The extended family and the poor asthma control in children. A look at family functioning, authority and hierarchies

Introduction

To the Editor, Despite adequate administration of daily controller medication, the number of children with uncontrolled asthma is considerably high and reduced quality of life is observed in both parents and children with poor control.¹ Multiple psychosocial problems can contribute to poor asthma control in a similar proportion to poor treatment adherence.² From previous studies of psychosomatic families, it has been postulated that there are certain stereotypical types of organisation within them such as agglutination, reciprocal overprotection, rigidity and avoidance of conflict.³ These types of family patterns are highly related to the development and maintenance of psychosomatic symptoms which play an important role in the homeostasis of the family.⁴ From a systemic perspective, the family becomes the protagonist in the symptoms of the indicated patient (scapegoat). The objective of the present study was to identify behavioural patterns within the family unit with respect to the asthmatic patient with uncontrolled asthma and living in extensive families, putting emphasis on authority and hierarchy in such families. Seven extensive families with a child between the ages of 6 and 11 years old with uncontrolled asthma, confirmed when 19 or less points were reached by children after application of the asthma control test.⁵ Children's data were obtained from the database of the Institute for Scientific Research in Family, Allergy and Immunology in Morelia, Mexico, in May, 2008. Ten extensive families with a child with uncontrolled asthma were initially considered to be included in the study, but only seven of them finally decided to participate in it. Family functioning...