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Asthma in children: gaps between current management and best practice
M M Haby1, C V E Powell, F Oberklaid
1Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia.
Insights
Many children with asthma lack adequate management, with over 60% not using preventive medication and many parents lacking information. Improving asthma care requires better doctor-led reviews and action plans for children.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Asthma Management
Background:
- The Australian six-step asthma management plan aims to optimize care for children with asthma.
- Effective asthma management is crucial for reducing exacerbations and improving quality of life in children.
Purpose of the Study:
- To assess the implementation of key steps (3-6) of the Australian asthma management plan in community settings.
- To identify barriers hindering the adoption of best practices in pediatric asthma care.
Main Methods:
- A cross-sectional descriptive study involving 231 children aged 2-5 years presenting with asthma to emergency departments.
- Data collected via parent-completed questionnaires focusing on asthma management practices and perceived barriers.
Main Results:
- Significant gaps identified: 51% parents lack information on triggers, >60% children with persistent asthma not on preventive medication, 48% lack action plans, 39% unreviewed in 6 months.
- Positive findings include: 83% doctors discussed triggers, <1% used inhalers without spacers, 83% of action plan users utilized them during emergency visits.
Conclusions:
- Current asthma management for emergency department attendees shows significant deviations from best practices.
- Enhancing pediatric asthma care necessitates proactive doctor-initiated reviews, provision of action plans, and adherence to medication guidelines.
Objectives:
To determine the extent to which steps three to six of the Australian six-step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management.
Methods:
A cross-sectional descriptive study was conducted at the Royal Children's Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty-one 2-5-year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent-completed questionnaire.
Results:
Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child's asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or 'triggers' their child's asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department.
Conclusions:
Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child's asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.