Poor Understanding Of Childhood Asthma And Medicines Needed To Treat It May Be Endangering Children's Health

One in four parents of children with asthma do not understand the difference between the asthma medicines their children need to relieve symptoms when they occur and those they need to take regularly to control the disease by preventing asthma attacks from occurring, according to the findings of a new pan-European survey. Parents also report that only four out of 10 asthmatic children take their 'controller' asthma medication regularly whether they have symptoms or not, something experts agree is essential to minimize long-term lung damage in the growing number of children with asthma around the world.

The compelling results of the survey — the first to assess the social and psychological impact of asthma on parents of children with asthma and their level of knowledge about the disease and how to treat it — were presented for the first time today during the annual meeting of the European Academy of Allergology and Clinical Immunology (EAACI) taking place here.

"Asthma is the epidemic of the 21st century," said Prof. Jean Bousquet, Chairman of the Global Initiative for Asthma (GINA) and Professor of Respiratory Medicine at the University of Montpellier in France. "These findings, which provide us with insights into the real-life issues facing asthmatic children and their families, are disappointing. They show that we need to find new ways to help families understand the importance of preventing asthma symptoms and achieving long-term management of the disease."

Prof. Bousquet underscored the need for better education about asthma and access to easy-to-take treatment for children with asthma. "Parents are the caretakers of their children's health and we are concerned that the correct education on controlling asthma is not being passed on to the children, who will ultimately need to manage the condition without their parents' support."

Results Indicate Childhood Asthma Not Under Control

The survey findings suggest that many children are not taking controller medication on a regular basis and therefore may not be receiving the full benefits of available asthma treatment, which may be causing them to miss out on important educational, social and sporting opportunities at school and at home. The responses of 631 parents of children with asthma who were surveyed this year in five European countries — France, Germany, Great Britain, Italy and Spain — revealed that:

• One in 4 parents of children with asthma believe that "controller therapy" is short term, fast acting medication that stops asthma symptoms after they have begun or when you experience an asthma attack - which is in fact the definition of reliever therapy.
• Three in 10 parents do not consider taking their children's asthma medication with them when planning family excursions and holidays.
• One in 7 children forget to take their asthma medication or take it at the wrong time, according to their parents.

The survey also showed that many parents of children with asthma said they worry about how the disease is affecting their lives and those of their children. A quarter of the parents surveyed expressed worry about:

• Environmental factors beyond their control affecting their child — such as pollen, tobacco smoke or other irritants — which are common triggers of asthma attacks.
• The possible long-term harmful effects of asthma treatments.
• Their child's ability to participate in games, lessons or play sport because of the asthma.

Finally, 40 percent of those surveyed — 2 in 5 parents — agreed that having a child with asthma has made life more stressful for them.

"It is understandable that parents are worried about their child's asthma, particularly if they do not have all the information they need to help control their disease and prevent asthma symptoms," said Dr. Errka Valovirta of Finland, a paediatric allergist who serves as vice-president of European Federation of Asthma and Allergy Associations (EFA) and a council member of the European Society of Paediatric Allergology and Clinical Immunology (ESPACI). Both organizations were involved in the development of the survey.

"This survey reinforces our view that we need to focus on asthma education programmes to improve parents' understanding about the proper management of asthma," Dr. Valovirta said.

His sentiments were echoed by Dr. Antonio Nieto, a paediatric allergist at Children's Hospital La Fe in Valencia, Spain, who also stressed the importance of good asthma control for the growing numbers of children who have the disease. "We now have convincing evidence that good asthma control reduces the need for hospital treatment and helps children lead normal lives at school, at home, on holiday and with their friends."

Dr. Nieto also said. "There are new, well-tolerated 'controller' treatments that come in tablet form and need only be taken once daily. This is ideal for children who might forget to take their treatment and has significant potential to improve compliance and control of asthma."

The survey was conducted by MORI, one of Europe's leading market research firms, with advice and counsel from the European patient asthma association, EFA, and ESPACI. EFA is an alliance of 40 patient organizations in 15 countries that works to promote prevention, research and education on asthma and allergy. It also represents the views and interests of people with asthma and allergies.

Founded in 1988, ESPACI is an independent scientific organization and a leading society for paediatric allergology in Europe. The society includes 300 members from 32 countries.

The survey was sponsored by Merck Sharp & Dohme (MSD), a leading research-based pharmaceutical company that recently introduced SINGULAIR TM (montelukast), a new, once-daily tablet and controller medication for the treatment of asthma in adults and children aged six and above.

SINGULAIR is a trade-unionsmark of Merck & Co., Inc., Whitehouse Station, NJ, USA

Topline Results

• MORI interviewed 631 parents of children (aged 0-17)* with asthma in France, Germany, Great Britain, Italy and Spain between 22 January - 27 March 1999.
• Each country's survey covered between 100 and 200 interviews.
• All interviews were conducted face-to-face, in-home and in the respective native tongues.
• The data have been weighted to the national profiles for each country.
• * Age range varied slightly by country

Here are the results from a five-country study carried out by the MORI Social Research Institute for Merck, among parents of children with asthma, on their perceptions and management of the condition.

Q Which, if any, would you say closely describes your understanding of the phrase 'controller therapy' …

• Short-term, fast-acting medications that stop asthma symptoms after they have begun or when you experience an asthma attack?
• Preventative medications that help keep asthma symptoms from occurring in the first place and are prescribed for daily use even if you don't have symptoms on a regular basis between attacks?

Base: All parents of children with asthma (631)

	Incorrect / Reliever (a)	Correct / Preventative (b)
	%	%
5 Country Average	26	60
Spain	29	71
France	26	64
GB	23	58
Italy	27	55
Germany	23	54

 

Q Now, thinking about your child's asthma, which, if any, of the following most closely describes your view? If you have more than one child with asthma, please think only about the oldest one.

Base: All parents of children with asthma (631)

Oldest Child …	5 Country Average
	%
Takes controller medication on a regular basis	41
Takes reliever medication to treat symptoms as they occur	54
Forgets to take or forgets to take it at right time	15
Experiences difficulties in taking correct dosage	6
Refuses to take medication	6
May pretend to take asthma medication	2
Am concerned about side-effects	5

Percentage of parents worried about possible long-term harmful effects from asthma treatment

Base: All parents of children with asthma (631)

	%
Spain	35
GB	28
Germany	27
Italy	14
France	10

 

Q Which, if any, of the following things on this list to do with your child's asthma do you worry about? If you have more than one child with asthma, please think only about the oldest one.

Base: All parents of children with asthma (631)

	%
Outside the home environment, coming into contact with allergens and irritants that cause asthma	37
Being in a situation e.g. at school, at a friend's house, at a cinema with people who don't know what to do when he/she has an asthma attack	34
Unpredictable nature of when an attack might occur	32
Not being able to join in games lessons or play sport	24
Possible long-term harmful effects from treatment	23
Friends/relatives who do not take asthma seriously and who, therefore, are reluctant to help or make concessions (e.g. stop smoking)	22
Taking time off school because of asthma	16
Being more stressed at exam time because of asthma	13
Family events/school outings being stopped short	13
Not being able to have access to new treatments	9
Emotional demands on the family	7

Source: MORI/Merck 1999