Researchers from the Children’s Hospital at Montefiore (CHAM) reported that a groundbreaking primary care-based program for asthma patients, called Pediatric Preventive Asthma Care Program, could improve the identification of mistreated asthma among children and improve treatment plans, compared to routine care provided during office visits.

The study, led by Karen Warman, M.D., and Ellen Silver, Ph.D., was published in the Journal of Asthma and titled “A primary care-based asthma program improves recognition and treatment of persistent asthma in inner-city children compared to routine care.”

Researchers assessed the severity of asthma in 79 children and teenagers ages 5 to 19 during routine checks, compared to asthma severity assessments made during a visit to the dedicated asthma program, where “The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma” was used.

The EPR-3 guidelines recommend asking five standard questions on topics including asthma symptoms, the use of rescue medication, and which methods are used for spirometry administration – a test that measures airflow during exhalation.

The research team found that:

• Among all children who were referred to the asthma program, most of them were either Latino or African American – and routine care wasn’t able to diagnose moderate to severe stages in some children;
• Answers to clinical questions showed that 47.9 percent of patients redirected had moderate or severe persistent asthma;
• Spirometry alone – though not usually used in pediatric primary care due to insufficient time and staff training – could identify 56.9 percent of participants as moderate or severe persistent asthma patients;
• When results were combined with answers from the standard questions and spirometry measurements, 75.3 percent of the program’s participants were diagnosed with moderate or severe persistent asthma – compared to only 15.2 percent who had been diagnosed during routine care;
• After the asthma program visit, more children were prescribed controller medications and were offered a full revision of their medication plans to match the severity of their condition.

After being referred to the asthma program, visits take nearly 30 minutes and each patient is evaluated, namely through spirometry tests. Based on the evaluation results, asthma specialists use an electronic medical record (EMR) template to classify asthma severity in each case. The notes of the visit are then shared with the referring primary care provider, and follow-up care is scheduled with either the asthma program physician or the primary care provider.

“An estimated seven million children in the U.S. have asthma and almost half are poorly controlled,” said Warman, the study’s lead author, in a press release. “Our study highlights that asthma severity is under-recognized and undertreated during routine care, and access to a dedicated asthma program can improve both assessment and treatment, which could ultimately improve quality of life and decrease hospitalizations and cost.”

Previous research has proven that pediatric asthma is to blame for roughly 10.5 million school days missed, 640,000 emergency hospital visits, and 157,000 hospitalizations annually. The study showed that the percentage of children who had to visit an emergency department due to asthma decreased from 32 percent in the months prior to the visit to this asthma program to 8 percent after the visit.

Warman is an attending physician at the Comprehensive Family Care Center (CFCC) – one of CHAM’s outpatient sites – and an associate professor of clinical pediatrics at Albert Einstein College of Medicine. She is a specialist in asthma management, and also leads the program at CFCC, along with an asthma coach trained nurse.

The team believes that, due to their family-oriented care, primary care providers are uniquely positioned to identify children at risk for asthma morbidity and to partner with families in the longer term. However, appropriate time and support must be dedicated to address asthma as a chronic disease to help children and their families achieve control over the condition.

“We recognize many demands are placed on primary care physicians during routine healthcare maintenance visits,” Warman said. “For this reason, we recommend arranging separate asthma-focused visits, which allow more time to speak with families, assess for environmental exposures, discuss medications, and demonstrate correct use of spacer devices.”