More Needed in Management of Persistent Pediatric Asthma

November 05, 2003

Alicia Ault

Nov. 5, 2003 (New Orleans) -- Initial data from a multiphase, multicenter study show that many pediatric asthma patients who present to emergency departments are not using controller medications or are using the medications inappropriately, researchers reported here at the American Academy of Pediatrics National Conference and Exhibition.

In the second phase of the study, being conducted in Hawaii, Milwaukee, and centers in Texas and Washington state, researchers will try to prove that targeted emergency room interventions such as giving patients written asthma action plans at discharge improve compliance and outcomes.

Results of early data from the Hawaiian sites were presented by Rodney Boychuck, MD, from the Kapiolani Medical Center for Women and Children in Honolulu. Dr. Boychuck's facility is coordinating four hospitals, including a military hospital and a Kaiser Permanente hospital.

The goal was to see if physicians are adhering to the American Academy of Allergy, Asthma and Immunology asthma guidelines, said Dr. Boychuck.

If patients presented with asthma symptoms and were interested in participating, they were enrolled. So far, 500 patients have been enrolled, Dr. Boychuck told meeting attendees. Of those, 253 had class I asthma, and 42 were taking controller medications. Of the 77 class II patients, 34 were on inhalers. Compliance seemed to worsen with disease severity. Of the 107 patients with class III asthma, only 37 were on medications, and of the 139 patients with class IV disease, only 50 were using inhalers.

Of the class III patients, 17 said they used controller medications only when sick, and 20 patients said they always used them, even when they were well. For the class IV group, 17 said they used inhalers only when sick, and 33 said they regularly used them.

The vast majority did not have an action plan or a peak flow meter. And, said Dr. Boychuck, "even if they did [have a peak control meter], they didn't use them.

"It is clear from this preliminary data that there is substantial room for improving care," he told meeting attendees.

Because 55% of patients said they planned to follow-up with their physician, most with a primary care doctor, the next phase will be to try to coordinate care, said Dr. Boychuck.

Emergency room physicians at the four Hawaiian centers have already begun using a six-minute instructional DVD with patients, and providing after-care action plans. Patients with persistent asthma are discharged with corticosteroid inhalers. The emergency department also faxes a notification to the primary care physician that the patient was seen. The notice provides details of asthma severity and medications given.

Dr. Boychuck told Medscape that the Hawaiian survey results are likely representative, as the facilities see a wide range of ethnicities and socioeconomic groups.

The survey shows that emergency department physicians "have to monitor these guidelines," he said, adding that primary care physicians also have a responsibility to teach patients about asthma and medication use.

"This preliminary phase [data] doesn't give us novel information," session moderator Richard John Scarfone, MD, FAAP, from the Children's Hospital of Philadelphia in Pennsylvania, told Medscape. Similar data in the literature have shown that "patients with persistent asthma are being undertreated," he said.

However, he said he looks forward to data from phase II of the study, which aims to show which of the interventions results in better treatment.

Dr. Boychuck's work is being supported by a grant from the Robert Wood Johnson Foundation.

AAP 2003 National Conference and Exhibition: Abstract 333. Presented Oct. 31, 2003.

Reviewed by Gary D. Vogin, MD

Alicia Ault is a freelance writer for Medscape.


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