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National experts outline a plan of action to improve asthma outcomes among U.S. children

Despite significant advances in the treatment of childhood asthma, it has reached epidemic proportions in the United States. The number of asthma cases in children under 5 years of age increased over 160 percent between 1980 and 1994 and 74 percent among children ages 5 through 14 years.

A committee of nationally recognized experts and leaders in childhood asthma recently outlined policy recommendations to improve childhood asthma outcomes. The recommendations appear in an article by Marielena Lara, M.D., M.P.H., of the University of California, Los Angeles, and other committee members. Dr. Lara's work was supported in part by the Agency for Healthcare Research and Quality (K08 HS00008).

The overall goals of the recommendations are to promote asthma-friendly communities nationwide in which children with asthma are quickly diagnosed and receive appropriate and ongoing treatment; health care, school, and social agencies are prepared to meet the needs of children with asthma and their families; and children are safe from environmental risks that worsen asthma. To achieve these goals, the committee recommends enhancing access to and quality of health care services for asthma, enhancing knowledge about asthma among affected individuals and the general public, and ensuring asthma-safe schools. They also recommend promoting asthma-safe home environments (absence of asthma-provoking allergens and irritants such as smoke, dust, mold, pet dander, and cockroaches), encouraging innovation in asthma prevention and management (for example, environmental modification, immunologic intervention, and lifestyle changes for preventing and managing symptoms), and reducing socioeconomic disparities in childhood asthma outcomes.

To improve asthma health care delivery and financing, the experts suggest developing and implementing quality of care standards in primary care, self-management education, and case management interventions, as well as expanding insurance coverage and benefit design to include essential pediatric asthma services. They also support a stronger public health infrastructure that includes public funding of asthma services, a national asthma public education campaign, a national asthma surveillance system, and a national agenda for asthma prevention research.

See "Improving childhood asthma outcomes in the United States: A blueprint for policy action," by Dr. Lara, Sara Rosenbaum, J.D., Gary Rachelefsky, M.D., and others, in the May 2002 Pediatrics 109(5), pp. 919-930.

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