Patient Self-Management of Acute Asthma: Adherence to National Guidelines a Decade Later

Scarfone, Richard J.; Zorc, Joseph J.; Capraro, Geoffrey A.

doi:10.1542/peds.108.6.1332

Cited by 85 publications

(61 citation statements)

References 31 publications

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“…Similar to some other ED-based studies, 16,23 we found that a relatively high proportion of children (46%) had only mild intermittent asthma, indicating that this patient population was not at particularly high risk. However, like most other studies, we found that a high proportion of these children exhibited health care-utilization patterns that suggest more severe or uncontrolled asthma; 25% had been hospitalized in the last year, and 60% had at least 1 prior ED visit for asthma in the last year.…”

Section: Discussionsupporting

confidence: 89%

“…Again, these findings are consistent with those of other ED-based studies, although most have reported even lower use of ICS or other long-term control medications. 8,10,11,[15][16][17][18] Our study found that the prevalence of undertreatment was much lower at the urban site compared with the suburban and rural sites. We can only speculate as to why this finding was observed; however, given that there were few differences in the underlying characteristics of the asthma populations across the 3 sites, the lower prevalence of undertreatment likely reflects better quality of care among subjects who attended the urban site.…”

Section: Discussionmentioning

confidence: 57%

“…8,9,11,[15][16][17][18] Approximately one third of the study population was black, which is much higher than the underlying population of the Grand Rapids area, in which ϳ10% of the population is black.…”

Section: Discussionmentioning

confidence: 95%

“…13,14 Most recent studies of children with asthma who use the ED have shown that although the majority do have access to primary care, 8,9,[15][16][17] this access does not ensure that they receive the recommended asthma care and self-management training in the outpatient setting. 9,10,15,16,18 For example, many children who use the ED seem to be undermedicated in terms of using an inhaled corticosteroid (ICS) or other long-term control medication, 8,10,11,16,17 and follow-up visits with a primary care provider (PCP) usually occur much later than the time frame recommended in the NAEPP guidelines. [19][20][21][22] Here we describe the characteristics of children treated for an acute asthma exacerbation in 3 EDs in western Michigan (selected to represent urban, suburban, and rural settings) and report on several quality indicators of care and management based on NAEPP guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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“…16 This lack of familiarity with the guidelines impacts ED populations, as demonstrated in a study that described a cohort of children with asthma presenting for ED care in which approximately two thirds met the criteria for persistent disease, yet only 38% took daily antiinflammatory medication. 27 Although it is not certain whether the primary source of these failures is the PCP or the family, it does suggest a failure to achieve the appropriate disease management.…”

Section: Table 4 Location and Severity Characterization Of First Asthmentioning

confidence: 99%

The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

et al. 2006

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OBJECTIVE. Our goal was to teach emergency department (ED) physicians how to use standardized criteria for diagnosing and classifying asthma severity and to describe the patterns of pediatric ED utilization of these criteria for classification of both acute and chronic severity. METHOD.A health care provider education module was developed and implemented in 4 participating EDs in southeast Texas to educate ED physicians and health care providers on the diagnosis and acute and chronic severity classification of pediatric asthma patients. We undertook both retrospective (medical chart extraction) and prospective surveillance over a 2-year period of all children presenting to 1 of 4 EDs with acute asthma. Demographic characteristics, classification of severity, health care resource utilization, and primary physician contact information were collected.RESULTS. The health care provider educational intervention was provided for 84 different physicians. A subset of 16 physicians was randomly tested preintervention and postintervention. Mean mock-scenario scores at 2 weeks showed an improvement of 55.6%, which was sustained at retesting at 6 months. Over the 2-year period, 6222 individual pediatric ED encounters were entered into the surveillance database. The median age of presentation was 5 years. More than 32% of the patients in the study were uninsured. The majority of the patients in each category had asthma of mild severity: mild intermittent chronic (58.7%) and mild acute (53.9%).CONCLUSIONS. Physicians who completed a health care provider education module learned to effectively diagnose asthma and recognize standardized acute and chronic severity classifications. The majority of children with asthma who presented to the Texas Emergency Department Asthma Surveillance project's participating EDs were classified as having mild acute severity and mild intermittent chronic disease. Almost one third of these patients did not have health insurance.

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Parental attitude and knowledge towards asthma care measures for their children in Saudi Arabia

Alhammad

Alajmi

Alenizi

et al. 2020

Pediatric Pulmonology

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Background: Appropriate asthma management in children reduces emergency department visits, hospitalization, and improves the quality of life. We aim to assess the level of children asthma control and its association with parental knowledge. Methods: A prospective study conducted to measure childhood asthma control with a validated childhood asthma control test (C-ACT), and to assess asthma knowledge among the parents of children aged 4-11 years and their parents upon asthma clinic visits. C-ACT score ≤ 19 is considered as uncontrolled child asthma. Results: We have invited 238 parents to participate in the study; 177 (74.4%) completed the survey. The mean age of the parents and their children were 38.8 ± 7.6 and 7.8 ± 2.7 years, respectively; 28.2% of parents were smokers, and 46.3% of them were college graduated. Nearly 61.6% of the parents and children scored ≤ 19 on C-ACT; 54.2% and 37.9% of parents knew how inhaled salbutamol and corticosteroids work, respectively. A quarter of the parents received an asthma action plan. Multinomial logistic regression analysis showed that parents who did not know their children's medications name (OR, 6.1; 95% CI, 2.15-17.29), and when to use inhaled corticosteroid (OR, 2.1; 95% CI, 1.32-3.45) were independent factors predicting uncontrolled asthma in children with score ≤ 19. Conclusions: The study indicated that there is an association between poor asthma control (scored ≤ 19 on C-ACT) and parental knowledge of asthma medications. The parents should be educated thoroughly on asthma care, including medications used to minimize asthma exacerbations in their children. K E Y W O R D S bronchial diseases, lung diseases, pediatric asthma 1 | INTRODUCTION Asthma is a common chronic respiratory disease in children. Uncontrolled asthma increases mortality, morbidity, emergency department (ED) visits, hospitalization, reduces the quality of life as well as increases health care costs. 1 An overall prevalence of asthma in children from Saudi Arabia ranged from 8% to 25%, depending on studies conducted over the past three decades. A recent study in Saudi Arabia reported prevalence of 45% of uncontrolled asthma in children. 2,3 In western countries, the reported prevalence of asthma in children was 8.6% in the United States (uncontrolled asthma 46%, 2010), and 11% in France (uncontrolled asthma 37.6%, 2013). 4-7

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Patient Self-Management of Acute Asthma: Adherence to National Guidelines a Decade Later

Cited by 85 publications

References 31 publications

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

Parental attitude and knowledge towards asthma care measures for their children in Saudi Arabia

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