A new study by specialists at the Johns Hopkins Children's Center and elsewhere suggests that only one in five inner-city children with chronic asthma gets enough medicine to control dangerous flare-ups of the disease.

The findings, reported in December's Pediatrics, are disturbing, the researchers say, because preventive therapy failure leads to over-reliance on fast-acting "rescue" drugs after an asthma attack strikes and to more complications and increased risk of death.

The scientists interviewed parents of 180 Baltimore city children 2 to 9 years of age diagnosed with persistent asthma and studied pharmacy records. Overall, only 20 percent of the 180 got the recommended amount of daily controller medication, which is six or more refills in a 12-month period. Sixty percent of children got too little therapy to fully prevent flare-ups and 20 percent either got no medication at all or relied solely on quick-relief rescue drugs, which stop an asthma attack from progressing.

Current guidelines call for any child asthmatic with wheezing, coughing and shortness of breath two or more times a week or night-time symptoms two or more times a month to use inhaled corticosteroids as controller drugs to curb inflammation and prevent acute attacks.

"It's clear that kids who need preventive drugs aren't getting them," says lead author Arlene Butz, Sc.D., R.N., asthma specialist at the Children's Center. Previous research indicates that inner-city children are at special risk because their living conditions include other asthma triggers, such as exposure to secondhand smoke and mouse and cockroach allergens.

The survey also showed that children cared for by asthma specialists in or out of the hospital were more likely to follow a proper drug regimen than those who were not in these groups.

Butz and colleagues said training primary care pediatricians to check pharmacy records will help them monitor their patients' adherence to the prescribed drug regimen.

Asthma is the country's leading pediatric chronic illness, affecting 6.2 million children under the age of 18.

Other Hopkins researchers in the study: Kim Mudd, M.S.N., of the Children's Center; and Michele Donithan, M.H.S., of the Johns Hopkins Bloomberg School of Public Health.

Other institutions participating in the study: University of Maryland. The study was funded by the National Institute of Nursing Research.

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