Advances in pediatric asthma in 2014: Moving toward a population health perspective

Szefler, Stanley J.

doi:10.1016/j.jaci.2014.12.1921

Cited by 21 publications

(24 citation statements)

References 113 publications

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“…Research on the causes of asthma commonly focus on individual risk factors for the development of asthma with smaller clinical studies rather than population-level data. 19 However, many theories have been forwarded to explain population-based patterns. Earlier during the “asthma epidemic,” diagnostic transfer from other respiratory conditions was believed to contribute to increasing trends 7 : improved identification of asthma may have been driven by the recognition of the role of inflammation and more effective preventive treatment.…”

Section: Discussionmentioning

confidence: 99%

Changing Trends in Asthma Prevalence Among Children

2016

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BACKGROUND Childhood asthma prevalence doubled from 1980 to 1995 and then increased more slowly from 2001 to 2010. During this second period, racial disparities increased. More recent trends remain to be described. METHODS We analyzed current asthma prevalence using 2001–2013 National Health Interview Survey data for children ages 0 to 17 years. Logistic regression with quadratic terms was used to test for nonlinear patterns in trends. Differences between demographic subgroups were further assessed with multivariate models controlling for gender, age, poverty status, race/ethnicity, urbanicity, and geographic region. RESULTS Overall, childhood asthma prevalence increased from 2001 to 2009 followed by a plateau then a decline in 2013. From 2001 to 2013, multivariate logistic regression showed no change in prevalence among non-Hispanic white and Puerto Rican children and those in the Northeast and West; increasing prevalence among 10- to 17-year-olds, poor children, and those living in the South; increasing then plateauing prevalence among 5- to 9-year-olds, near-poor children, and non-Hispanic black children; and increasing then decreasing prevalence among 0- to 4-year-olds, nonpoor, and Mexican children and those in the Midwest. Non-Hispanic black-white disparities stopped increasing, and Puerto Rican children remained with the highest prevalence. CONCLUSIONS Current asthma prevalence ceased to increase among children in recent years and the non-Hispanic black-white disparity stopped increasing due mainly to plateauing prevalence among non-Hispanic black children.

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Section: Discussionmentioning

confidence: 99%

Changing Trends in Asthma Prevalence Among Children

2016

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“…11,36,37 Features of specialist care that favorably impact asthma outcomes have been suggested to include increased knowledge of guideline recommended care, more aggressive use of inhaled corticosteroids and written asthma action plans, more attention to determining and managing atopic triggers and allergic rhinitis, longer office visits with more frequent follow-up, and education provided by highly trained ancillary staff. 5,36,38 There are significant barriers to implementation of some of these processes in primary care, but sharing patient care provides the specialist with an opportunity to influence care beyond an individual patient.…”

Section: Discussionmentioning

confidence: 99%

Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences

Garbutt

Yan

Strunk

2016

The Journal of Allergy and Clinical Immunology: In Practice

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Background Although specialist asthma care improves children’s asthma outcomes, the impact of primary care management is unknown. Objective To determine if variation in preventive and acute care for asthma in pediatric practices affects patients’ outcomes. Methods For 22 practices, we aggregated 12-month patient data obtained by chart review and parent telephone interviews for 948 children, 3 to 12 years old diagnosed with asthma to obtain practice-level measures of preventive (≥1 asthma maintenance visit/year) and acute (≥1 acute asthma visit/year) asthma care. Relationships between practice-level measures and individual asthma outcomes (symptom-free days, SFD; parental quality of life, pQOL; emergency department visits, ED; and hospitalizations) were explored using generalized estimating equations, adjusting for seasonality, specialist care, Medicaid insurance, single family status, and race. Results For every 10% increase in the proportion of children in the practice receiving preventive care, SFDs/child increased by 7.6 days (p=0.02) and ED visits/child decreased by 16.5% (p=0.002), with no difference in pQOL or hospitalizations. Only the association between more preventive care and fewer ED visits persisted in adjusted analysis (12.2% reduction, p=0.03). For every 10% increase in acute care provision, ED visits/child and hospitalizations/child decreased by 18.1% (p=0.02) and 16.5% (p<0.001), respectively, persisting in adjusted analyses (ED visits 8.6% reduction, p=0.02; hospitalizations 13.9%, p=0.03). Conclusions Children cared for in practices providing more preventive and acute asthma care had improved outcomes, both impairment and risk. Persistence of improved risk outcomes in the adjusted analyses suggests practice-level interventions to increase asthma care may reduce childhood asthma disparities.

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“…This requires careful analysis of data regarding patient visits, medical costs, and urgent care utilization within a system, a population health perspective. 12 For example, Teach et al 13 recently reported risk factors for seasonal exacerbations, especially those that occur in the fall season. In general, the lower the pulmonary function, the higher the risk of an asthma exacerbation at any time during the year.…”

Section: New Strategies To Predict and Prevent Asthma Exacerbationsmentioning

confidence: 99%

“…However, we still need medications that prevent disease progression and the onset of the dis- Table 1 Key factors in asthma management for inner city children Asthma deaths and hospitalizations are decreasing but the African American/black population still bears a heavier burden of the disease It is important to standardize and harmonize asthma care; there is also a need for collaboration to address health disparities in asthma care Asthma care must be focused on achieving asthma control by preventing asthma exacerbations, progression, and adverse effects to medications Response to new medications has been linked to specific biomarkers, e.g., sputum or blood eosinophil count with anti-interleukin-5 therapy It is possible that poorly controlled asthma may lead to chronic obstructive lung disease, such as the "asthmachronic obstructive pulmonary disease overlap syndrome" ease. 2,8,12 There are reasons for optimism that our overall management of asthma will continue to improve. There are devices that can effectively measure adherence to asthma therapy and also send reminders when medication administration is delayed.…”

Section: Reducing Asthma Mortality Morbidity and Asthma Prevalence mentioning

confidence: 99%

“…12 The benefits and risks of such an approach, including an assessment of the costs of implementation will need to be carefully assessed in terms of lifetime benefits. It is hoped that this new form of treatment for childhood asthma coupled with preventative measures, such as environmental control measures, including but not limited to reduction in tobacco smoke exposure and smoking avoidance, will lead to an improved quality of life and reduced risk of chronic obstructive airway disease as children reach adulthood.…”

Section: Reducing Asthma Mortality Morbidity and Asthma Prevalence mentioning

confidence: 99%

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Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies

Szefler

2016

allergy asthma proc

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Asthma in the inner city contributes to high morbidity and mortality, and, in school children, reduced school attendance and alteration in academic performance. There is a need to improve asthma care in the inner city by reducing asthma exacerbations. Methods are currently available to predict and prevent seasonal exacerbations of asthma. In addition, new medications are being developed that will be effective in improving pulmonary function and reducing asthma exacerbations. School-centered asthma programs can also be helpful to assist children and clinicians in applying asthma treatment plans and assuring optimal adherence to these plans.

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Advances in pediatric asthma in 2014: Moving toward a population health perspective

Cited by 21 publications

References 113 publications

Changing Trends in Asthma Prevalence Among Children

Changing Trends in Asthma Prevalence Among Children

Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences

Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies

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