outcomes," senior author Dr. Michelle N. Eakin of Johns Hopkins School of Medicine, in Baltimore, Maryland.

Preschoolers with asthma are more likely to visit the emergency department and be hospitalized than older children with asthma, Dr. Eakin and her team note in Pediatrics online. 

Guideline-based medication regimens

"Guideline-based medication regimens is a key strategy for controlling asthma symptoms in younger children and preventing hospitalizations," they write. But children's adherence to asthma treatment can be low, they add, especially among urban African Americans who already face increased risks of asthma morbidity.

Most studies of adherence have relied on filled prescriptions or patient report. To investigate whether medications were actually available in the home, Dr. Eakin and her colleagues analyzed data from the Asthma Basic Care Education in Head Start trial on 288 2- to 6-year-olds with asthma participating in Baltimore City Head Start programs. Sixty-one percent had uncontrolled asthma.

Ninety-six percent of caregivers reported having one or more rescue medications on hand, while 56% had at least one controller medication. Albuterol metered-dose inhalers (MDI) accounted for 89% of rescue medications prescribed. Fluticasone MDI was the most frequently reported controller medication (42%).

Rescue medications were ready for use only 60% of the time, and controller medications 49% of the time, based on five readiness index criteria. These include three availability criteria (located, not expired, and not empty) and two knowledge criteria (caregivers could state dosing instructions and determine if a medication was a controller or rescue).

One-third of children whose caregivers reported using an MDI had an empty canister, while 71% had spacers. Caregivers were more likely to meet knowledge requirements for rescue medications than for controller medications.

Providers should be aware that many families of children with asthma don't have medication available at home, Dr. Eakin said. "We need to look at the whole spectrum and make sure that they have the medicine in their homes, that they know when it's empty, and they know where to check if it's expired."

For children who attend school and may also stay with other family members, the researcher added, it can be difficult to keep track of medications. While families with the resources can buy an extra container of medicine out-of-pocket to keep at school or a relative's home, she added, Medicare typically does not cover multiple asthma medication refills. "It's a health policy issue that we really need to revisit," she said.