July 05, 2016
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New primary care-based program improves asthma detection by 60%

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Recent findings published in the Journal of Asthma showed that a new primary care-based asthma program, which applies more focused guidelines, improved asthma detection by 60% compared with routine care.

“An estimated 7 million children in the U.S. have asthma and almost half are poorly controlled,” Karen Warman, MD, associate professor of clinical pediatrics at Albert Einstein College of Medicine, said 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.”

The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, published in 2007, includes more questions about impaired activity and rescue medication use compared with the previous guidelines, the researchers wrote. The guidelines also changed the criteria used to interpret spirometry test results and added an assessment of the ratio of forced expiratory volume in 1 second to forced vital capacity to examine peak flow. For each level of asthma severity, there is a recommended “step of care” with different combinations of medicines.

To evaluate these recommendations, the researchers conducted a retrospective chart review of 79 children (mean age, 9.6 years; 45.6% Latino; 35.4% African-American) consecutively referred to the program between 2011 and 2013. Asthma severity recorded during routine visits was compared with asthma severity recorded during new program visits.

The researchers found that more children were determined as having moderate to severe asthma based on clinical questions (47.9%), spirometry (56.9%) or combined criteria (75.3%) compared with routine care (15.2%) (P < .05 for all). In addition, the new program resulted in more controller medications prescribed after visits (82.3% vs. 63.3%; P < .05), and 40.6% of patients had their medications “stepped up.”

This study suggested that asthma management for inner-city children can be improved by providing asthma-focused visits in addition to routine visits and by using the guideline recommendations for spirometry testing, the researchers wrote.

“We recognize many demands are placed on primary care physicians during routine health care maintenance visits,” Warman said in the release. “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.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.