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PubMed2003

Bridging the gap between doctors' and patients' expectations of asthma management.

OBJECTIVES: To assess the prevalence of asthma symptoms, their impact on daily activities, and perceptions of disease severity among people with asthma. METHODS: A telephone survey of 699 people with asthma was conducted in 1999 in metropolitan and nonmetropolitan New South Wales, Victoria, and Queensland, Australia. RESULTS: Forty-two percent of adults and 26% of children reported experiencing asthma symptoms at least every 2-3 days. Thirty-seven percent of adults and 26% of children reported using a reliever more than four times in the previous week. Of those for whom preventer therapy had been prescribed (61% of respondents), 30% of children and 45% of adults did not use their preventer as instructed. A high proportion of respondents reported avoiding physical and social activities because of their asthma, while 75% said asthma generally made them feel tired. Many respondents attributed frustration (61%), irritability (57%), fear (38%), and worry (43%) to their asthma. Only 50% of respondents had been reviewed by a general practitioner for asthma in the past year. Respondents generally underestimated the severity of their asthma, compared with symptom frequencies reported. CONCLUSIONS: The Living with Asthma Survey suggests that national asthma management goals are not being achieved in a high proportion of patients, with evidence for both underprescribing and underusage of preventer medication. Achieving closer alignment between medical and patient perspectives is an important goal of asthma education and management in order to help bridge the gap between current concepts of best practice and the reality of persistently poor asthma outcomes.

Adult↗
PubMed2005

Asthma management programs in managed care organizations.

The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.2%) responding medical directors reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including general member education (90%), member education by mail (87%), self-management education (85%), and provider education (82%). Educational resources (89%) and telephone advice nurse (77%) were the most common self-management strategies offered. Among factors impeding the provision of effective asthma care, noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications were cited by virtually all respondents. Health plans rely on an array of strategies to manage asthma patients. Education encouraging patient self-management is a key component of asthma management programs. However, a considerable number of treatment approach barriers are impeding the achievement of proper asthma care. Without innovative approaches to care, it appears that current MCOs' asthma management efforts may not result in substantial improvements in asthma outcomes.

Asthma↗
PubMed2006

Occupational asthma in New South Wales (NSW): a population-based study.

BACKGROUND: The proportion of asthma in adults that is due to occupational exposures is not known. AIM: To examine the contribution of workplace exposures to the development of asthma in adults in New South Wales (NSW) in a cross sectional, population-based study. METHODS: A randomly selected population of 5,331 18- to 49-year olds completed and returned a mailed questionnaire (response rate 37%). In adult-onset asthmatics we examined the association of asthma with reported exposure, within 1 year of asthma onset, to a list of occupations and exposures known to be at risk for occupational asthma (high-risk jobs and exposures). RESULTS: Among 910 subjects (18%) with asthma, 383 (7%) subjects reported adult-onset disease. After adjusting for sex, age and smoking, working in any high-risk job or exposure at the time of asthma onset was significantly associated with adult-onset asthma (OR 1.51, 95% CI 1.19-1.92). The population attributable risk (PAR) of adult-onset asthma for either a high-risk job or an exposure was 9.5%. Sudden onset, irritant or reactive airways dysfunction syndrome type exposures were associated with adult-onset asthma (OR 4.65, 95% CI 1.64-13.2). The PAR of adult-onset asthma for these exposures was 0.2%. CONCLUSION: Reported adult onset of asthma is common and occupational exposures may be associated with 9.5% of prevalent cases of adult-onset asthma in NSW.

Adolescent↗
PubMed2002

Process of care for Medicaid-enrolled children with asthma: served by community health centers and other providers.

OBJECTIVE: To compare the process of care received by Medicaid-enrolled children with asthma served by community health centers (CHCs) and other Medicaid providers. DESIGN: Retrospective cohort study. SETTING: Five provider types serving Massachusetts Medicaid enrollees: three provider groups--CHCs, hospital outpatient departments (OPDs), and solo/group physicians--participating in the statewide Primary Care Clinician Plan; a staff model health maintenance organization (HMO); and fee-for-service (FFS) providers. STUDY POPULATION: Six thousand three hundred twenty-one Medicaid-enrolled children (age 2-18) with asthma assigned to one of the above provider types in 1994. DATA: Person-level files were constructed by linking Medicaid claims, demographic and enrollment files with HMO encounter data. METHODS: Five claims-based process of care measures reflecting aspects of care recommended in national guidelines were developed and used to analyze patterns of care across provider types, controlling for case-mix and other covariates. RESULTS: Children served by CHCs and the HMO had significantly higher asthma visit rates compared with those served by OPDs, solo/group physicians and FFS providers. CHCs emergency department (ED) visit rates for asthma were lower than those of OPDs (P <0.001) and similar to other providers. However, CHC patients averaged more asthma hospitalizations relative to solo/group physicians or the HMO (P <0.0001). In multivariate analyses, children served by CHCs were 2.2 times as likely (95% CI, 1.02-4.91) as those served by solo/group physicians to receive a follow-up visit within 5 days of an asthma ED visit and 4.3 times as likely (95% CI, 1.45-12.68) to receive a follow-up visit within 5 days of hospital discharge. CHC patients with utilization suggestive of persistent asthma were less likely (OR, 0.28; 95% CI, 0.13-0.59) than those served by solo/group physicians to be seen by an asthma specialist. There were no significant differences in measures of asthma pharmacotherapy across providers types. CONCLUSION: These data suggest that CHCs provide more timely follow-up care after an asthma ED visit or hospitalization relative to solo/group physicians, but diminished access to asthma specialists. There were no differences in asthma pharmacology across providers. Relatively low access to asthma specialists among children served by CHCs warrants further investigation.

Adolescent↗
PubMed1997

Why is asthma becoming more of a problem?

From antiquity to the 1920s, the frequency of asthma and especially death from asthma was considered to be rare. In fact, asthma was not considered a significant cause of death during the early years of the 20th century. The Frenchman Armand Trousseau declared in his Clinique Medicale that "asthma n'est pas fatale" ("asthma is not fatal"). In the United States, Oliver Wendell Holmes had described asthma as a "slight ailment that promotes longevity." Clearly this perception of asthma has changed for many reasons. It has been only in the past 10 years that death from asthma has received increased attention when evidence was obtained that the rate was increasing. Few reports of asthma death had appeared until the late 1950s. Mortality today is disproportionately high for asthmatic patients aged 5 through 34 years. Asthma mortality rates have increased worldwide. Substantial increases in the rates of death from asthma in patients aged 5 through 34 years between the mid-1970s and the mid-1980s had been reported. Although asthma is still a relatively infrequent cause of death, it is nonetheless important to emphasize that the rates of death from asthma have risen in England and Wales, Australia, Canada, the Netherlands, Sweden, France, West Germany, Israel, the United States, and Denmark. This review attempts to put this data in perspective and to highlight some features, including pollution and treatment, that may contribute to this alarming problem.

Adolescent↗
PubMed2006

Posttraumatic stress in adolescents with asthma and their parents.

OBJECTIVE: To assess posttraumatic stress (PTS) symptoms in adolescents with and without asthma and their parents and the relationship between PTS symptoms and asthma morbidity. METHOD: Three groups of adolescents (12-18 years) participated: adolescents who had experienced a life-threatening asthma episode (n=49), asthma controls (n=71), and healthy controls (n=80). Adolescents completed the UCLA PTSD Reaction Index, Multidimensional Anxiety Scale for Children, and Reynolds Depression Inventory. Parents completed the Impact of Events Scale-Revised, Brief Symptom Inventory, and Asthma Functional Morbidity Scale. RESULTS: Twenty percent of adolescents with life-threatening asthma met criteria for PTSD compared with 11% of the asthma controls and 8% of the normal controls. Twenty-nine percent of parents of adolescents with life-threatening asthma met criteria for PTSD compared with 14% of parents of asthma controls and 2% of normal controls. Adolescent PTS symptoms accounted for 5% of the variance in functional asthma morbidity even after controlling for disease severity and other anxiety and depressive symptoms (beta=.26). CONCLUSIONS: Adolescents with asthma and their parents, particularly those who have experienced a life-threatening event, have high levels of PTS symptoms that are linked to asthma morbidity. Interventions to improve asthma outcomes should include assessment and treatment of trauma and PTS symptoms.

Adolescent↗
PubMed2005

Polymorphisms in the 5-lipoxygenase activating protein (ALOX5AP) gene are not associated with asthma in an Australian population.

BACKGROUND: The cysteinyl-leukotrienes (cys-LTs) are important pro-inflammatory mediators in asthma, and have been shown to have a role in specific disease subtypes, including asthma severity. Few studies have investigated the role of polymorphisms in the ALOX5AP gene, encoding 5-lipoxygenase activating protein (FLAP), and asthma. We hypothesized that polymorphisms in this gene are associated with asthma and in particular, with asthma severity, in an Australian population. OBJECTIVE: To screen the coding region of the ALOX5AP gene for polymorphisms and to determine the association between previously described polymorphisms and asthma and asthma severity in an Australian population. METHODS: We used PCR-SSCP and PCR-RFLP analysis to examine a previously described promoter polyA variable repeat polymorphism and two intronic polymorphisms (IVS2+12C>A, IVS2+105T>C), and to screen all five exons of the gene for new polymorphisms, in a large Australian population of randomly selected, non-asthmatic controls (n=457), mild asthmatics (n=274), moderate asthmatics (n=231) and severe asthmatics (n=79). RESULTS: We confirmed the presence of two polymorphisms in intron 2 and found no association between these polymorphisms and asthma or asthma severity, nor between a promoter polymorphism in the ALOX5AP gene and asthma or asthma severity. Gene fragment analysis of the promoter polymorphism revealed novel, conserved repeat numbers in our population, and no new polymorphisms were found in the coding region of the gene. CONCLUSION: These findings in a large, well characterized asthma population, reveal that, while FLAP is an important enzyme in cys-LTs biosynthesis, polymorphisms in the ALOX5AP gene are not likely to be functionally associated with the asthma phenotype.

5-Lipoxygenase-Activating Proteins↗
PubMed2006

Asthma in every fifth child in Oslo, Norway: a 10-year follow up of a birth cohort study.

BACKGROUND: The western world's increase in childhood asthma is suggested to level off. We aimed to investigate asthma prevalence in 10-year-old children within the prospective birth cohort Environment and Childhood Asthma (ECA) Study in Oslo established in 1992/1993. SUBJECTS AND METHODS: Six hundred and sixteen (77%) of 803 children (mean age 10.9 +/- 0.9 (SD) years) with lung function measurements at birth were reinvestigated at age 10 years. At birth they corresponded to the entire birth cohort (n = 3754) regarding gender, socio-demographic factors, parental allergic diseases, pet keeping and maternal smoking. Results from structured parental interview, spirometry, and skin prick test for inhalant and food allergens are presented. Asthma definition required minimum two positive criteria, (i) doctor's diagnosis of asthma, (ii) wheeze and/or chest tightness, (iii) use of anti-asthmatic treatment. Current asthma required asthma definition plus either (ii) and/or (iii) in the last 12 months, and/or > or = 10% fall in forced expired volume in 1 s after treadmill running. RESULTS: Lifetime prevalence of asthma was 20.2%; current asthma 11.1%, doctor diagnosis of asthma 16.1% and wheezes ever 30.3%. Allergic sensitization (29.3% overall) was more common among children with current (56.3%) compared to asymptomatic (last 12 months) (26.0%) or no asthma (27.6%) (P < 0.001). Boys more often than girls had current asthma (14.4 vs 7.1%, P = 0.004), wheeze ever (36.9 vs 22.5%, P = 0.002) and allergic sensitization (36.2 vs 22.1%, respectively, P < 0.001). CONCLUSION: Childhood asthma apparently continues to increase in Oslo, having affected every fifth 10-year-old child.

Asthma↗
PubMed2005

Agreement between parental and self-completed questionnaires about asthma in teenagers.

In studies of asthma in children, a common method is for the parents to complete questionnaires about their child's asthma symptoms. With longitudinal studies of asthma, children reach an age when they can complete the questionnaire themselves. The aim of this paper was to compare the prevalence of asthma symptoms as well as the agreement between responses to an asthma questionnaire completed by teenagers and their parents. As a part of the Obstructive Lung Disease in Northern Sweden Study (OLIN) pediatric study, where 3345, 13-14-yr-old children completed an asthma questionnaire, 294 (84%) randomly selected parents also completed the questionnaire, which included the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. There were no significant differences in the prevalence of wheeze in the last 12 months, ever asthma, or physician diagnosed asthma as reported by the parents compared with the teenagers. However, the teenagers reported a significantly higher prevalence of wheeze during or after exercise. The absolute agreement was generally very high while the level of agreement (kappa-value) was slightly lower. The highest results in both absolute agreement and kappa-value, were reached by the questions on diagnosis of asthma (98.9% and 0.93), use of asthma medicines (95.5% and 0.78), and whether the child ever had had asthma (97.2% and 0.86), respectively. In conclusion, the agreement between the parents' and the teenagers' responses to the asthma questionnaire was good. The change in methodology from parental to self-completion of the questionnaire did not affect the results in the study.

Adolescent↗
PubMed2005

School-based asthma surveillance: a comparison of student and parental report.

This study addressed the comparability of data obtained from a student-based and parent-based asthma and respiratory health survey. Our goal was to ascertain whether there were meaningful and systematic differences in asthma classification based on symptom and diagnosis reports obtained separately from students and their parents. A brief, written survey, based on the International Study of Asthma and Allergy in Children questionnaire, was administered to 6th through 10th grade students in two schools in Oakland, CA, USA. Students who reported asthma-like indicators for the previous 12-month period were defined as positive and a more extensive questionnaire was mailed home to those parents. A more refined classification of asthma based on parent report of indicators was compared with student report. Forty-four percent of 1298 students were classified as positive for current asthma-like symptoms and 50% of parent surveys were returned. For the positive students with parent surveys, 59% were classified as 'probable' for asthma based on the parent survey. Overall, the agreement between parent and students' classification was 70%, and 83% for students with a parent report of physician diagnosis of asthma. Students who were discordant with parents for physician diagnosis of asthma were more likely to be male, and more likely to have a parent report of unscheduled Emergency Department visit for wheezing or trouble breathing. Findings indicated that with the exception of medication, students reported asthma indicators more frequently that parents, independent of classification. Student report of physician diagnosis with a 12-month report of an asthma symptom was determined to be a good indicator of probable current asthma. Inclusion of or reliance on a parental questionnaire is not likely to improve the reliability of a school-based asthma surveillance program in our population.

Adolescent↗
PubMed2004

Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population.

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Adolescent↗
PubMed1997

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995.

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.

Adolescent↗
PubMed1998

Admission rates as an indicator of the prevalence of severe asthma in the community.

BACKGROUND: A reliable indicator of the prevalence of severe asthma in the community is needed to monitor population-based asthma control strategies. We examined the potential use of asthma admissions to hospital as such an indicator. METHODS: We recruited subjects from the Emergency Department (ED) of a children's hospital. The attending doctor completed the 'physician questionnaire' which included questions on the patient's asthma severity and interval severity/chronicity of asthma. The parent/guardian completed the 'parent questionnaire'. It included questions on demography, asthma knowledge and attitudes, asthma history and social support. We performed univariate and multiple logistic regression to determine predictors for hospital admission. RESULTS: Interval severity of asthma, pre-treatment severity of wheeze and low post-treatment pulse oximetry best predicted whether children presenting with asthma were admitted. Demographic variables, factors associated with access to health services and factors related to the asthma history and management were not significant predictors of admission. DISCUSSION: At the population level, it may be possible to utilise routine hospital admission rates as an indicator of the prevalence of severe asthma in the community, especially within the context of monitoring trends in asthma prevalence. Our study was conducted in a metropolitan tertiary paediatric hospital. The reliability of hospital admission rates as indicators of the prevalence of severe asthma in other hospital settings, in different population groups and over time remains to be established.

Adolescent↗
PubMed2001

Asthma outcomes at an inner-city school-based health center.

Childhood asthma has reached near-epidemic levels in the US cities. Innovative strategies to identify children with asthma and prevent asthma morbidity are needed. This study measured asthma outcomes after initiation of an inner-city elementary school health center with a schoolwide focus on asthma detection and treatment. The site was an inner-city elementary school in Minneapolis, Minn. The study design incorporated a pre and post comparison with a longitudinal cohort of children (n = 67) and a cross-sectional cohort of children before (n = 156) and after (n = 114) the intervention. Hospitalization rates for asthma decreased 75% to 80% over the study period. Outpatient visits for care in the absence of asthma symptoms doubled (p < .01), and the percentage of students seeing a specialist for asthma increased (p < .01). Use of peak flow meters, use of asthma care plans, and use of inhalers also improved (p < .01). While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans. This schoolwide intervention that included identification of children with asthma, education, family support, and clinical care using an elementary school health center was effective in improving asthma outcomes for children.

Adolescent↗
PubMed2006

Asthma status and severity affects missed school days.

Excessive school absence disrupts learning and is a strong predictor of premature school dropout. School-aged children with asthma are absent more often compared to their healthy peers without asthma; yet, the causes are inadequately documented. We sought to determine the difference in mean absence days between children with and without asthma, the relationship between asthma severity and missed days from school, and if incident absences were due to asthma in a predominantly African American urban school district in the Midwestern United States. A cross-sectional analysis was conducted of 9014 students (grades K-12) followed for absenteeism over the 2002-2003 academic year. A subset of 543 students with asthma was assessed for asthma severity and cause of absence. Those with asthma (9.7% of students) were absent (mean = 9.2 days) approximately 1.5 more days compared to those without asthma (mean = 7.9 days) (p = .006). In the analysis comparing asthma severity and absenteeism, after adjusting for demographic variables and enrollment time, mean days absent increased with increasing asthma severity level: mild intermittent (mean = 8.5 days), mild persistent (mean = 11.3 days), moderate persistent (mean = 10.3 days), and severe persistent (mean = 11.6 days) (p = .001). Out of 1537 tracked absences that resulted from illness, 478 (31%) were due specifically to asthma-related symptoms. Children with asthma are absent from school more often compared to their healthy peers and this appears to be driven by the underlying severity of symptoms. (J Sch Health. 2006;76(1):18-24).

Absenteeism↗
PubMed2006

Asthma severity and atopy: how clear is the relationship?

BACKGROUND: The relationship between asthma severity and atopy is complex. Many studies have failed to show significant relationships between clinical severity or lung function and markers of atopic sensitisation. AIM: To determine whether increasing asthma severity is related to atopic sensitisation in a population of children with asthma. METHODS: A total of 400 children (7-18 years) with asthma were recruited as part of a multicentre study of the genetics of asthma. Detailed phenotypic data were collected on all participants. Associations between measures of asthma severity and atopic sensitisation were sought using multilevel models allowing variation at the individual and family level. RESULTS: Children recruited to the study had a range of asthma severities, with just over a third having mild persistent asthma. The logarithm of total serum IgE was associated with increased asthma severity score, decreased FEV1, increased airways obstruction, risk of hospital admission, and inhaled steroid use. Increasing skin prick test reactivity to a panel of seven aeroallergens was associated with increased risk of hospital admission, use of an inhaled steroid, and airways obstruction. The results remained highly significant after corrections for age, gender, and birth order. CONCLUSIONS: In children with asthma, increasing atopy is associated with increasing asthma severity. However, the relationships between asthma severity and skin prick tests, and asthma severity and total serum IgE values, appear subtly different.

Adolescent↗
PubMed1992

Asthma care in Darley Dale: general practitioner audit.

OBJECTIVE: To complete a first audit cycle of asthma care in Darley Dale after starting an asthma clinic. DESIGN: Pre-clinic (1989) and post-clinic (1990) analysis of medical records of patients with asthma. SETTING: A group practice in Derbyshire. PATIENTS: 161 pre-clinic, 238 post-clinic patients with asthma. MAIN OUTCOME MEASURES: Term "asthma" in the patient's computerised problem list, recording of peak expiratory flow rate, smoking history, clinical review, medication, and hospital admissions for asthma. RESULTS: There were significant improvements post-clinic with respect to the term "asthma" in the computer file (1989, 93/161 (58%); 1990, 233/238 (98%) (difference 0.40; 95% confidence interval 0.32 to 0.48)); at least one peak flow measurement (1989, 24/161 (15%); 1990, 143/238 (60%) (0.45; 0.37 to 0.53)); three or more peak flow measurements (1989, 15/161 (9%); 1990, 40/238 (17%) (0.08; 0.02 to 0.14)); and smoking history (1989, 24/161 (15%); 1990, 133/238 (56%) (0.41; 0.33 to 0.49)). There were no significant differences post-clinic with respect to asthma reviewed at least once (1989, 61/161 (38%); 1990, 74/238 (31%) (0.07; -0.03 to 0.17)); recording long term medication; treating acute asthma; or ratio of average to best peak flow rate of 38 patients who had one or more measurements (1989, 31/38 (82%); 1990, 34/38 (89%) (0.08; -0.08 to 0.24)). CONCLUSIONS: Setting up an asthma clinic resulted in better recording of data relevant to patients with asthma. However, objective improvement in patients' asthma could not be detected. Renewed emphasis on prophylactic measures may result in measurable improvement in these patients' asthma in the future.

Ambulatory Care Facilities↗
PubMed2003

Proactive asthma care in childhood: general practice based randomised controlled trial.

OBJECTIVES: To assess the feasibility and effectiveness of a general practice based, proactive system of asthma care in children. DESIGN: Randomised controlled trial with cluster sampling by general practice. SETTING: General practices in the northern region of the Australian Capital Territory. PARTICIPANTS: 174 children with moderate to severe asthma who attended 24 general practitioners. INTERVENTION: System of structured asthma care (the 3+ visit plan), with participating families reminded to attend the general practitioner. MAIN OUTCOME MEASURES: Process measures: rates for asthma consultations with general practitioner, written asthma plans, completion of the 3+ visit plan; clinical measures: rates for emergency department visits for asthma, days absent from school, symptom-free days, symptoms over the past year, activity limitation over the past year, and asthma drug use over the past year; spirometric lung function measures before and after cold air challenge. RESULTS: Intervention group children had significantly more asthma related consultations (odds ratio for three or more asthma related consultations 3.8 (95% confidence interval 1.9 to 7.6; P = 0.0001), written asthma plans (2.2 (1.2 to 4.1); P = 0.01), and completed 3+ visit plans (24.2 (5.7 to 103.2); P = 0.0001) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6% (1.7 to 3.5); P = 0.0001) less than control children. The number needed to treat (benefit) for one additional written asthma action plan was 5 (3 to 41) children. Intervention group children had lower emergency department attendance rates for asthma (odds ratio 0.4 (0.2 to 1.04); P = 0.06) and less speech limiting wheeze (0.2 (0.1 to 0.4); P = 0.0001) than control children and were more likely to use a spacer (2.8 (1.6 to 4.7); P = 0.0001). No differences occurred in number of days absent from school or symptom-free day scores. CONCLUSIONS: Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial.

Asthma↗