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Researchers focus on management of asthma in children

Asthma-related illnesses and deaths in children continue to rise, despite the availability of increasingly effective therapies to prevent and treat asthma episodes. Adequate treatment of childhood asthma depends on parental knowledge of symptoms and appropriate use of medications, as well as timely communication with the health care provider.

Three new studies that were supported in part by the Agency for Healthcare Research and Quality examine parental perceptions about asthma management, misunderstanding of appropriate medication use, and length of hospitalization of children with asthma (HS09983). They are briefly described here.

Peterson-Sweeney, K., McMullen, A., Yoos, L., and Kitzman, H. (2003, May). "Parental perceptions of their child's asthma: Management and medication use." (AHRQ grant HS10689). Journal of Pediatric Health Care 17, pp. 118-125.

These researchers examined parental experiences with their children with asthma, specifically their beliefs, knowledge, and attitudes about asthma management, including medication use. They conducted one-on-one interviews with 18 parents of children 2 to 18 years of age who were from diverse racial and socioeconomic backgrounds and who represented the range of illness severity. The interviews focused on parental beliefs, knowledge, and attitudes about asthma management, including medication use.

Results showed that parents need to partner more with health care providers to manage their child's asthma, and they need more education about asthma. Parents were frustrated when health care providers ignored their input, since they felt they knew their child's symptoms and responses best. Parents who sought care from specialists were more comfortable with the doctor's treatment plan and received more information about asthma management.

Nearly half of the parents interviewed said they received minimal or no education when their child was first diagnosed with asthma. Most of them developed systems of care over time through "trial and error."

Half of the parents who were taught about their children's asthma medications could not remember the mechanism of action of the medications. More than half of the parents who had children with long-standing asthma didn't understand or were confused about how the medications worked. Many parents used other resources to learn how to manage their child's asthma, such as Web sites, asthma networks and newsletters, family members, and pharmacists.

Farber, H.J., Capra, A.M., Finkelstein, J.A., and others (2003). "Misunderstanding of asthma controller medications: Association with nonadherence." (AHRQ grant HS09935). Journal of Asthma 40(1), pp. 17-25.

Daily use of inhaled antiinflammatory medications (for example, inhaled corticosteroids) has been shown to improve the functioning of children with persistent asthma and to decrease the risk of asthma-related emergency room visits, hospitalization, and death. Yet, this study found that nearly one-fourth (23 percent) of parents misunderstood the role of their child's inhaled antiinflammatory medicine. They thought it should be used to treat the symptoms (for example, cough or wheeze) of persistent asthma instead of as a daily medication to prevent symptoms before they start. This misunderstanding was associated with 82 percent lower adherence to recommended daily use of these medications, even after adjusting for demographic and process of care factors.

The risk for misunderstanding was lowered if the patient had seen a specialist or the parent had completed some post-high school education. Medication education efforts should target parents with less formal education and those whose children have not seen an asthma specialist, suggest the researchers. They conducted telephone interviews with a sample of 1,663 parents of asthmatic children insured by Medicaid managed care programs in California, Washington, and Massachusetts. They focused on the 571 parents of children who had persistent asthma and reported their child's use of an inhaled antiinflammatory medication.

Silber, J.H., Rosenbaum, P.R., Even-Shoshan, O., and others (2003, June). "Length of stay, conditional length of stay, and prolonged stay in pediatric asthma." (AHRQ grant HS09983). Health Services Research 38(3), p. 867-886.

Hospitals appear more efficient in overall management of pediatric asthma admissions in Pennsylvania than in New York State. This is primarily due to the efficient treatment of less severely ill children who can be rapidly discharged and a lower readmission rate after discharge. However, once children stay in the hospital beyond 3 days, there appears to be little difference between the two States, suggesting that medical care for severely ill asthmatic children is similar across States, according to the authors of this study. They conclude that policy initiatives in New York and other States should focus on improving the care provided to less severe asthmatic children in order to help reduce overall length of hospital stay.

The researchers used claims data to study all pediatric asthma admissions to children's and general hospitals in Pennsylvania and New York for the years 1996 to 1998. They examined length of stay, the probability of prolonged stay (more than 3 days), conditional length of stay, and the probability of readmission, controlling for patient factors, State, location, and hospital type. Overall, one-third of children were treated in children's hospitals, and two-thirds were treated in general hospitals.

Discharge rates in children's hospitals and general hospitals in Pittsburgh/Philadelphia were 20 percent and 26 percent faster, respectively, than discharge rates in children's and general hospitals in New York City. The odds of prolonged length of stay were 27 percent and 64 percent higher, and the likelihood of being readmitted was 3.38 and 2.33 times higher in children's and general hospitals in New York City, respectively, than in Pittsburgh/Philadelphia children's and general hospitals. However, there were no State differences in the discharge rate after hospital day three in either type of hospital.

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