Education and environment contribute to asthma risk

A thorough health assessment is necessary for any home care patient, but the assessment of a pediatric asthma patient needs to look at a wide range of issues to make sure the treatment plan is effective, according to experts interviewed by Hospital Home Health.

Lack of education about medications and symptoms increases the risk that a child will experience an acute asthma attack. A common reason for repeated asthma attacks is a misunderstanding of the medication, says Maryam Navaie-Waliser, PhD, senior research associate for the Center for Home Care Policy and Research for the New York City-based Visiting Nurse Service of New York.

Families don’t understand the difference between medications that relieve asthma symptoms during an attack and medications that control symptoms at all times, she says.

"We find patients that are using relievers on a continuous basis rather than controllers," Navaie-Waliser explains. This continuous use can exacerbate an attack, she adds.

Another area in which families lack knowledge is the identification of symptoms at the beginning of an attack during which relievers can be very effective and recognition of relief of the attack, according to Navaie-Waliser.

When the family and child can’t recognize when to use the medication most effectively, the attack escalates into an acute episode that requires a trip to the emergency department, clinic, or hospital, she adds.

Demographic factors also can increase a child’s risk of developing asthma, says Navaie-Waliser. Of the 400 to 600 children seen by the Visiting Nurse pediatric asthma program, 64% are male, 35% to 40% are Hispanic, and 20% to 25% are African-American, she says. The ethnic breakdown of the patient population is typical of the urban population served by her agency, she adds. "Children living in an urban environment are more likely to develop asthma because they are surrounded by more environmental triggers," she explains.

Factors within the home that are likely to trigger asthma attacks include molds, roaches, rodents, stuffed animals, pets, and cigarette smoke, says Rhonda Chetney, RN, MS, director of clinical operations for Sentara Home Care Services in Chesapeake, VA.

"Once we’ve identified triggers, we suggest ways to minimize their effect on the child’s asthma," she says. "Vacuuming frequently, not leaving food out to attract roaches, and keeping the family pet out of the child’s room are a few suggestions," she explains. Although pets are a major trigger for many children’s asthma, it is not feasible to tell every family to get rid of the pet, she says. "We just explain that minimizing contact is important," she adds.

Because many children are as attached to their stuffed animals as to their family pets, Chetney does not suggest throwing all stuffed animals out either. "If you place the stuffed animals in the freezer for 24 hours, the mites will be killed," she explains. Also, reduce the number of stuffed animals the child actually keeps in the bed at night, she suggests.