Inhaled corticosteroid beliefs, complementary and alternative medicine in children presenting to the emergency department for asthma

Abstract

Objective

Negative beliefs about inhaled corticosteroids (ICS) and endorsement of complementary and alternative medicine (CAM) have been associated with medication non-adherence and uncontrolled asthma. The association of CAM and negative health beliefs is not described in children in acute care settings. Our study objective is to determine the relationship between negative ICS beliefs, CAM use and poorly controlled asthma among a predominantly Latino population in an acute care setting.

Methods

The study was conducted in the pediatric emergency department of a children’s hospital. During an ED asthma encounter, validated questionnaires surveyed parents about negative ICS beliefs, CAM use, and asthma health and control. We compared asthma health reports between parents who did or did not endorse negative ICS beliefs or CAM use, by chi-squared test (or a Fisher’s exact test where appropriate)

Results

Parents of 174 children identified mostly as Latino with Medicaid insurance and high asthma morbidity. CAM endorsement and negative ICS beliefs were both associated with increased use of lifetime glucocorticoid (p = 0.03 and p=0.01 respectively). While CAM endorsement was associated with less hospitalizations (p = 0.04) and parental report of asthma “getting better” (p = 0.01), CAM users reported trouble with paying for rent or food (p = 0.02). Negative ICS beliefs and CAM endorsement were not associated with medication adherence.

Conclusions

Negative ICS beliefs are associated with higher number of oral glucocorticoid courses. The association between CAM endorsement and asthma control is varied, but mostly in favor of improved control. Financial difficulties may make CAM use more likely.

Keywords:

• pediatric
• negative health beliefs
• asthma control
• medication adherence

Acknowledgements

Research Associates: Anita Schmidt, Sofronia Munoz

Research Assistants: Chloe Holifield, Jessica Flores-Vasquez, Patricia Alvarez

Students: Stephanie Hernandez, Rafael Garibay Rodríguez

Declaration of interests

Study was approved by local Institutional Review Board. Funding was provided by the American Thoracic Society. Maureen George has received consulting fees from AstraZeneca, Mylan and Teva but these were not associated with this study.