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CLINICAL PEDIATRIC ASTHMA
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CLINICAL PEDIATRIC ASTHMA
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Asthma is one of the more common reasons for children’s visits to emergency departments (EDs). National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. The number of ED visits for asthma in children 14 years of age increased 14% in the United States from 1992–1999, and there now are >600000 ED visits annually for asthma in this age group. ED use for asthma care in children has been associated with many factors including younger age, gender, minority status, poverty, living in an urban area, having Medicaid or lack of insurance, access to care, quality of care, allergen-prone environments, and poorer health. However, the vast majority of these studies have been conducted in the inner-city environments of very large urban centers. There is less known about whether the characteristics of children who visit EDs in more suburban and rural settings differ from those of their urban counterparts.
Studies have shown that the care and management of asthma in children in the outpatient setting frequently fall short of what is recommended in the National Asthma Education and Prevention Program (NAEPP) guidelines. Most recent studies of children with asthma who use the ED have shown that although the majority do have access to primary care, this access does not ensure that they receive the recommended asthma care and self-management training in the outpatient setting. For example, many children who use the ED seem to be undermedicated in terms of using an inhaled corticosteroid (ICS) or other long-term control medication, and follow-up visits with a primary care provider (PCP) usually occur much later than the time frame recommended in the NAEPP guidelinesThe most common chronic disease of childhood is associated with wide variations in quality of care. These findings suggest that continuing medical education can lead to better health outcomes in children with asthma, if the education initiative is interactive, multidisciplinary, and intense .
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