329 - Caregiver Burden Among Families of Adolescents with Persistent Asthma

Publication Number: 2318.329

Amanda Milligan, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Maria Fagnano, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Emily Aman, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Paul Tremblay, University of Rochester Medical Center, Rochester, NY, United States; Jill Halterman, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: Adolescents with persistent asthma often require substantial caregiver involvement in their care, even as they transition toward greater self-management. These responsibilities can lead to disruptions in caregivers' work, sleep, and quality of life (QOL), yet how specific aspects of teen asthma functioning contribute to caregiver burden is not well understood.

Objective: To identify factors associated with caregiver missed work, sleep loss, and QOL, and to examine how adolescent asthma contributes to overall caregiver burden.

Design/Methods: We analyzed baseline data from caregivers of teens enrolled in the Telemedicine Enhanced Asthma Management - Uniting Providers for Teens (TUFT) study, conducted in a socioeconomically disadvantaged urban community (participation rate: 60%). Caregivers reported employment, missed work in the past 14 days (yes/no), nights of lost sleep, and asthma-related QOL (1-7 scale; higher=better). Teen asthma functioning included symptom-free days (SFDs), quick-relief medication use, activity limitation, and asthma-related school absences. Analyses included bivariate tests and multivariable models.

Results: Among 305 caregivers (mean age 40.5 years; 58% Black; 70% family income <$35,000), nearly 1 in 5 employed caregivers missed work due to their teen's asthma in the prior two weeks. Teens of caregivers who missed work had more activity limitation (4.4 vs 2.7 days, p=.03), more quick-relief medication use (6.5 vs 4.3 days, p=.02), and more school absences (1.4 vs 0.5 days, p=.02). In adjusted models, missed work was more likely when teens were limited in mild activities, such as walking, (aOR=3.10, 95%CI: 1.11-8.66) and when teens used more quick-relief medication (aOR=1.15, 95%CI: 1.00-1.32). Caregiver sleep loss increased with teen activity limitation (β=1.19, p=.02) and fewer teen SFDs (β=0.19, p<.001). Lower caregiver QOL was associated with teen activity limitation (β=-0.40, p=.002), more quick-relief use (β=-0.04, p=.015), more school absences (β=-0.08, p=.022), and caregiver depressive symptoms (β=-0.54, p<.001).

Conclusion(s): Although adolescence is a time of increasing independence, caregivers remain deeply affected by their teens' asthma-particularly when symptoms limit daily activities. Teen activity limitation emerged as the most consistent predictor across models, associated with greater work disruption, sleep loss, and poorer caregiver QOL. These findings highlight the interconnected physical, psychosocial, and economic impact of teen asthma on families and the need for family-centered interventions that support both adolescent self-management and caregiver wellbeing.

Table 1. Caregiver and Teen Characteristics


Table 2. Associations Between Teen Asthma Functioning and Caregiver Burden
Analyses were limited to employed caregivers for missed-work comparisons (n=178) and included the full sample for sleep and QOL analysis (n ≈ 300).
Group differences in teen functioning by missed-work status were tested using independent-samples t-tests for continuous variables and χ² tests for categorical variables.
Associations of teen functioning with caregiver nights of sleep loss and QOL were evaluated using Pearson correlation coefficients (r) for continuous variables and t-tests for the categorical variable (limited in mild activities).
Statistical significance was defined as p < .05.

Table 3. Multivariable Models of Caregiver Burden Related to Teen Asthma Functioning
Logistic regression model for missed work due to teen asthma among employed caregivers.
Linear regression model for caregiver nights of sleep lost due to teen's asthma and caregiver asthma-related quality of life (QOL).
For interpretive clarity, the direction of the symptom-free days variable was reversed in presentation (fewer symptom-free days = worse control).
Significance levels: †p < .10, *p < .05, **p < .01, ***p < .001.
ns = not significant