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Impact of guideline adherence and race on asthma control in children
Shahid I Sheikh1,2, Nancy A Ryan-Wenger3, Judy Pitts4
1Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. Shahid.Sheikh@nationwidechildrens.org.
Insights
Asthma control improved similarly for African American and Caucasian children using National Asthma Education and Prevention Program (NAEPP) guidelines. Consistent guideline adherence led to comparable asthma outcomes over one year.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Public Health
Background:
- Asthma control is often more challenging in African American (AA) children compared to Caucasian American (CA) children.
- This study investigated asthma control differences between AA and CA children managed under established guidelines.
Purpose of the Study:
- To compare asthma control trajectories in African American and Caucasian children over a one-year period.
- To evaluate the effectiveness of National Asthma Education and Prevention Program (NAEPP) guidelines in diverse pediatric populations.
Main Methods:
- A one-year prospective study involving children referred to a specialty asthma clinic.
- All participants received asthma care consistent with NAEPP (EPR-3) guidelines.
- Asthma control metrics, symptoms, and acute care utilization were compared between AA and CA children at baseline and quarterly intervals.
Main Results:
- At baseline, AA children had significantly more emergency department visits for asthma exacerbations compared to CA children.
- Within 3-6 months, both groups showed significant improvements in asthma control test scores, symptom frequency, and acute care utilization.
- The rate of improvement over time was comparable between groups, with AA children experiencing a greater reduction in emergency department visits.
Conclusions:
- Consistent application of NAEPP asthma care guidelines resulted in similar improvements in asthma control for both African American and Caucasian children.
- The findings suggest that adherence to evidence-based guidelines can effectively bridge disparities in asthma management outcomes.
Background:
Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines.
Methods:
This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year.
Results:
Of the 345 children, ages 2-17 years (mean = 6.2 ± 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 [Formula: see text] compared to CA (1.4 ± 2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3-6 months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002).
Conclusion:
Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.
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