2019-20 TOW #19: Asthma diagnosis and management

This past week our REACH pathway R2s shared some asthma management tips and tricks for morning report. Our residents reminded us how we can recognize and address social needs through screening, referral and use of support systems. The IHELP mnemonic is used to screen for Income, Housing, Education, Legal/Literacy and Personal safety needs that affect overall health, including asthma. We want to provide effective care for children of all backgrounds and to recognize and address the powerful influence of social/economic factors on health.

A big thank you to Dr. Cathy Pew our intrepid gen peds team leader at Neighborcare – Meridian who developed our local outpatient asthma management guidelines.

Materials:

Asthma Diagnosis and Management take-home points:

  1. Epidemiology: Asthma rates are increasing every year in the US. Asthma affects 1-2 out of 10 children in the US and rates are even higher among black and Hispanic children. From 2001 through 2009 asthma rates rose the most among black children, almost a 50% increase.
  2. Asthma diagnosis and management is based on age, severity, and level of control. “Severity” is the intrinsic intensity of the disease process, which is based on impairment and risk. Severity is classified as “intermittent” or as “persistent” with mild, moderate, or severe levels. “Control” refers to the degree to which manifestations of asthma are minimized and the goals of therapy are met. This is classified as “well controlled,” “not well controlled”, or “very poorly controlled.” To help make this diagnostic process easier, please refer to our UW Division of General Pediatrics outpatient clinical guidelines for asthma which are based on the 2007 NHLBI guidelines and include flow diagrams for 0-4 yo, 5-11 yo and 12 and older (as above).
  3. We use a step-wise treatment to help manage asthma. The National Asthma Control Initiative outlines 6 priority messages for clinicians to help control asthma:
  4. To reduce environmental exposures for children, there are a number of resources we can use. Key resources locally include the American Lung Association home health assessment program that we can refer families to that helps identify environmental triggers through home visits. The Medical-Legal Partnership is also helpful to access the legal system to ensure environmental triggers are minimized in rental properties where children live.
  5. Be sure to review your clinic’s management approaches and tools including action plans, EMR tools, screening questionnaires, and spirometry options. For clinics using EPIC, there is a great smartset for asthma that Dr. Sheryl Morelli helped champion based on the outpt guidelines.

Thanks for all you do to care for our community’s children and address their needs at many levels.

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