Improving Health for Children With Asthma
Childhood Asthma
Improving Health Outcomes for Inner-City Children with Asthma
Improving Health Outcomes for Inner-City Children with Asthma
Centers for Disease Control and Prevention (CDC) engages in active surveillance of childhood asthma because it is prevalent, contributes significantly to childhood morbidity, and imposes an economic burden on families (CDC, 2012). The main recommendations for diagnosing and managing asthma by the National Heart, Lung, and Blood Institute (NHLBI) and the National Asthma Education and Prevention Program (NAEPP) at the National Institutes of Health are: (1) objective measures of lung function, (2) reduce or eliminate environmental triggers, (3) patient and family education, and (4) long-term disease management using comprehensive pharmacotherapy (2007, p. 1). Not only are these recommendations important for limiting the disease burden during childhood, but recent studies have begun to uncover links between chronic childhood respiratory problems and the development of chronic obstructive pulmonary disease (COPD) in older adults (Guerra, Stern, & Morgan, 2013).
Among the children who suffer from asthma, minority children tend to have the worst outcomes (Moorman, Person, Zahran, & CDC, 2013). This is due in part to children and adolescents having poor knowledge about the use and benefits associated with inhaled corticosteroid therapy (Mosnaim et al., 2014). Patient and family education about asthma and treatment regimens therefore represents one important method for reducing not only disease burden, but also health disparities suffered by U.S. children. This research proposal will therefore investigate the efficacy of family education for reducing asthma-associated morbidity and economic burden.
Literature Review
Among all U.S. children, 9.4% have reported current asthma (Howden & Meyer, 2011). Based on the 2010 U.S. Census data this represented almost 7 million children. Asthma attacks among children were also very common, with approximately 56.1% of these children, between the ages of birth and 17-years, reporting an asthma attack during the same period (Moorman, Person, Zahran, & CDC, 2013). In 2007, 185 asthma attacks resulted in the death of the child (AAAAI, 2014). An average of $1,039 was spent annually per child diagnosed with asthma (CDC, 2012), which translates into about $7.2 billion overall. In addition, these children missed 10.5 million days of school in 2008 as a result of their disease (CDC, 2012). When asthma prevalence is examined along racial lines, minorities tend to suffer more (Moorman, Person, Zahran, & CDC, 2013). Close to 17% of non-Hispanic African-American children suffered from asthma in 2009 and between 2001 and 2009 the prevalence of asthma within this demographic nearly doubled (AAAAI, 2014). Poverty and access to health care services therefore play a significant role in determining asthma prevalence.
Efforts to improve health outcomes for minority children with asthma have varied greatly. A recent randomized, controlled trial (RCT) tested the efficacy of peer support and peer messages sent to MP3 players for increasing inhaled corticosteroid therapy (ICT) compliance among minority adolescents, but found no benefit (Mosnaim et al., 2013). When the same research group examined a number of possible predictive factors, including demographic variables, disease history, exacerbations, depression, asthma knowledge, ICT knowledge, and ICT self-efficacy, only older age and less ICT knowledge were significant predictors of low ICT adherence (Mosnaim et al., 2014). These results are consistent with the NHLBI/NAEPP (2007) guidelines recommending patient education as an important disease management strategy with the potential to reduce health disparities.
As Julian and colleagues (2014) noted in their recent research paper, very few studies have examined the efficacy of patient and family education on health outcomes. Accordingly, they studied the impact of a therapeutic education intervention on outcome variables, including child quality of life, caregiver quality of life, treatment compliance, lung function testing, asthma attack incidence, emergency department visits, hospital admissions, missed school days, and parent sick days due to a sick child. The intervention took place in the pediatric pulmonary department at the Clermont-Ferrand teaching hospital in France and consisted of three phases: (1) disease description and written action plan for asthma attacks during the first consultation, (2) individual educational diagnosis by a doctor with patient and caregiver, and (3) group consultation with up to four families and two doctors for the purpose of providing detailed descriptions of asthma pathophysiology, symptomology, triggers, attacks, and treatments. The first two phases occurred on the same day and the third phase a month later. Outcome measures were collected using a pretest and posttest study design without a control, with the posttest taking place four months after the initial consultation.
The quality of life for the children enrolled in...
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