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AAP News Vol. 20 No. 5
May 2002, p. 218
© 2002 American Academy of Pediatrics
NEWS AND FEATURES |
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As the number of children who suffer from asthma escalates, the Academy is calling on pediatricians to establish communication with schools and develop asthma management programs to help patients manage the disease.
Nearly 5 million children suffer from asthma — the third ranking cause of hospitalizations for children under age 15, according to the U.S. Centers for Disease Control and Prevention (CDC).
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"One of the things that we’re working on is making sure that everybody knows and understands that [asthma] can be controlled," said Dr. Wheeler. Many patients are not aware of the options that can help them control asthma, attend school every day and participate in physical education, she added.
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Pediatricians should establish a written management plan for each asthma patient. After obtaining parental consent, pediatricians should share the plan with the child’s school. With the help of school nurses, asthma documentation can be maintained on the child during the school day. Pediatricians also should encourage patients with asthma and parents to keep their own asthma diaries.
"The frequency in which patients use rescue medications like albuterol could be information that is really attainable at some schools and is also important for diagnosing a child with a more severe form of asthma," said Dr. Taras.
Pediatricians should be especially concerned about minority populations, in which asthma is more prevalent and access to care is sometimes lacking, said Dr. Wheeler. "One of the things that I always encourage schools to do — school nurses in particular — is to identify the students who have asthma and to make sure they have a medical home," she added.
Next, pediatricians should ensure their patients are properly trained to use asthma gadgets, like inhalers or spirometers.
"The basic problem is that when these prescriptions are given, the doctors don’t often have the medications and the patients in the room together. The patient picks up the medication a day later or that afternoon and to actually have the patient come back and do that training involves more appointments. It is not so difficult for the doctor, because I think they’re willing to do it, but it’s difficult for the parents," said Dr. Taras.
Making a concerted effort to get patients back into the office for regular monitoring also is important, he added.
Although treatment is improving, much more needs to be done to reduce morbidity from the disease.
The CDC offers programs to address asthma’s impact on children and adolescents, including the National Asthma Control Program. It also has funded a number of national organizations, including the Academy, and several school districts to develop programs, training, policies and resources that inform parents, students, school staff, school nurses and community health care providers about asthma; and to promote coordinated school health programs as a means of preventing major health and social problems that affect school-age children (www.cdc.gov/nceh/airpollution/asthma/children.htm).
Additionally, a group of nationally recognized leaders in childhood asthma has developed a blueprint for policy action that proposes to improve health care delivery and financing and strengthen public health infrastructure (
Pediatrics. 2002;109:919-930
The blueprint calls for coordination of activities at the national, state and community level and within and outside the health care delivery system.
"We have to be thinking along the lines of quality of life," said Dr. Welch. "We’re doing a pretty good job keeping [kids with asthma] out of the hospital. We’re doing a good job in the E.R. Now we have to tackle the next part of this problem, which is the impact on the function of the family and the school."
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