Pediatr Pulmonol. 2026 May;61(5):e71673. doi: 10.1002/ppul.71673.
ABSTRACT
BACKGROUND: Despite asthma being one of the most common chronic conditions among children in the United States, real-world evidence on medication adherence and healthcare utilization in underserved pediatric populations remains limited. Therefore, we aim to evaluate adherence, persistence, and asthma-related healthcare utilization among Medicaid-enrolled children receiving inhaled corticosteroids (ICS) versus ICS-long-acting beta-agonist (ICS-LABA) inhalers.
METHODS: We conducted a retrospective cohort study using Texas Children’s Health Plan claims data from 2016 to 2019. Children aged 4-17 years with asthma diagnoses and ≥1 prescription for an ICS or ICS-LABA were included. Adherence was determined as the proportion of days covered (PDC) of ≥ 50%, and persistence was defined as continuous therapy without a 60-day gap. The PDC ≥ 80% was evaluated in sensitivity analysis. Multivariable logistic regression was used to estimate adherence, asthma-related emergency department (ED) visits, and hospitalizations.
RESULTS: Among 8622 eligible children, 82.4% received ICS and 17.6% received ICS-LABA. In inverse probability of treatment weighting (IPTW) adjusted analyses, compared with ICS, ICS-LABA users had higher adherence rate i.e., 21.08% versus 16.56% achieved PDC ≥ 50% (aOR = 1.35; 95%CI: 1.25-1.45), and 10.82% versus 6.74% achieved PDC ≥ 80% (aOR = 1.61; 95%CI: 1.31-1.97). Refill persistence was also higher with ICS-LABA (36.16% vs. 23.35%, aOR: 1.86, 95%CI: 1.74-1.99). However, despite better adherence, we found ICS-LABA users exhibited greater asthma-related healthcare utilization, i.e., ED visits occurred in 18.69% versus 11.25% (aOR = 1.81; 95%CI: 1.56-2.11) and hospitalizations in 2.53% versus 1.00% (aOR= 2.55; 95%CI: 1.68-3.89), which persisted even after adjusting for adherence.
CONCLUSIONS: We found that adherence was greater in children with asthma who were dispensed an ICS-LABA as compared to those dispensed an ICS-only inhaler; however, adherence rates were low in both groups. Higher hospitalization and ED visit rates among those prescribed ICS-LABA therapy likely reflect higher disease severity in this group. Our findings should be interpreted in light of claims-based adherence measures and potential residual confounding due to unmeasured asthma severity and control.
PMID:42165090 | DOI:10.1002/ppul.71673
