Baltimore, MD—While everyone agrees that children too often fail to take their asthma anti-inflammatory medication, why that occurs generated a lot of explanations in a recent survey.

A report based on interviews conducted with children who have asthma, their caregivers, and their clinicians was published recently in the Journal of Asthma. Because of the widespread lack of agreement, Johns Hopkins University School of Medicine researchers suggest their study highlights the need for improved communication among patients, families, and pediatric clinicians.

“Consistent use of daily anti-asthma drugs—generally steroids delivered by inhaler—is lifesaving and the best way to prevent recurrent exacerbations and costly hospitalizations,” pointed out lead author Carolyn Arnold of Johns Hopkins.

Arnold cites estimates indicating that as many as 60% of children with chronic asthma do not get or take their prescribed daily regimen of anti-inflammatory medication. For the study, a Medicaid managed care organization identified 88 children with asthma—aged 7 to 17 years—who received care at two hospital-affiliated pediatric clinics in Baltimore. Participants all had visited the emergency department for an asthma exacerbation between March 2013 and May 2014, and were also prescribed a daily inhaled corticosteroid.

After receiving invitations to be interviewed either in person or by telephone, 50 child-caregiver pairs opted to participate in the survey, and 34 of 50 corresponding clinicians also signed on. Most of the children, 90%, had non-Hispanic black caregivers, most of whom, 68%, had a high school education or less.

Each child and caregiver pair answered the same set of questions separately, with a simplified version available for children aged less than age 12 years; the 26 healthcare providers completed an online survey.

Participants were asked to rate the frequency with which they believed several barriers to medication use—medication runs out, forgetfulness, don’t think they need it, worry about taking medication every day, don’t want to admit they have asthma, too much of a pain, embarrassed and friends say not to take it—applied to the child on a five-point scale, from never to always.

In addition, children and caregivers completed the Asthma Control Test, a five-question test used to determine how well asthma symptoms are controlled, and the researchers gathered information on the estimated number of doses taken by the child in a typical week.

The top reasons provided for missing doses were forgetfulness (82% children, 80% caregivers, and 100% clinicians) and medication running out (65% children, 44% caregivers, and 94% of clinicians) as top barriers to medication adherence.

“There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications,” study authors concluded. “To tailor asthma management conversations, clinicians should understand family-specific barriers and child–caregiver disagreements.”