Childhood Asthma Care Research Articles

"Will anybody listen?" parents' views on childhood asthma care: a qualitative study.

Asthma is the most common chronic disease in children, resulting in considerable morbidity and health care utilisation, especially in geographical areas with high deprivation. Parents play a pivotal role in children's asthma management. To explore the views of parents whose children have asthma, regarding barriers and facilitators to receiving adequate asthma care. A qualitative study conducted in an urban, multi-ethnic setting with high socioeconomic deprivation and paediatric asthma related hospital admissions. The study used a pragmatic approach underpinned by a perspective of critical realism. Parents of children with asthma were recruited through purposive and convenience sampling and data collected through semi-structured interviews. Transcripts were analysed using thematic analysis, facilitated by NVivo software. 10 parents participated in nine interviews. Six themes were identified relating to: (1) the establishment of a new life dynamic following a diagnosis of asthma; (2) the turbulent and drawn-out process of asthma diagnosis; (3) the roles and expectations of the partnership established between parents and healthcare services; (4) the importance of schools in asthma management; (5) sources and access to relevant information; and (6) the importance of social support networks. Parents frequently felt unsupported and misunderstood, particularly during the diagnostic process. Unmet parental educational and emotional needs, particularly around the time of diagnosis were identified as a key barrier to adequate asthma management. Deeper understanding of gaps in support can instruct asthma care delivery and inform co-produced interventions, thus improving asthma outcomes in children.

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers

ObjectivesThis study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.DesignOne of the aims of our National...

Toward a new model of childhood asthma care: community needs assessment in an underserved urban population

Objectives The objective of this study was to utilize a community-engaged research approach to better understand gaps and opportunities for improving asthma care from the perspectives of patients, caregivers, community organization representatives, and healthcare providers in a predominantly minority community. Methods Forty-one participants from four groups (patients, caregivers, community organization representatives, healthcare providers) participated in interviews or focus groups. A phenomenological approach to this qualitative research allowed the research team to better understand the lived experiences of families seeking asthma care in this community. Results Five gaps and five corresponding opportunities were identified. The gaps identified were unequal healthcare resource distribution; underrepresentation of health professionals from diverse backgrounds; experiences of environmental racism; mistrust, bias, and discrimination in healthcare encounters; and systemic marginalization of communities. The opportunities identified include increasing healthcare infrastructure and accessibility; increasing racially, culturally, and linguistically congruent healthcare; implementing equitable improvements to the built environment; building relationships with communities and individuals; and acknowledging communities’ strengths and resilience. Conclusion This study identified systemic gaps to asthma care that are of prominent concern to the community.

The West Philadelphia asthma care implementation study (NHLBI# U01HL138687)

Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5–13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.

Increasing Childhood Asthma Care Appointments on a Mobile Asthma Van

Children in two communities of a large city in the Midwestern United States have higher rates of asthma than other areas of the city. The communities have barriers to accessing care, including high rates of unemployment and being uninsured and undocumented. A mobile van provides no-cost asthma care to children at schools in these communities, but use of these services has decreased more than 50% over the past 5 years. School nurses have the potential to improve asthma outcomes by collaborating with health-care providers. The purpose of the program was to increase the number of appointments scheduled and attended on the asthma van at both schools. For this program, we (a) implemented an unaccompanied minor consent, (b) enhanced care coordination, and (c) improved a respiratory health survey tool. Results showed an increased number of appointments scheduled and attended on the asthma van. The program was successful even though community-specific barriers existed.

The pharmacist's role in managing and ameliorating childhood's asthma care: a descriptive and transversal study about 104 pharmacists in the city of Rabat in Morocco.

This work aims at enhancing the management of childhood asthma, with a focus on pharmacists in particular, by evaluating their knowledge of childhood asthma and assessing their attitude while they are providing asthma medicines. Consequently, it will look at the necessity of introducing training days about childhood asthma for pharmacists. This is a transversal and descriptive study which lingered from August to October 2015. Data has been collected using a questionnaire that was self-administered to every surveyed pharmacist in the city of Rabat. The 104 pharmacists who replied to the questionnaire have an average general understanding about asthma and its treatment. Only a quarter of them managed an asthma crisis in their pharmacy before directing the child to the emergency. 50% of them do not know the difference between the basic asthma therapy and the asthma attack therapy. However, all of them recommended the parents to see a physician regarding their child’s asthma. 75% advise the systematic use of an asthma spacer with the inhaler. 87.5% of them give advice to parents regarding the good measures for environmental control, and 98% estimate that the therapeutic education is important in childhood asthma management. 88.5% among them are interested in training days about childhood asthma.This study shows the necessity of further pharmacists’ education about asthma and its management.

Barriers in the management of childhood asthma: what care giver thinks about long term controller medication?

Introduction: Asthma is the most common, chronic lower respiratory disease in childhood. Despite of the several guidelines and/or consensus documents available to support medical decisions to paediatric asthma; there are little updates available on the barriers’ to childhood asthma care among communities. Objectives: We aimed to determine social barriers to the management of childhood asthma. Methods: This was a qualitative, cross-sectional hospital based study in children aged between 1-15 years. Results: total 423 children with asthma were recruited from July 2014 to July 2016.out of them 126(29.78%) had mild intermittent, 190(44.91%) had mild persistent, 73(17.25%) had moderate persistent and 32(7.56%) had severe persistent asthma. In all persistent asthma cases long term controller medication was prescribed in which only 186(62.62%) accepted long term controller, while 111(37.37%) patients did not. Reasons for non-acceptance of long term controller medication in new cases were of financial constraints 25(22.52%), fear of dependency of controller medication 23(20.72%),fear ofside effect 17(15.31%), social stigma of inhalational device 15(13.51%), more preference to cough syrup 31(27.97%). Conclusion: A large numbers of barriers existed in the management of childhood asthma which has a bad impact on the patients and their families.

Application of a Natural Language Processing Algorithm to Asthma Ascertainment. An Automated Chart Review.

Difficulty of asthma ascertainment and its associated methodologic heterogeneity have created significant barriers to asthma care and research. We evaluated the validity of an existing natural language processing (NLP) algorithm for asthma criteria to enable an automated chart review using electronic medical records (EMRs). The study was designed as a retrospective birth cohort study using a random sample of 500 subjects from the 1997-2007 Mayo Birth Cohort who were born at Mayo Clinic and enrolled in primary pediatric care at Mayo Clinic Rochester. Performance of NLP-based asthma ascertainment using predetermined asthma criteria was assessed by determining both criterion validity (chart review of EMRs by abstractor as a gold standard) and construct validity (association with known risk factors for asthma, such as allergic rhinitis). After excluding three subjects whose respiratory symptoms could be attributed to other conditions (e.g., tracheomalacia), among the remaining eligible 497 subjects, 51% were male, 77% white persons, and the median age at last follow-up date was 11.5 years. The asthma prevalence was 31% in the study cohort. Sensitivity, specificity, positive predictive value, and negative predictive value for NLP algorithm in predicting asthma status were 97%, 95%, 90%, and 98%, respectively. The risk factors for asthma (e.g., allergic rhinitis) that were identified either by NLP or the abstractor were the same. Asthma ascertainment through NLP should be considered in the era of EMRs because it can enable large-scale clinical studies in a more time-efficient manner and improve the recognition and care of childhood asthma in practice.

Shining the Light on Parity and Disparity in Childhood Asthma Care.

We grew up in an area of the United States with racial inequality, where white and black persons experience disparate opportunities for community inclusion, education, employment, wealth, and wellbeing. As general pediatricians, we felt it was our duty to decrease the impact of these disparities on the health of our patients. Unfortunately, we continue to witness differences by race in the survival, access to care, use of health services, and the development and control of chronic conditions in children. These racial disparities have been reported repeatedly in children throughout the United States for decades.1 The work of Silber and colleagues2 published in the current issue of Pediatrics assesses differences by race in lengths of stay and 30-day readmission rates for hospitalized children with asthma who were enrolled in Medicaid. The work applies rigorous methods to match children across race groups by their other demographic characteristics, comorbid conditions, and history of asthma medication use. Using these methods, the authors found that length of stay and 30-day readmission did not vary significantly by the children’s race. Previous studies of inpatient asthma care using standard risk adjustment methods in children report similar … Address correspondence to Jay G. Berry, MD, MPH, Boston Children’s Hospital, 21 Autumn St, Room 212.2, Boston, MA 02115. E-mail: jay.berry{at}childrens.harvard.edu

Easy Breathing—Definition of a Gamification System to Support the Chronic Care of Childhood Asthma

Asthma is the most common noncommunicable disease among children. It leads to substantial problems both in health and economic terms to individuals and families. This paper introduces a technological solution, Easy Breathing, that supports the man-agement of childhood asthma, providing tools for both doctors and patients. Through the establishment of an asthma chronic care model, it combines doctors’ professional guidance and a gamification system to improve the compliance of patients with their treatments and to provide them with tools for the self-management of their disease. The system is in the testing phase, the first mockup has been developed and validated with 270 medical experts and patients, and it will be tested with 540 end-users over the next months.

Diagnosis and management of childhood asthma: How far we have reached? A survey of pediatrician′s knowledge, attitude, and practices from Rajasthan

Background: Despite the development and propagation of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice. Objectives: To assess the paediatrician`s attitude towards asthma guidelines and their adherence to its recommendations. Materials and Methods: 131 pediatricians engaged in direct childhood asthma care in state of Rajasthan were subjected to a self-administered questionnaire with 50 questions of which most were multiple choices, aiming at assessment of three important aspects about the involved pediatricians; paediatrician`s knowledge, practice and attitude. Results: Agreement with asthma guidelines was present with 87% of the studied pediatricians, however those who are not in agreement with the guidelines claimed that this was mainly due to patient factors and low socioeconomic status. Poor knowledge was found in 37%, poor practice in 49% and poor attitude in 19% of the studied physicians. Our study revealed that proper prescription of corticosteroids was carried out by only 56% of pediatricians. Significant number of doctors prescribed antihistamines, antibiotics and dietary restrictions on all asthmatic children and nebulisers/inhalers remained under-used. Pediatricians relied commonly on journals, company brochures, and conferences to keep themselves updated. Conclusion: The attitude of the majority of the studied pediatricians revealed agreement with the guidelines, while the disagreement was mainly explained by the poor socioeconomic standard of the patients. The degree of poor practice is more marked than that of poor knowledge or poor attitude reflecting resources limitations and application obstacles in the pediatricians's practice.

Domestic Experiments: Familial Regimes of Coping with Childhood Asthma in New Zealand

In this article, I examine the self-positioning of many New Zealand mothers of children with asthma as parent-experts whose authority supersedes that of implementing the self-management strategies advocated by medical professionals. In a socio-political context that emphasizes neoliberal values of autonomy and self-responsibility, these parent-experts experiment with a variety of pharmaceutical regimes, determining familial modes of care that privilege the achievement of what they consider to be ‘normal childhoods.’ While some families accept asthma as a chronic condition and encourage children to adopt standardized, daily preventative regimes, others craft alternative strategies of pharmaceutical use that allow them to experientially maintain asthma as a sporadic and temporary, if frequent and sometimes dramatic, interruption of everyday life. Childhood asthma care practices are thus not only vested in kinship networks, but often arise out of familial-based experiments whose goal is to determine regimes that enable the preservation of ‘normality.’

G138(P) Designing a Behavioural-Educational Intervention Using Intervention Mapping to Reduce the High Rates of Paediatric Asthma Hospital Admissions in an Inner-City Area of Birmingham

AimTo develop asthma self-management programme working with children and families to prevent paediatric asthma emergency admissions in order to provide effective care and promote behaviour change (BC) towards effective management.MethodAn...

Medicaid Payment Innovations to Financially Sustain Comprehensive Childhood Asthma Management Programs at Federally Qualified Health Centers

Background. One in 7 children in the United States is diagnosed with asthma, the leading cause of chronic childhood disease. Although a manageable condition when recommended medication regimens are followed and environmental control measures implemented, asthma remains the third most common reason for hospitalization among non-newborn hospital stays. As the primary health care home to a fifth of all low-income children who are especially vulnerable to asthma, federally qualified health centers play a critical role in providing comprehensive and preventive asthma care to their pediatric patients. Many health centers rely on the asthma education and counseling services of traditional and nontraditional providers, such as clinicians and community health workers, who may or may not be certified as asthma educators, as essential elements of asthma management and control. Asthma counselors are particularly valuable for patient home assessments and tailored education and counseling that are recommended components of evidence-based asthma care. Yet sustainable reimbursement for their services is a frequent challenge. Methods. We conducted an environmental scan of innovative approaches to securing adequate Medicaid reimbursement for asthma educator services provided as part of asthma management and control. Results. We identified a number of models at the individual health center, Medicaid health plan, and Medicaid state program level for securing sustainable reimbursement for asthma educators. Whereas state-based approaches are preferable to more incremental options at the health center and health plan level, local approaches may be more feasible for some health centers. Conclusion. Asthma educators provide essential, cost-effective services as part of childhood asthma care management. This analysis identifies creative solutions for health centers and other health care organizations to consider as mechanisms for sustaining the important services of these providers.

P274 Designing a Behavioural-Educational Intervention Using Intervention Mapping to Reduce the High Rates of Paediatric Asthma Hospital Admissions in an Inner-City Area of Birmingham

BackgroundInterventions based on empirically supported theory are effective in eliciting behaviour change (BC) (Michie & Prestwich, 2010). We used intervention mapping to design a BC intervention to promote effective asthma...

Does Using an Asthma Prompting Form Improve Asthma Care in a Pediatric Office?

An asthma exacerbation can be a life-threatening experience. This project tested the effectiveness of using a prompting form to improve childhood asthma care. Thirty randomly selected charts without a prompt form in a pediatric practice were compared for differences with thirty randomly selected charts with a completed prompting form. The number of medications reviewed (p=.001) and the frequency of refills written (p=.024) were significantly higher in the prompt group. Education was higher (p=.000) and triggers were more frequently discussed in the prompt group. The use of a prompting form facilitates discussion and improves preventive asthma care.

Health care utilization and medical costs for childhood asthma in Taiwan: using Taiwan National Health Insurance Research Database

Asthma is an important health problem worldwide and the prevalence is increasing in most part of the world. The burden of this disease to governments, health-care systems, and patients and their families have been greater more than ever despite efforts advocated by Global Initiative for Asthma for total asthma controls. Using Taiwan National Health Insurance Research Database, in this review, the population-based prospective studies showed the costs and health care utilization of childhood asthma in Taiwan was 2 folds higher than non-asthmatic children, and the prescription patterns of anti-asthmatic medications among physician in different discipline were all far from satisfied. The appropriateness of combinational therapy of inhaled corticosteroids and long acting β-agonists for moderate to severe childhood asthma was only 62%. In a government-sponsored disease management program for asthmatic patients within national health insurance, though the total mean costs (26.5%) and outpatient costs (26.1%) increased, the mean emergency department visits and hospitalization rates were significantly reduced by 34.4% and 51.74%, respectively, compared to the previous year. Therefore, in the real-world situation, asthmatic patients as well as medical professions who take care of asthmatic children still have much space for their symptoms controls and knowledge improvement to reduce the burden of asthma. From the experience of care and management of childhood asthma in Taiwan may reveal same problems of childhood asthma care in the similar cultural and ecological environments of Asian pacific countries, and suggest government-sponsored program may also have significant impact aimed at improving the care of patients with asthma.

Attendance for general practitioner asthma care by children with moderate to severe asthma in Auckland, New Zealand

Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6–9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6–9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these ‘high attendees’. Low attendees (0–2 visits) were mainly NZ Europeans. The NBRM ( n=155) showed that expected visits were increased by perceived need, ill–health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care.

Childhood asthma in the United States: Urban issues

The prevalence and morbidity of asthma are growing problems that appear to affect urban populations and particularly impoverished centers disproportionately. Poor children are more likely to be hospitalized for asthma than nonpoor children, and are more likely to experience clinical and social dysfunction due to asthma. While guidelines exist for best care of childhood asthma, the neediest children are least likely to encounter the benefits of these recommendations. The relationship between host and environment in both primary causation and disease exacerbation is an area of research and debate. Allergen exposure in early life appears to correlate with sensitization and expression of atopy and asthma. Impoverished households are more likely to be reservoirs for dust mite and cockroach antigen in high concentrations than more affluent settings. Lifestyle factors, including diet and ambient air quality, may be disease modifiers. Suboptimal systems for delivery of healthcare to high-risk populations are obvious targets for blame. Poor children are more likely than nonpoor children to receive sick care in emergency rooms that lack a connection to chronic care providers. Besides the method of delivery, the quality of care is questionable, as poor children are less likely to receive the anti-inflammatory maintenance medications for asthma that evidence-based guidelines recommend. Efforts to correct these problems must take into account such issues as explaining the nature of the disease and the best intervention strategies to people who have a diverse array of cultural backgrounds, belief systems, and life stressors. Efforts to improve the status quo are underway in many communities. Environmental control measures to reduce dust mite and cockroach exposure have met with some success. Models to improve access to care and acceptance of care may improve community outreach maneuvers that connect the medical establishment with families and patients. Examination and assessment of new approaches to facilitate this sort of communication hold promise and are receiving attention as well as research dollars.

Using homeopathy for treating childhood asthma: Understanding a family's choice

The incidence and severity of asthma are increasing despite concerted efforts in comprehensive management. Families may be expected to look to complementary or alternative therapies (CAM) for help in treating persistent childhood asthma. One such therapy is homeopathy, a system of medicine that uses specially prepared, highly dilute substances to induce the body's self-healing in a comprehensive manner. This article describes the contrasting experiences for a family who undergoes specialty consultations with an allergist and with a homeopath. The style of the interview and the diagnostic tools used vary, as well as the basic philosophies and goals. The advantages and limitations, as well as the regulatory framework of homeopathy are explained, as evidenced by the literature. For nurses and other clinicians caring for children and families who use nonconventional therapies, the clinical implications are that these professionals need to become knowledgeable about the various alternative therapies which can complement conventional care. Families who wish to try homeopathy along with conventional care need to have open lines of communication and cooperation between their providers, both conventional and homeopathic. The care of childhood asthma may prove to benefit from clinical trials in homeopathy. Copyright © 2001 by W.B. Saunders Company