How Can Clinicians Improve Pediatric Asthma Care?

Jennifer Barrett, Assistant Editor
Published Online: Tuesday, March 6th, 2018
Clinicians who focus on personalized assessments prior to prescribing asthma therapy to pediatric patients can help improve the accuracy and quality of care, according to a new study published in Hospital Pediatrics.

According to the study, streamlined patient care decision tools, an electronic medical record system, and access to a mobile phone application to guide each patient’s personalized care can assist health care providers in determining the best therapy for each patient.
The study found that asking these 6 key questions can be effective in accurately prescribing the right medication therapy:
1.     Number of asthma symptoms per week?
2.     Number of nighttime awakenings per month?
3.     Inhaler use for symptoms per week?
4.     What is the degree of asthma’s interference with your normal activity?
5.     Number of asthma exacerbations requiring oral corticosteroids in the last year?
6.     How many doses per week are you missing of your current controller therapy?
In each week of 2015-2016, the first 5 pediatric patients discharged with status asthmaticus were reviewed for documentation of the 6 asthma control questions and the accuracy of the discharge controller therapy. Correct discharge medication was defined as being prescribed the age-appropriate medication and dose on the basis of baseline controller therapy, compliance with baseline medication, and response to asthma control assessment.
Overall, a total of 240 pre-intervention and 252 post-intervention charts were reviewed. Patients discharged with appropriate controller therapy improved from 60% in pre-intervention data to 80% in the post-intervention period.
The study improved the frequency of asking the questions from 40% to 98%.  
“The key to caring for pediatric asthma patients is that the most appropriate medication at the right dosage must be prescribed, and the child has to take their medication every day,” Alexander Hogan, MD, assistant professor in the Department of Pediatrics at UConn School of Medicine, said in a press release about the study.2
Additionally, Dr. Hogan noted these counseling tips for children with persistent asthma:
1.     Use a controller medication inhaler twice daily with a spacer (a clear mask tool for easier pediatric application).
2.     To improve adherence, keep your child’s inhaler next to their toothbrush as a reminder to use the inhaler each morning and night.
3.     Stay aware of your symptoms: difficulty breathing, wheezing, shortness of breath, and cough.
4.     Use a mobile app to keep track of your symptoms and potential triggers.
5.     Follow-up with your primary pediatrician or asthma doctor every 3 to 4 months.
6.     Make an appointment with your child pediatrician if you are concerned their asthma is not well controlled.
Poorly-controlled asthma can increase chances of missed days of school, emergency room visits, and hospital readmissions. Sticking to these key decision-making tools can allow health care providers to effectively and consistently improve quality of care.
“While it is challenging to be consistent on the frontlines of medicine, providers can’t forget to ask these key questions that are an important part of the asthma patient care puzzle,” Dr. Hogan said.2
1.     Hogan AH, Rastogi D, Rinke ML. A quality improvement intervention to improve inpatient pediatric asthma controller accuracy. Hospital Pediatrics. February 2018. 2017-0184. Doi: 10.1542/hpeds.2017-0184.
2.     Improving Pediatric Asthma Care is Possible [news release]. UConn’s website. Accessed March 5, 2018.

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