Outcome of asthma in children and adolescents at a specialty-based care program

Background: Asthma remains a major cause of morbidity for children despite national guidelines. Objective: To evaluate outcome from a structured specialty-based care program. Methods: Comparison of previous and subsequent years for children ranging from infancy to adolescence who entered a specialty clinic program at a university hospital serving a widely dispersed patient population. One hundred fifty-seven patients previously receiving primary care for their respiratory symptoms were seen during the study period; 23 were lost to followup, 15 were excluded because of other serious concurrent medical problems, and 119 were available for outcome analysis. Evaluation included historical data base from a structured interview, evaluation of pulmonary physiology, and allergy skin testing. Treatment decisions were evidence-based. Patient and/or family education was targeted at decision-making. Toll-free telephone access to the specialty service was provided around the clock. Frequency of unscheduled medical care, hospitalizations, sleep disturbance, activity interference, attainment of defined criteria for control, and medication use were quantified. Results: Seven hundred thirty-five acute care visits were reduced to 47, and 99 hospitalizations were decreased to 10 (P < 0.001 for both). Nocturnal symptoms and exercise limitation decreased significantly (P < 0.001 for both). All criteria for control of asthma were met in 89% of 75 without tobacco smoke exposure and 50% of 44 with exposure (P < 0.0001 for the difference in outcome). Frequent antibiotic use for respiratory symptoms were eliminated after entering the program. Maintenance medications were not used in 72 with an intermittent pattern of viral respiratory infection-induced asthma. Inhaled corticosteroid use increased from 38 to 68% among 47 subjects with a chronic pattern. Conclusions: Morbidity from asthma is largely prevented with often less, but better selected, medication than had been occurring in previous primary care. These data have implications for revised guidelines directed at primary care physicians.