Asthma and lower airway disease
Achieving and maintaining asthma control in inner-city children

https://doi.org/10.1016/j.jaci.2011.03.020Get rights and content

Background

Despite guidelines-defined care, inner-city children of low socioeconomic status have poor asthma control.

Objective

This study evaluated time to achieve control, maintenance of control, and factors associated with well controlled asthma for pediatric patients receiving specialty-based asthma care in mobile asthma clinics designed to reduce barriers to delivering effective asthma care (the Breathmobile Program).

Methods

Existing clinical data collected from January 1998 to June 2008 for 7822 pediatric patients with asthma (34,339 visits) enrolled in similarly structured mobile asthma programs across the United States evaluated the effect of asthma control on the reduction of asthma-related morbidity, time to achieve asthma control, maintenance of asthma control, and factors associated with well controlled asthma.

Results

Comparison of pre and post year data for subjects enrolled in the program for at least 1 year revealed reductions in the percentage of patients reporting emergency department visits (mean, 66%), hospitalizations (mean, 84%), and missed school days ≥5/year (mean, 78%). Well controlled asthma was achieved by visit 3 for an estimated 80% of patients. Factors contributing to well controlled asthma include non-African American race, visit interval <90 days, and adherence to prescribed therapy.

Conclusion

This study demonstrates the ability to achieve and maintain asthma control in high-risk populations in association with intensive, accessible, guidelines-defined care with close follow-up.

Section snippets

Study population

This study evaluated asthma control for patients enrolled in similarly structured mobile asthma programs previously described13, 14 for the following sites (program name, launch date): Los Angeles, Calif (Los Angeles County + University of Southern California Pediatric Asthma Disease Management Program, LAC+USC PADMAP, Breathmobile Program, November 16, 1995), Chicago, Ill (Mobile Children's Asthma Research and Education [C.A.R.E.] Foundation, November 9, 1999), Baltimore, Md (University of

Patient demographics

Table I describes the patient populations with regional variations noted (P < .05). Subjects had a mean age of 8.6 years (SD, 3.4) and a median number of 4 program visits/year (interquartile range, 2-5); the median visit interval length was 56 days (interquartile range, 42-91 days; visit data not presented in Table I). Ethnicity and race varied by site (overall, 67% Hispanic vs 33% non-Hispanic; 22% African American, 5% Caucasian, and 6% other). Nearly half of patients had a BMI ≥85% (similar

Discussion

African American and Hispanic children with asthma living in underserved areas have the highest asthma-related morbidity and mortality, yet have limited access to specialty-based asthma care to improve asthma-related outcomes effectively.10, 19, 20, 21, 22, 23, 24, 25, 26, 27 Implementation of the Breathmobile program sought to remove barriers to care, providing preventive specialty-based asthma care to this high-risk population.11, 13 Participation in this program is associated with reductions

References (59)

  • R. Evans et al.

    A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study

    J Pediatr

    (1999)
  • S.J. Szefler et al.

    Achieving asthma control in the inner city: do the National Institutes of Health Asthma Guidelines really work?

    J Allergy Clin Immunol

    (2010)
  • S.J. Szefler et al.

    Management of asthma based on exhaled nitric oxice in addition to guideline-based treatment for inncer city adolescents and young adults: a randomized controlled trial

    Lancet

    (2008)
  • J.S. Halterman et al.

    The impact of health insurance gaps on access to care among children with asthma in the United States

    Ambul Pediatr

    (2008)
  • L.K. Williams et al.

    Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma

    J Allergy Clin Immunol

    (2004)
  • E.C. Matsui et al.

    Asthma in the inner city and the indoor environment

    Immunol Allergy Clin North Am

    (2008)
  • P.A. Eggleston

    The environment and asthma in US inner cities

    Chest

    (2007)
  • J. Corburn et al.

    Urban asthma and the neighbourhood environment in New York City

    Health Place

    (2006)
  • L. Cicutto

    Supporting successful asthma mangement in schools: the role of asthma care providers

    J Allergy Clin Immunol

    (2009)
  • W. Phipatanakul et al.

    Mouse exposure and wheeze in the first year of life

    Ann Allergy Asthma Immunol

    (2005)
  • E.C. Matsui et al.

    Household mouse allergen exposure and asthma morbidity in inner-city preschool children

    Ann Allergy Asthma Immunol

    (2006)
  • Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007

    J Allergy Clin Immunol

    (2007)
  • E.D. Bateman et al.

    Global strategy for asthma management and prevention: GINA executive summary

    Eur Respir J

    (2008)
  • L.J. Akinbami et al.

    Status of childhood asthma in the United States, 1980-2007

    Pediatrics

    (2009)
  • J.S. Halterman et al.

    Inadequate therapy for asthma among children in the United States

    Pediatrics

    (2000)
  • G. Flores et al.

    Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care

    J Asthma

    (2009)
  • C.A. Jones et al.

    The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program

    Dis Manag

    (2005)
  • M.E. Bollinger et al.

    The Breathmobile Program: a good investment for underserved children with asthma

    Ann Allergy Asthma Immunol

    (2010)
  • Expert panel report: guidelines for the diagnosis and management of asthma

    (1997)
  • Cited by (0)

    Support for analysis of data was provided by the Asthma and Allergy Foundation of America, California Chapter.

    Disclosure of potential conflict of interest: C. A. Jones is on the Merck US Respiratory Advisory Board. The rest of the authors have declared that they have no conflict of interest.

    View full text