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PEDIATRICS Vol. 103 No. 2 February 1999, pp. 422-427

How Does Home Management of Asthma Exacerbations by Parents of Inner-city Children Differ From NHLBI Guideline Recommendations?

Received Feb 23, 1998; accepted Aug 5, 1998.

Karen L. Warman, Ellen Johnson Silver, Mary P. McCourt, and Ruth E. K. Stein

From the Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.

Objectives.  1) To describe the asthma morbidity, primary care practices, and asthma home management of inner-city children with asthma; 2) to determine the responses of parental caretakers to asthma exacerbations in their child; and 3) to compare these responses to the recommendations of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines for home management of acute exacerbations of asthma.

Design and Methods.  A 64-item telephone survey was administered between July 1996 and June 1997 to 220 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center from January, 1995 to February, 1996. Sociodemographics, primary care practices, asthma morbidity, and asthma home management were assessed. Parents were asked what they would do if their child "began wheezing and breathing faster than usual."

Results.  Morbidity measures indicated that there were an average of 2.5 ± 4.5 emergency department visits for asthma in the last 6 months, 1.6 ± 2.2 hospitalizations for asthma in the last 12 months, and 18.1 ± 17.9 asthma-related school absences in the previous school year. Most, but not all, of the families had primary care providers and most had phone access to them. Half of the families (51%) reported having been given a written asthma action plan. Only 30% of families with children age 5 years and older had peak flow meters. In contrast, almost all families (97%) had equipment for inhalation of beta -agonists. Only 39% of the 181 children with persistent symptoms were receiving daily antiinflammatory agents as recommended in the guidelines of the NHLBI. In response to the scenario of an acute exacerbation of asthma, no one mentioned that they would refer to a written plan, only 1 caretaker would measure peak flow and 36% would give beta -agonists. Two percent would give oral steroids initially, and 1 additional person would do so if wheezing continued 40 minutes later. Only 4% responded that they would contact their clinician. Reports of actual practice differed from the scenario responses in that more people began beta -agonists and oral steroids in response to an exacerbation in the past 6 months than said they would in response to the scenario.

Conclusion.  In this population of previously hospitalized inner-city children with asthma, the NHLBI guidelines for the home management of asthma exacerbations are not being followed. Interventions are needed to affect both clinician and caretaker practices.  Key words:  asthma, children, morbidity, inner city, management, guidelines, standard of care, scenario, peak flow, oral steroids, beta -agonist, access to care, symptoms, antiinflammatory agents.




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