Application and implementation of the GINA asthma guidelines by specialist and primary care physicians: a longitudinal follow-up study on 264 children

Abstract

Aims: To implement GINA guidelines and to assess their impact on the management of childhood asthma.Methods: A working group of primary care physicians (PCPs) and specialists developed a GINA-based clinical pathway. We then monitored the impact on 385 children (aged 0-15 years) referred to the respiratory outpatients clinic at the University Children's Hospital Results: Mean follow-up for 264 children with complete datasets was 10 months. Guidelines were followed by 94.6% of the PCPs. 98.6% of children learned to manage exacerbations. Half of the patients with persistent symptoms became intermittently symptomatic. Maintenance treatment was suspended in 47.2%, reduced in 27.6%, and increased in 4.9%. Asthma severity diminished (p<0.0001) and requirement for medication for exacerbations was significantly reduced (p<0.0001).Conclusions: Regular specialist visits, a website, and a written management plan shared by all those involved, led to clinical improvements as well as a reduction in, and more efficient use of, asthma medication.

Evaluation of a diagnostic therapeutic educational pathway for asthma management in youth

“…The Center “Io e l'Asma” is an outpatient pediatric asthma center which provides a diagnostic therapeutic educational pathway (DTEP) aimed to obtain and maintain the asthma control, to reduce future risk of exacerbations and adverse outcomes, focusing on the autonomy of child and family and relying on a strong collaboration between specialists, primary care physicians, and healthcare assistants …”

“…In spite of the evidence of the positive effects of education of asthmatic patients to self‐management of their disease, there is still poor assessment of the impact of patients’ educational programs on asthma control in the real world. In our practice, we have adopted current guidelines for asthma control through the development of a diagnostic therapeutic educational pathway (DTEP) called “Io e l'Asma,” based on a strong integration between clinicians and therapeutic educators and between specialists and primary care physicians . In the present study, we aimed to assess the impact of the DTEP of children and adolescents, by comparing the frequency of outcomes indicative of asthma control before and after attending the pathway.…”

Adherence to national guidelines for children with asthma at primary health centres in Sweden: potential for improvement

“…Such a follow-up should include an assessment of asthma control, comprehensive patient education, demonstration of the inhalation technique, implementation of a self-management plan, and a routine medical examination. 5,6,45 Of the children who had received a diagnosis of obstructive bronchitis or cough at the studied PHC, 22% fulfilled the evidencebased criteria of asthma provided by national or international guidelines. Obviously, if the diagnosis is incorrect, treatment may be inappropriate which could result in more unplanned visits due to obstructive symptoms as well as a lower quality of life.…”

Review of the management of childhood asthma in Tasmania

“…Adequate control of asthma relies on effective implementation of evidence‐based medicines as outlined by management guidelines with established efficacy . Implementation of and adherence to guideline‐based asthma management have been associated with improved clinical outcomes and reduced risk of exacerbations in children with asthma, as well as improved quality of life for the children and their families …”