A recent study showed that a certain set of primary care-based asthma guidelines, established in 2007, helps to improve persistent asthma in children by 60 percent, compared to routine care.
The study “A primary care-based asthma program improves recognition and treatment of persistent asthma in inner-city children compared to routine care,” was published recently in the Journal of Asthma.
“An estimated 7 million children in the U.S. have asthma and almost half are poorly controlled,” said Dr. Karen Warman, associate professor of clinical pediatrics at Albert Einstein College of Medicine, in a news release. “Our study highlights that asthma severity is under-recognized and under-treated 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.”
The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, 2007 recommended classifying asthma severity based upon impairment (symptoms, rescue medication use, and lung function) and risk (need for oral steroids). Asthma severity is the basis for beginning long-term medication plans.
The EPR-3 severity classification criteria differs from much earlier guidelines because it includes additional questions for impaired activity and rescue medication use. It also includes modifications to criteria used to interpret spirometry results and classify asthma severity.
Additionally, the guidelines added accessing the ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC) to the existing criteria to assess FEV1 or peak flow based upon predicted percentiles. For each level of asthma severity, there is a recommended “step of care” with increased doses and/or combinations of medicines for greater levels of disease severity.
In the current study, a research team sought to determine if a primary care-based asthma program that applies the EPR-3 criteria actually increases detection of persistent asthma and affects “step of care” compared to routine care. The study included 79 inner-city children with an average age of 9.6 years. Of the children, 45.6% were Latino and 35.4% were African-American.
Results revealed that more children, through the program visits, were identified with moderate or severe persistent asthma based upon clinical questions (47.9%), spirometry (56.9%) or combined criteria (75.3%). Only 15.2 percent were identified during routine care.
After the asthma program visit, more children were prescribed controller medications (82.3% vs 63.3%), and 40.6 percent of the patients medication plans stepped up.
Based on the results, the researchers found that EPR- 3 criteria, at the primary care-based asthma program, increased recognition of persistent asthma, higher asthma severity classifications, and step-ups in treatment plans.
The researchers concluded that combining the EPR- 3 guidelines with primary care, improved asthma treatment and management for inner-city children at high risk.
“We recognize many demands are placed on primary care physicians during routine health care 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.”
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