Improve asthma education to reduce visits, admissions by as much as 77%

CDC: 1 in 3 patients unfamiliar with asthma action plans

Children's Medical Center in Dallas found families were making repeated visits to the emergency department seeking treatment for a child with an asthma attack. These children were being admitted to the hospital repeatedly. To address the problem, the Asthma Management Program was initiated in 2001.

"Because many of our patients are high risk and have multiple hospital and ER visits, the program saves thousands of dollars," says Robin Brown, RN, BSN, AE/C, the program manager.

The cost of the six-month outpatient program is around $1,500 per patient, which is less than the cost of one visit to the emergency department, says Brown. As of December 2010, there has been a 77% reduction in the number of asthma-related emergency department visits and in the number of asthma-related inpatient admissions.

"Since the program began in 2001, we have reduced medical outcomes, improved overall control, and improved the quality of life for the child," says Brown.

When a child is taken to the emergency department or admitted to Children's Medical Center for treatment, education is conducted; however, parents often are tired after being up for days with a sick child. Also, these settings are not conducive to education because there is not enough time to effectively teach, says Brown.

Asthma education takes time, says Marc Riedl, MD, assistant professor of medicine, Division of Clinical Immunology and Allergy at Ronald Reagan UCLA Medical Center in Los Angeles. Asthma is a complex condition, and while most patients can accomplish good control, education is a process and can't be completed in a 15-minute office visit, Riedl says.

Asthma sufferers can decrease the number and severity of attacks by using their medications as prescribed and avoiding or treating triggers of asthma, such as allergies, says Scott Phillips, MD, an otolaryngologist and otolaryngic allergist with the Center for Ear, Nose, Throat and Allergy in Carmel, IN, and a physician with Indiana University Health in Indianapolis. The key is for them to understand their medications, for example, which of their inhalers is for immediate relief of an "attack," and which is for daily use to control their asthma over the long term. An asthma action plan, prepared specifically for each individual, will outline the proper response.

Write down the steps

An asthma action plan should be given to every patient who has asthma, according to the National Heart Lung and Blood Institute asthma guidelines, says Brown.

It is a plan of care that helps patients select the appropriate medication based on zones. Patients who are breathing well are in the green zone. The plan indicates what medications a patient should take when problems occur, which is the yellow zone. The red zone is the danger zone, explains Brown.

Every family enrolled in the Asthma Management Program is taught that their child should take his or her routine medications when in the green zone. When the child is in the yellow zone, parents need to add the reliever inhaler every four hours, and if the child is in the red zone, he or she needs to receive immediate medical attention, says Brown.

The primary way to prevent asthma attacks is through the use of anti-inflammatory medications that keep the airway from becoming obstructed or blocked by asthma. The medications need to be taken on a regular basis to keep the inflammation under control and to avoid acute issues such as coughing, wheezing, and shortness of breath that send people to the emergency department or physician's office, says Riedl.

To use an action plan well, patients must learn to recognize the early signs of an attack and respond accordingly with the correct medication. Riedl says people don't always realize the cough they have in the middle of the night is their asthma getting worse. People need to learn the symptoms of worsening asthma such as coughing, wheezing, chest tightness, or shortness of breath that can point to uncontrolled asthma, says Riedl.

Other areas of asthma self-management include taking the medication correctly with the medication pulled deep into the lungs, says Brown. Also the medication for controlling asthma must be taken daily.

An asthma management plan not only helps people avoid the emergency department or hospitalization, but it also can prevent missed school, work, sporting events, and birthday parties. The goal is to prevent asthma from interfering with patient's daily living, says Riedl.

Sources/Resources

For more information about creating self-management plans for people diagnosed with asthma, contact:

Marc Riedl, MD, Assistant Professor of Medicine, Division of Clinical Immunology and Allergy at UCLA Medical Center in Los Angeles. Telephone: (310) 825-6011.

For samples of an asthma action plan, visit www.asthma.com. In the toolbox, select "asthma action plan." An asthma control test available at http://www.asthma.com/resources/asthma-control-test.html.

"Guidelines for the Diagnosis and Management of Asthma" used at Children's Medical Center in Dallas can be obtained at http://www.nhlbi.nih.gov. Under "Health Professionals," click on "Clinical Practice Guidelines." Under "Current Guidelines and Reports," select "Asthma, Expert Panel Report 3."