WIP 32 - Association Between Neurodevelopmental Conditions and Asthma Medication Adherence and Control in a Pediatric Asthma Trial

Publication Number: WIP 32.7462

Sonia Radu, UMass Chan Medical School, Uxbridge, MA, United States; Christine Frisard, University of Massachusetts Medical School, Worcester, MA, United States; Sybil Crawford, University of Massachusetts Medical School, Worcester, MA, United States; Melissa Goulding, University of Massachusetts Medical School, Worcester, MA, United States; Grace Ryan, University of Massachusetts Medical School, Worcester, MA, United States; Michelle Spano, UMass Chan Medical School, Worcester, MA, United States; Deicy Mejia Agudelo, Umass Chan Medical School, North Brookfield, MA, United States; Stephanie Simms, University of Massachusetts Medical School, Charleston, SC, United States; Jeneva A. Smith, UMass Memorial Children's Medical Center, Shrewsbury, MA, United States; Milagros C.. Rosal, UMass Chan Medical School, Worcester, MA, United States; Stephenie C. Lemon, UMass Chan Medical School, Worcester, MA, United States; Nancy Byatt, UMass Chan Medical School/UMass Memorial Health, Shrewsbury, MA, United States; Wanda Phipatanakul, Boston Children's Hospital, Hopkinton, MA, United States; Lynn B. Gerald, University of Illinois at Chicago, Chicago, IL, United States; sarabeth broder-fingert, UMASS Medical School, Worcester, MA, United States; Lori Pbert, University of Massachusetts Medical School, Harvard, MA, United States; Michelle Trivedi, UMass Memorial Children's Medical Center, Worcester, MA, United States

Background: Asthma Link is an intervention of school-supervised inhaled corticosteroid (ICS) administration, wherein pediatric providers identify children with persistent/poorly controlled asthma and engage school nurses to initiate daily supervised administration of ICS. Pilot studies have demonstrated potential for Asthma Link to improve ICS adherence and asthma symptoms. Children with comorbid attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), the most common neurodevelopmental conditions, tend to have worse asthma outcomes due to sensory, behavioral, and executive function challenges, which may impact asthma management, particularly adherence to a daily ICS. We hypothesize these neurodevelopmental comorbidities may pose challenges and influence asthma self-management, ICS adherence, and asthma outcomes. This has not been previously explored and may guide targeted self-management strategies for children with ADHD/ASD.

Objective: To investigate whether children with ADHD or ASD have different baseline daily ICS adherence and asthma control test (ACT) scores than children without these diagnoses enrolled in a clinical trial of Asthma Link.

Design/Methods: To date, our ongoing clinical trial has enrolled an initial sample of 125 children identified by pediatric providers to have persistent/poorly controlled asthma requiring daily ICS therapy. ADHD or ASD diagnoses were obtained from medical record problem lists. Baseline ICS adherence was evaluated using the Pediatric Inhaler Adherence Questionnaire and pharmacy refill data over the 6 months preceding study enrollment. Childhood-ACT (age 5-11) and ACT scores (age 12+) were measured at baseline for all participants. Differences in baseline ACT scores between children with/without ADHD/ASD diagnoses were estimated using multi-level logistic and linear regression models, adjusting for age, gender, socioeconomic status, medication regimen, number of parents/guardians at home, and a random effect for clinic to account for correlation within pediatric practice.