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

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    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.

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