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Published on: November 8, 2013
Implementation and Effectiveness of Guideline-Recommended Clinical Activities for Children With Asthma:
Zainab Khalaf1, Sejal Saglani1, Chloe I Bloom1
1National Heart and Lung Institute, Imperial College London, London, England.
Insights
Most children in the UK don't receive recommended asthma reviews, inhaler technique checks, or management plans. Implementing these activities, especially together, significantly reduces asthma exacerbations in children.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Clinical Practice Research
Background:
- Asthma exacerbations pose significant risks to children's health.
- Guidelines recommend regular asthma reviews, inhaler technique checks, and management plans to mitigate these risks.
- The frequency and effectiveness of these guideline-recommended activities in real-world clinical practice are not well understood.
Purpose of the Study:
- To assess the frequency of guideline-recommended asthma management activities provided to children in the UK.
- To determine the effectiveness of individual and combined asthma management activities in preventing asthma exacerbations.
- To identify risk factors associated with the under-provision of these essential asthma care activities.
Main Methods:
- Retrospective review of UK primary care and hospital records (2004-2021) for children diagnosed with asthma up to age 16.
- Measurement of annual implementation rates for asthma reviews, inhaler technique checks, and management plans.
- Multivariable logistic regression to identify risk factors for non-receipt of activities.
- Self-controlled case series analysis to evaluate the impact of each activity on exacerbation risk over 12 months.
Main Results:
- Only 30-45% of eligible children received each annual activity, with only 8% receiving all three.
- Younger age, socioeconomic deprivation, and lack of BMI measurement were associated with lower activity provision.
- Standalone asthma management plans and reviews reduced exacerbations by approximately 15% and 8% respectively over 12 months.
- Combined provision of all three activities demonstrated a significant reduction in exacerbations by approximately 30% over 12 months.
Conclusions:
- A substantial proportion of children in the UK do not receive guideline-recommended asthma monitoring activities.
- These recommended activities are effective in reducing asthma exacerbations when implemented in clinical practice.
- Combining asthma reviews, inhaler technique checks, and management plans during a single visit maximizes their effectiveness in preventing exacerbations.
Background:
Guidelines advise minimizing asthma exacerbation risk, which is achieved partially through good clinical practice activities, including scheduled asthma reviews, inhaler technique checks, and asthma management plans. We assessed how frequently these activities are provided and how effective they are in clinical practice.
Research Question:
Do guideline-recommended activities such as asthma reviews, inhaler technique checks, and asthma management plans prevent asthma exacerbations?
Study Design And Methods:
This retrospective chart review used United Kingdom primary care medical records between 2004 and 2021, linked to hospital records. Children were eligible from asthma diagnosis until age 16 years. Annual implementation of asthma review, inhaler technique check, and asthma management plan was measured. Risk factors for these activities not being undertaken were determined by using multivariable logistic regression. Self-controlled case series was adopted to assess the effectiveness of each activity over 12 months; this was divided into two 6-month periods.
Results:
A total of 126,483 children were eligible; 30% to 45% received each annual activity, and 8% received all three together. Risk factors for not receiving activities included younger age, more socioeconomic deprivation, and higher or no BMI measurement. Management plans and asthma reviews, as standalone activities, were associated with an approximately 15% exacerbation reduction over 12 months and 8% over 6 months, respectively (asthma management plan, n = 4,624; 0-180 days [incidence rate ratio (95% CI)]: 0.87 [0.79-0.96]; 181-365 days: 0.83 [0.73-0.95]; asthma review, n = 6,948; 0-180 days: 0.92 [0.85-0.99]; 181-365 days: 0.93 [0.83-1.03]). Standalone inhaler technique checks were not associated with exacerbations. Provision of all activities together was associated with an approximately 30% exacerbation reduction over 12 months (n = 3,643; 0-180 days: incidence rate ratio, 0.76 [0.68-0.85]; 181-365 days: incidence rate ratio, 0.69 [95% CI, 0.60-0.81]).
Interpretation:
Our results indicate that most children in the United Kingdom do not receive the guideline-recommended activities to monitor their asthma. This study suggests that these activities, if implemented, are effective in clinical practice and maximally effective when combined in the same visit.
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