Pediatric Asthma and Related Allergic and Nonallergic Diseases: Patient-Oriented Evidence-Based Essentials That Matter

Miles Weinberger

Disclosures

Pediatr Health. 2008;2(5):631-650. 

In This Article

Abstract and Introduction

Abstract

Asthma is the most common medical diagnosis among hospitalized children. In the USA, asthma has accounted for approximately 15% of nonsurgical admissions to hospital in the pediatric age group. Asthma is also one of the leading causes for emergency care requirements, one of the leading causes for missed school, and a cause for considerable morbidity, disability and occasional mortality at all ages. Despite these discouraging statistics, convincing data indicate that this failure of asthma management is not the result of inadequate therapeutic potential, but instead represents ineffective delivery of medical care. Management of asthma and its major co-morbidities, allergic and nonallergic rhinitis, and atopic dermatitis requires a knowledge of the alternative therapies, natural history, and educational techniques for providing patients and families with the ability to manage these troublesome chronic disorders.

Introduction

Asthma is the most common medical diagnosis among hospitalized children. In the USA, asthma has accounted for approximately 15% of nonsurgical admissions to the hospital in the pediatric age group. Asthma is also one of the leading causes for emergency care requirements, one of the leading causes for missed school, and a cause for considerable morbidity, disability, and occasional mortality at all ages.[1]

Despite these discouraging statistics, convincing data indicate that this failure of asthma management is not the result of inadequate therapeutic potential, but instead represents ineffective delivery of medical care.[2,3] Guidelines proposed by the National Asthma Education and Prevention Program (NAEPP) have been published as Expert Panel Reports beginning in 1991, with updates in 1997 and 2002.[4,5,6] A 415 page 2007 Expert Panel Report 3 with a 60 page summary has now been released.[7,8] An international guideline, the Global Initiative for Asthma (GINA) is a somewhat less weighty 92 pages; a 24 page 'Pocket Guide' version provides guidelines for treating children with asthma.[201] Despite the considerable efforts and ambitious goal of these various guidelines for improving asthma outcome, indications are that these lengthy and complex guidelines are not followed by primary care physicians,[9,10] and published reports continue to show little decrease in urgent care requirements, hospitalizations or deaths from asthma.[11,12]

Several specialist guided and team-directed model programs involving selected primary care physicians have been shown to impact positively on the outcome of asthma in children.[13,14,15] However, the greatest degree of effectiveness for asthma management has been documented for care programs directed by subspecialists that utilized continuity of care, an organized plan for effective therapeutic decisions, and patient education to carry out the plan.[2,16,17,18,19,20] Even among particularly difficult groups of patients where socio-economic factors complicate care, controlled clinical trials have demonstrated that specialized programs substantially improve outcome.[2,19]

Rhinitis, allergic and nonallergic, and atopic dermatitis are comorbid conditions frequently associated with asthma in addition to occurring independent of asthma. Published guidelines for these troublesome clinical problems have also been published in an attempt to improve care of these related disorders in primary care settings.[21,22,23,24,25,26,27]

The purpose of this review is to identify those measures with accepted potential benefit for these disorders that are the most important and should be utilized in primary care. Additional measures that go beyond the common scope of primary care will also be discussed to identify where specialty care may provide additional benefit.

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