Improving Pediatric Asthma Care
Asthma continues to be the most prevalent chronic condition in children under 18.1 Boys are more likely to be diagnosed than girls (10% vs. 7%).1
According to the National Health Statistics Report for 2015, 96% of children under 18 have a usual place of health care, with 73% receiving care in a doctor’s office.2 This presents an opportunity for consistent oversight of asthmatic children, which can greatly reduce factors associated with chronic exacerbations, time lost from school, and emergency department (ED) visits.
In 2013, 1.6 million emergency department visits listed asthma as the primary diagnosis.3 Education can help reduce ED visits when patients understand the link between daily management, triggers, and attacks. For example, researchers in Saudi Arabia, upon reviewing the ED records of two major hospitals, found that the ED was used for convenience and rapid access to care. 56% of patients said they had not been educated about their condition; patients were unaware of the impact of environmental factors such as passive smoking and the presence of carpets in the bedroom.4
Poorly controlled asthma is often attributed to poor adherence to a treatment plan. Lack of adherence can stem from desire to avoid regular medication use, inappropriate high tolerance of symptoms, not fully comprehending that asthma is a chronic condition, and poor inhaler technique.5
Yet many children (and their parents) have never received a treatment plan. Saudi researchers reported that nearly half of patients surveyed had not received asthma management training from a professional; 42% were untrained on the proper use of an inhaler. The majority lacked a plan to treat or prevent an attack and 92% were without a written treatment plan.4 This lack of plan is similar in the US, where studies show only approximately half of younger patients have ever received a written treatment plan,6 and adherence to established asthma treatment guidelines is low.7
Given the burden on the healthcare system of 10.5 million annual visits for pediatric asthma,8 strategies that work with this population are especially important. Children’s unique physiology must be considered in developing a management plan. Obtaining a thorough medical history could identify either comorbid upper airway disorders or allergies that could exacerbate asthma.9 Special concerns for treating children with asthma include:
- Monitoring medication adherence and drug delivery techniques.
- Balancing corticosteroid use with the risk of adverse impact on bone mineral density and bone growth.
- Addressing psychosocial factors that could hinder asthma management.9
The Functional Medicine approach provides a framework for integrating environment, patient readiness, and nutrition for patients with chronic conditions like asthma. The framework applies to many chronic conditions, not just asthma.
In the Pediatrics Advanced Clinical Training, Advanced Functional Medicine Strategies for Pediatrics: From Chronic Illness to Wellness, expert clinicians discuss their strategies to address many common pediatric conditions. They will review cases that provide experience with this framework, as well as practical, hands-on knowledge and tools to take back to your clinical practice. For your young patients with asthma, allergies, obesity, migraines, and many other chronic conditions, this program provides tools and strategies for improved outcomes.
Register for the Pediatrics Advanced Clinical Training
- National Current Asthma Prevalence (2015). (Sourced from the 2015 National Health Interview Survey (NHIS) Data, Table 3-1 and Table 4-1). Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/most_recent_data.htm. Updated June 7, 2017. Accessed August 9, 2017.
- Bloom B, Simpson JL. Table C-7a: Age-adjusted percentages (with standard errors) of having a usual place of health care, and age-adjusted percent distributions of type of place, for children under age 18 years, by selected characteristics: United States, 2015. In: Tables of Summary Health Statistics for U.S. Children: 2015 National Health Interview Survey. National Center for Health Statistics. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2015_SHS_Table_C-7.pdf. Published 2016. Accessed August 9, 2017.
- Asthma FastStats: Emergency department visits. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/asthma.htm. Updated March 31, 2017. Accessed August 8, 2017.
- Al-Muhsen S, Horanieh N, Dulgom S, et al. Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children. Ann Thorac Med. 2015;10(2):123-31. doi:10.4103/1817-1737.150735.
- Yawn BP. The role of the primary care physician in helping adolescent and adult patients improve asthma control. Mayo Clin Proc. 2011;86(9):894-902. doi:10.4065/mcp.2011.0035.
- Simon AE, Akinbami LJ. Asthma action plan receipt among children with asthma 2-17 years of age, United States, 2002-2013. J Pediatr. 2016;171:283-89.e1. doi:10.1016/j.jpeds.2016.01.004.
- Yawn BP, Rank MA, Cabana MD, Wollan PC, Juhn YJ. Adherence to asthma guidelines in children, tweens, and adults in primary care settings: a practice-based network assessment. Mayo Clin Proc. 2016;91(4):411-21. doi:10.1016/j.mayocp.2016.01.010.
- Centers for Disease Control and Prevention: Ambulatory and Hospital Care Statistics Branch. Table 16: Twenty leading primary diagnosis groups for office visits: United States, 2012. In: National Ambulatory Medical Care Survey: 2012 State and National Summary Tables. CDC; 2012:20. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2012_namcs_web_tables.pdf. Accessed August 9, 2017.
- Jassal MS. Special considerations—asthma in children. Int Forum Allergy Rhinol. 2015;5(Suppl 1):S61-67. doi:10.1002/alr.21577.