OBJECTIVE: To evaluate and identify potentially modifiable factors in children with problematic asthma by a nurse-led assessment and home visit. DESIGN: Observational cohort study. SETTING: A tertiary paediatric respiratory centre. PATIENTS: 71 children, aged 4.5-17.5 years, with problematic asthma currently under follow-up at a tertiary respiratory centre. INTERVENTIONS: A nurse-led hospital visit followed by a home visit. MAIN OUTCOME MEASURES: Identification and attempted change of exacerbating factors so that further investigations and consideration of off-label, potentially toxic, asthma therapies were not necessary. RESULTS: Potentially modifiable factors were identified in 56 (79%) children. Many children had multiple causes for poor control. The most important were ongoing allergen exposure, 22 children (31%); passive or active smoking, 18 children (25%); medication issues including adherence, 34 children (48%); psychosocial factors, 42 families (59%). The home visit contributed valuable information to this assessment. At the home visit house dust mite avoidance measures were found to be inadequate in 84% of those sensitised; medications were not easily available for inspection or were out of date in 23%; 74% of psychology referrals were made after the home visit. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided. CONCLUSIONS: Nurse-led assessments including a home visit can help identify potentially modifiable factors for poorly controlled symptoms in children with problematic asthma.
OBJECTIVE: To evaluate and identify potentially modifiable factors in children with problematic asthma by a nurse-led assessment and home visit. DESIGN: Observational cohort study. SETTING: A tertiary paediatric respiratory centre. PATIENTS: 71 children, aged 4.5-17.5 years, with problematic asthma currently under follow-up at a tertiary respiratory centre. INTERVENTIONS: A nurse-led hospital visit followed by a home visit. MAIN OUTCOME MEASURES: Identification and attempted change of exacerbating factors so that further investigations and consideration of off-label, potentially toxic, asthma therapies were not necessary. RESULTS: Potentially modifiable factors were identified in 56 (79%) children. Many children had multiple causes for poor control. The most important were ongoing allergen exposure, 22 children (31%); passive or active smoking, 18 children (25%); medication issues including adherence, 34 children (48%); psychosocial factors, 42 families (59%). The home visit contributed valuable information to this assessment. At the home visit house dust mite avoidance measures were found to be inadequate in 84% of those sensitised; medications were not easily available for inspection or were out of date in 23%; 74% of psychology referrals were made after the home visit. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided. CONCLUSIONS: Nurse-led assessments including a home visit can help identify potentially modifiable factors for poorly controlled symptoms in children with problematic asthma.
Authors: Michael Seid; Elizabeth J D'Amico; James W Varni; Jennifer K Munafo; Maria T Britto; Carolyn M Kercsmar; Dennis Drotar; Eileen C King; Lynn Darbie Journal: J Pediatr Psychol Date: 2011-12-13
Authors: Paul E Moore; Jason T Poston; Debra Boyer; Emily Barsky; Jonathan Gaffin; Kathleen B Boyne; Kristie R Ross; Laura Beth Mann Dosier; Timothy J Vece; Alicia M Casey; Sebastian K Welsh; J Wells Logan; Edward G Shepherd; Pelton A Phinzy; Howard B Panitch; Christina M Papantonakis; Eric D Austin; Amir B Orandi; Maleewan Kitcharoensakkul; Mark K Abe; Amjad Horani; Jordan S Rettig; Jessica Pittman Journal: Ann Am Thorac Soc Date: 2017-08
Authors: Arlene M Butz; Jill S Halterman; Melissa Bellin; Joan Kub; Kevin D Frick; Cassia Lewis-Land; Jennifer Walker; Michele Donithan; Mona Tsoukleris; Mary Elizabeth Bollinger Journal: J Asthma Date: 2012-09-19 Impact factor: 2.515