A few home visits by a health care specialist to educate children with asthma about basic strategies for earlier symptom recognition and improving medicine use can lead to fewer flare-ups and less frequent trips to the ER, as per research from Johns Hopkins Children's Center reported in the recent issue of Pediatrics
An estimated 6.5 million children in the United States have asthma, which is the leading pediatric chronic illness in this country and disproportionately affects minorities.

"We compared several strategies to improve asthma control among children and, much to our delight, we observed that taking a few simple steps can go a long way toward doing so," says senior investigator Kristin Riekert, Ph.D., a pediatric psychology expert at Hopkins and co-director of the Johns Hopkins Adherence Research Center.

Scientists say the key is providing regular asthma education that includes:

in-the-home demonstration and training on the proper use of inhalers by an asthma specialist and a discussion with the family about regular access to a pediatrician, ensuring they have access to one.

an asthma action plan specifically tailored to each child with a list of must-take daily controller medicine to keep inflammation at bay, a checklist of what to do when symptoms start and when to seek emergency care.

Scientists compared the effectiveness of three different strategies in 250 African-American children with asthma who ended up in the ER with an asthma attack. One group received a booklet with basic asthma information the standard and usual care. The other two groups received educational home visits by asthma educators, with one group receiving education only, and the other receiving education plus feedback on how well the patient was following their medicine instructions, which scientists determined by a monitoring device on the child's inhaler to record each use, as well as coaching on how to improve adherence.

Follow-ups at six, 12 and 18 months showed that:

• Children in the two groups that received home visits and whose medicine use was monitored had 15 percent fewer trips to the ED in comparison to children who got the standard care. They also had a 52 percent faster rate of refill of inhaled corticosteroids, daily controller medicine that helps keep inflammation at bay.
  
• Children who got educational home visits reported on average fewer symptoms per month in comparison to children who received the informational booklet.
  
• Children who got the informational pamphlet the standard of care had 12 percent more ED visits and 17 percent higher use of oral corticosteroids, a marker of an asthma flare-up, when in comparison to children from the other two groups.
  
• There was no added value in providing medicine monitoring and feedback above providing at-home educational visits alone.
  
• There was no significant difference in the number of hospitalizations among the three groups.

Posted by: Emily    Source

---