Achieving and maintaining asthma control in inner-city children

Scott, L.; Morphew, Tricia; Bollinger, Mary E.; Samuelson, Steve; Galant, Stanley P.; Clement, Loran T.; O’Cull, Karen; Jones, Felita; Jones, Craig

doi:10.1016/j.jaci.2011.03.020

Cited by 44 publications

(44 citation statements)

References 53 publications

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“…Most parents and children in our study population came from Caucasian middle-class families, and the study was performed in a dedicated, secondary care, specialised asthma clinic. However, previous studies pointed out the importance of ICS adherence in determining good asthma control in inner-city populations from ethnic minorities [11,12]. In addition, the relationship between adherence and asthma control in our study was not influenced by demographic and clinical characteristics of the study population.…”

Section: Strengths and Limitationscontrasting

confidence: 59%

“…Previous studies have also shown a high prevalence of well-controlled asthma during comprehensive guideline-based asthma care [11,12,23]. Because such comprehensive care comprises several components that may promote asthma control, including reduction of allergen and irritant exposure, identification and treatment of relevant comorbidity, and ensuring proper inhalation technique and self-management, the independent role of adherence in determining asthma control remained uncertain in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Thirdly, the focus of guideline-based comprehensive asthma care is not only on adherence, but also on improving inhalation technique, elimination of exposure to relevant allergens and irritants (including environmental tobacco smoke) and treating comorbidities such as allergic rhinitis, all of which may contribute to improved asthma control [10]. Previous studies have shown that such comprehensive asthma care with regular follow-up was associated with achieving and maintaining well-controlled asthma in innercity asthmatic children [11,12]. Although the authors suggested that adherence may explain the relationship between comprehensive asthma care and asthma control, adherence in these studies was assessed by healthcare providers instead of being monitored electronically.…”

Section: Introductionmentioning

confidence: 99%

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It’s the adherence, stupid (that determines asthma control in preschool children)!

et al. 2013

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Although guideline-based asthma care and adherence to inhaled corticosteroids are predictors of asthma control, the role of adherence in maintaining long-term asthma control is largely unknown. This study was designed to explore the relationship between adherence to inhaled corticosteroids and long-term asthma control in young children with asthma.In this observational study, 81 2-6-year-old asthmatic children, using inhaled corticosteroids, closely followed-up in a programme with extensive self-management training, were enrolled. Adherence was measured daily for 12 months using Smartinhaler (Nexus6 Ltd, Auckland, New Zealand) devices. Longterm asthma control was assessed by parents and physicians and included clinical assessment, an asthma control questionnaire and lung function measurement. We examined the association of adherence to asthma control, adjusting for seasonal influences and clinical characteristics.Median (interquartile range) adherence was 87% (70-94%), and 64 (79%) children had well-controlled asthma throughout follow-up. Adherence .80% was associated with better asthma control, and we found no important confounders of this association. Children with persistent mild symptoms had lower adherence rates (p50.028).Guideline-based asthma care was associated with good asthma control in most children. Adherence to inhaled corticosteroids was an independent strong predictor of long-term asthma control, with highest levels of asthma control found in children with adherence .80% of doses prescribed. @ERSpublications Adherence to inhaled corticosteroids strongly predicts long-term asthma control in young children

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Section: Strengths and Limitationscontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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It’s the adherence, stupid (that determines asthma control in preschool children)!

et al. 2013

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“…However, despite the availability of clinical practice guidelines and efficacious treatment options, [9][10][11][12][13][14] asthma is not well controlled for many patients, 15 and poorer asthma control is associated with higher costs and increased resource use. [15][16][17][18] In addition, large gaps still exist between the care recommended by guidelines and that actually provided, [19][20][21][22][23][24][25][26][27][28] and there is an inadequate focus on self-management. 29 A study from the Rand Corporation published in 2007 showed that adherence to 17 recommended ambulatory care indicators for children with asthma was only 46%.…”

mentioning

confidence: 99%

Improving Outcomes for Underserved Adolescents With Asthma

et al. 2014

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BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting. METHODS:Interventions were guided by the Chronic Care Model and focused on standardized and evidence-based care, care coordination and active outreach, self-management support, and community connections. RESULTS:Patients with optimally well-controlled asthma increased from ∼10% to 30%. Patients receiving the evidence-based care bundle (condition/severity characterized in chart and, for patients with persistent asthma, an action plan and controller medications at the most recent visit) increased from 38% to at or near 100%. Patients receiving the required self-management bundle (patient selfassessment, stage-of-readiness tool, and personal action plan) increased from 0% to ∼90%. Patients and parents who were confident in their ability to manage their or their adolescent' s asthma increased from 70% to ∼85%. Patient satisfaction and the mean proportion of patients with asthma-related emergency department visits or hospitalizations remained stable at desirable levels.CONCLUSIONS: Implementing interventions focused on standardized and evidence-based care, self-management support, care coordination and active outreach, linkage to community resources, and enhanced followup for patients with chronically not-well-controlled asthma resulted in sustained improvement in asthma control in adolescent patients. Additional interventions are likely needed for patients with chronically poor asthma control. Pediatrics 2014;133:e418-e427 Drs Britto and Byczkowski conceptualized and designed the project, contributed to the acquisition of the data and analysis and interpretation of the results, and drafted the initial manuscript; Ms Vockell, Ms Munafo, Ms Wimberg, and Mr Pruett contributed to the conception and design the project, the acquisition of the data, and analysis and interpretation of the results; Ms Schoettker contributed to the analysis and interpretation of the results and drafted the initial manuscript; Dr Yi contributed to the conception and design of the project and helped to draft the initial manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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“…Children living in poverty have been shown to have higher utilization of urgent and acute care, lower utilization of primary and specialist care, and higher prevalence of both asthma and obesity. [42][43][44] Even when obesity was recognized in this study, the provider did not always identify it as a discharge diagnosis. At the time of discharge only 5.4% of subjects with overweight or obesity received a diagnosis that indicated overweight or obesity.…”

Section: Discussionmentioning

confidence: 77%

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

Borgmeyer

Ercole²,

Niesen

et al. 2016

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS:A retrospective record review was conducted for children admitted to the hospital with asthma in 2012. Charts were reviewed for evidence of recognition, diagnosis, and treatment of overweight and obesity. Subjects were classified into age-adjusted Centers for Disease Control and Prevention weight categories based on BMI percentile and chronic asthma severity categories according to National Asthma Education and Prevention Program guidelines. RESULTS:A total of 510 subjects aged 3 to 17 years were studied. Obesity was present in 19.6% and overweight in 13.3% of subjects. BMI percentile was recorded in only 3.3% of all charts, in only 11% of subjects with obesity, and in 0% of subjects with overweight. BMI percentile was documented more often in subjects with severe obesity (P 5 .013) and with moderate to severe persistent asthma (P 5 .035). Only 9 of 168 subjects who were overweight or obese (5.6%) were given a discharge diagnosis indicating overweight or obesity, and 14 (8.3%) received treatment. Chronic asthma severity differed by BMI weight category (P , .001), with a significant relationship between obesity status and chronic asthma severity in older subjects (P 5 .033). There were no differences in severity of acute episodes based on weight group.CONCLUSIONS: Overweight and obesity were underrecognized, underdiagnosed, and undertreated in children hospitalized for asthma.

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Achieving and maintaining asthma control in inner-city children

Cited by 44 publications

References 53 publications

It’s the adherence, stupid (that determines asthma control in preschool children)!

It’s the adherence, stupid (that determines asthma control in preschool children)!

Improving Outcomes for Underserved Adolescents With Asthma

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

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