Parental Perceptions and Preferences of Asthma Medication Delivery Devices in a Pediatric Emergency Room Pubblico

Abstract

Many children in the United States suffer from asthma, which is a common chronic lung disease characterized by airway inflammation and swelling. Typical symptoms include coughing, wheezing, shortness of breath, and sputum production. While patients and families can treat symptoms of asthma at home, there are numerous incidents in which parents bring asthmatic children to emergency departments for medical treatment.

Children’s National is one such hospital that treats children with asthma. The hospital is a world-renowned pediatric hospital located in the center of Washington, D.C. It is also the only pediatric level I trauma center in the nation’s capital, making it a premiere center to treat sick patients. Children’s National uses the short acting bronchodilator albuterol to treat children who come to the emergency department experiencing asthma attacks.   

Albuterol is typically administered either through a nebulizer or a metered dose inhaler with spacer (MDI+S). Both devices have been extensively studied to compare their efficacy in treating asthma. Studies have determined that the MDI+S is as effective as the nebulizer is at treating acute asthma exacerbations in pediatric emergency rooms. Additionally, the MDI+S cuts down time spent in the emergency department for patients. Thus, physicians at Children’s National have been attempting to treat children with albuterol via an MDI+S. However, some doctors have been met with parental resistance to this treatment plan.

Determining whether parents prefer the nebulizer or MDI+S and why is critical for understanding the treatment perceptions and preferences of parents. The culture of American biomedicine has swayed towards emphasizing the preferences and decisions of physicians. However, patient care in emergency departments will hopefully be improved upon by developing treatment plans in accordance with the preferences of not only the physicians but also patients and their families.

A sample of parents visiting the emergency department at Children’s National completed a survey inquiring into their perceptions and preferences of asthma medication delivery devices.  The responses from this research project conducted at Children’s National were used to explore parental perceptions as they relate to device ease, speed, comfort, and effectiveness.  

Table of Contents

Table of Contents

Chapter One: Introduction..................................................................... 1

Chapter Two: Literature Review........................................................... 4

Defining Asthma.................................................................................... 4

Etiology.................................................................................................. 5

Prevalence and Burden of Pediatric Asthma......................................... 7

Clinical Classification of Asthma Severity, Exacerbations, and Control ............................................................................................................... 9

Diagnosis and Treatment .................................................................... 12

Nebulizer versus MDI+S Efficacy ...................................................... 15

Asthma Education and Partnerships ................................................... 18

The Culture of American Biomedicine ............................................... 21

Parental Perceptions of Treatments and Disease ................................ 24

Parenting: A Cultural Construct ......................................................... 29

Children’s National: A Pediatric Emergency Room in Washington D.C ............................................................................................................. 34

Research Objectives and Hypotheses ................................................. 36

Chapter Three: Design and Methods.................................................. 39

Survey ................................................................................................. 39

Screening: Patient Eligibility .............................................................. 41

Survey Administration ........................................................................ 42

Data Storage and Analysis .................................................................. 44

Chapter Four: Quantitative Results.................................................... 48

Asthma Severity and Device Ownership Responses .......................... 48

Parent Perception Responses .............................................................. 51

Additional Variables ........................................................................... 55

Sample Demographic Distribution ..................................................... 57

Results of Regression Model .............................................................. 59

Chapter Five: Qualitative Results........................................................ 61

Convenience ........................................................................................ 63

Length of Treatment ........................................................................... 64

Medication Delivery Beliefs ............................................................... 64

Efficacy ............................................................................................... 65

Severity ............................................................................................... 67

Technique Demands ........................................................................... 68

Concluding Remarks ........................................................................... 69

Additional Themes .............................................................................. 72

Significance Results of Theme Discussion in Free Responses........... 73

Chapter Six: Discussion and Limitations............................................ 75

Limitations .......................................................................................... 81

Appendix ............................................................................................... 83

References ............................................................................................. 96

Tables:

Table 1. Reorganization of Response Scale ........................................... 47

Table 2. Association between Asthma Severity Indicators and Overall Device Preference ................................................................................... 49

Table 3. Association between Device Usage and Overall Device Preference ............................................................................................... 50

Table 4. Association between Device Ownership and Overall Device Preference ............................................................................................... 51

Table 5. Parental Responses: MDI+S and Nebulizer Variable Comparison ............................................................................................. 52

Table 6. Parental Responses: Significance of MDI+S and Nebulizer Variable Comparison .............................................................................. 53

Table 7. Overall Device Preference by Demographic Distribution ....... 58

Table 8. Significance of Overall Device Preference by Theme Discussion ................................................................................................................. 62

Table 9. Correlation Significance between Asthma Severity, Device Usage, and Device Ownership Variables and Overall Preference.......... 92

Table 10. Correlation Significance between Device Perception Variables and Overall Device Preference................................................................ 92

Table 11. Correlation Significance between Responses to Hospital Preference Questions and Overall Device Preference............................. 93

Table 12. Correlation Significance between Sample Demographic Variables and Overall Device Preference............................................... 93

Table 13. Correlation Significance between Coded Free Responses and Overall Device Preference....................................................................... 94

Table 14. Model Summary ..................................................................... 95

Table 15. Change Statistics..................................................................... 95

Table 16. Coefficients ............................................................................ 95

Figures:

Figure 1. Image of a nebulizer shown to parents during parental perceptions survey................................................................................... 43

Figure 2. Image of an MDI+S shown to parents during parental perceptions survey................................................................................... 43

Figure 3. Chart indicating where parents prefer to bring their child with asthma...................................................................................................... 56

Figure 4. Chart displaying likelihood of parents bringing their child to a hospital that primarily uses MDI+S to treat asthma ............................... 57

About this Honors Thesis

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School	Emory College
Department	Anthropology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Anthropology, Cultural
Parola chiave	Asthma Inhaler Nebulizer
Committee Chair / Thesis Advisor	Worthman, Carol, Emory University
Committee Members	Brown, Peter, Emory University Salhi, Bisan, Emory University

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