Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2394-2401 (doi:10.1542/peds.2006-0871)
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ARTICLE

Initiation of Maintenance Antiinflammatory Medication in Asthmatic Children in a Pediatric Emergency Department

Heather K. Lehman, MDa, Kathleen A. Lillis, MDb, Steven H. Shaha, PhD, DBAc, Marilyn Augustine, MDa and Mark Ballow, MDa

a Divisions of Allergy/Immunology
b Emergency Medicine, Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Women and Children's Hospital of Buffalo, Buffalo, New York
c Center for Patient Quality, Women and Children's Hospital of Buffalo, Buffalo, New York

BACKGROUND. Despite National Asthma Education and Prevention Program guidelines recommending the use of daily controller medication in patients with persistent asthma, less than half of children requiring emergency department treatment for asthma exacerbations are receiving antiinflammatory therapy.

OBJECTIVE. The purpose of this study was to evaluate a pediatric emergency department–based intervention designed to affect the prescribing practices of primary care physicians to better comply with national asthma guidelines. The intervention involved initiating maintenance antiinflammatory therapy in children with an asthma exacerbation who met guidelines for persistent disease but were not on antiinflammatory medications.

METHODS. Guardians of children 2 to 18 years of age presenting to the pediatric emergency department with an asthma exacerbation were asked to complete an asthma survey. Patients were classified into severity categories. Those with persistent disease not on antiinflammatory medications were given a 2-week supply of medication and were instructed to follow-up with their primary care physicians to obtain a prescription for the antiinflammatory medication. Patient adherence information was obtained through telephone calls, pharmacy claims data, and physician office records.

RESULTS. Forty-seven of 142 patients met criteria and were enrolled in the intervention. Seven patients were lost to follow-up. Of the remaining 40 patients, 28 followed-up with their primary care physician. Of these patients, 75% were continued on an antiinflammatory medication. Primary care physicians were significantly more likely to continue an antiinflammatory prescription in patients with severe persistent asthma (88.9% vs 68.4% of mild- or moderate-persistent asthmatics). Of the 28 patients who followed-up with their primary care physician, 13 had a prescription written, dispensed, and reported using the medication at the time of follow-up.

CONCLUSIONS. Pediatric emergency department physicians can successfully partner with primary care physicians to implement national guidelines for children requiring maintenance antiinflammatory asthma therapy. Patient nonadherence continues to be a significant barrier for asthma management.

Key Words: asthma • emergency department • inhaled antiinflammatory agents • compliance • guideline adherence

Abbreviations: NAEPP—National Asthma Education and Prevention Program • PCP—primary care physician • ED—emergency department • PED—pediatric emergency department • WCHOB—Women and Children's Hospital of Buffalo

Accepted Jul 24, 2006.