Trends in Asthma Control, Treatment, Healthcare Utilization and Expenditures among Children in the United States by Place of Residence: 2003-2014.

BACKGROUND: Examining national trends in asthma treatment and control is essential to inform treatment and public health initiatives.

OBJECTIVE: Explore national trends in asthma control and treatment over time among children and those residing in poor-urban areas.

METHODS: This was an analysis of trends from 2003-2014 among children (aged 1-17) in the Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of >3 canisters short-acting beta agonist (SABA) in 3 months, asthma attack, Emergency Department (ED)/inpatient (IP) hospitalization and systemic corticosteroids (SCS). Treatment included inhaled corticosteroids (ICS), controller medications, SABA and ratio of controller-to-total prescriptions ≥ 0.7. Other measures included the number of asthma medications, outpatient visits, asthma-specific drug and total expenditures per-patient-per-year.

RESULTS: There were 8.4 million children with asthma in the U.S. in 2014; 11.1% lived in poor-urban areas. There was a statistically significant decrease in the percentage of children using ICS, controller medications, daily preventive medications, SCS, SABA, > 3 canisters SABA (in 3 months), overall asthma prescriptions and outpatient visits. There was a significant increase in the percentage of children reporting having an asthma attack. Trends for children residing in poor-urban areas were compared to all others, however, limited data and variability in annual estimates prevent clear conclusions.

CONCLUSION: Results suggest lack of improvement in treatment and control since 2003 among children with asthma in the U.S. There is significant room for improvement in asthma control and disease management among children.