Puerto Rican Children with Asthma Less Likely to Use Inhalers than Mexican American Children

Feb. 8, 2019
Latino girl with inhaler

Puerto Rican children were more likely to have poor or decreasing use of inhaled medication needed to control their asthma than Mexican American children, according to a new study by University of Rochester Medical Center researchers.

The study, published online in the Annals of the American Thoracic Society, also found that girls of both ethnic groups were more likely than boys to have poor or decreasing use of the asthma control medications.

Patients with chronic asthma often require consistent use of inhaled corticosteroids (ICS) even when their symptoms aren’t present in order to prevent exacerbations. This study, led by Kimberly Arcoleo, PhD, MPH, associate professor in the UR School of Nursing, is the first to show that unique ethnicities within Latino communities may be associated with difference levels of ICS adherence.

Kim Arcoleo

“Researchers tend to study Latinos as a single group, but we have seen that variations in controller medication adherence may be a factor in observed health disparities between Mexican and Puerto Rican children,” said Arcoleo. “Gaining a better insight into factors affecting medication adherence will provide evidence needed to identify children at the highest risk for acute episodes so that providers can offer more intensive interventions.”

The study followed 123 children, ages 5-12, with persistent asthma living in Phoenix, Arizona, and Bronx, New York, for one year. A device attached to their inhalers monitored their inhaler use, and the researchers categorized use as poor, moderate, declining adherence or increasing adherence. All of the children received their medication for free.

The study found that between 23 percent and 32 percent of all children had poor adherence (less than 50 percent of prescribed doses taken) and less than 15 percent had good adherence (more than 80 percent of prescribed doses taken) at each three-month follow-up appointment.

Puerto Rican children were more than five times as likely as Mexican American children to have their ICS use described as poor and nearly three times as likely to have their ICS use described as decreasing. Girls were five times as likely as boys to have their ICS use described as poor or decreasing. Children with poor adherence were more likely to go to the ER or be hospitalized for an asthma attack throughout the study period. 

“We have also demonstrated that adherence is not static and there are naturally changing patterns of children’s ICS adherence over time,” said Arcoleo. “We cannot assume that a child who demonstrates good adherence at one visit will remain adherent. We need easy-to-use, validated methods of assessing adherence during the clinical visit, which is something our team is working on developing.”

Co-authors on the manuscript include Jill Halterman, MD, MPH, professor in the Department of Pediatrics at the UR School of Medicine and Dentistry, and Hugh Crean, PhD, assistant professor of clinical nursing at the UR School of Nursing.