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Use of asthma care guidelines reduces emergency visits and improves asthma care in children

When primary care practices implement asthma management guidelines, asthma care improves and asthma-related emergency department (ED) and other care visits decline among children with asthma, according to a new study. A team led by Michelle M. Cloutier, M.D., of the University of Connecticut Health Center, examined asthma care and care use among children enrolled in an asthma disease management program, Easy Breathing II. The program was based on national asthma management guidelines and involved 20 private pediatric practices from 2001 through 2003. Overall, 490 of the children studied had asthma.

After being enrolled in Easy Breathing II, children with persistent asthma had a 47 percent increase in use of inhaled corticosteroids (controller medications that can prevent or minimize asthma episodes), a 56 percent reduction in asthma-related outpatient visits, and a 91 percent decrease in ED visits for treatment of asthma. Asthma care also improved. The pediatric practices studied followed national asthma guidelines for prescribing inhaled corticosteroids 95 percent of the time. In addition, 5 years after program implementation, 17 of the 20 practices are still using Easy Breathing II.

Easy Breathing II was designed to aid clinicians in recognizing asthma, classifying asthma severity by using a scripted series of questions, and creating a written asthma treatment plan based on asthma severity. Before implementing Easy Breathing II, practices gave parents a written set of asthma instructions less than 5 percent of the time. These instructions tell parents when to intensify medicine or add additional medicine based on asthma symptoms and readings from a handheld peak flow meter into which the child breathes. The study was supported by the Agency for Healthcare Research and Quality (HS11147).

See "Asthma guideline use by pediatricians in private practices and asthma morbidity," by Dr. Cloutier, Dorothy B. Wakefield, M.S., Pamela Sangeloty-Higgins, M.S., M.P.H., and others, in the November 2006 Pediatrics 118(5), pp. 1880-1887.

Editor's Note: Another AHRQ-supported article (HS13110) on a related topic concludes that household-reported asthma information does not appear to overlook as many children with active asthma as previously reported. For more details, see Joesch, J.M., Kim, H., Kieckhefer, G.M., and others (2006, November). "Does your child have asthma? Filled prescriptions and household report of child asthma." Journal of Pediatric Health Care 20(6), pp. 374-383.

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