Improving Asthma Outcomes in an Urban Pediatric Population
Improving Asthma Outcomes in an Urban Pediatric Population
Little is known about how ED-based programs can help to reduce pediatric ED visits for
 asthma. The current study evaluated a novel intervention in which the ED itself became the
 site of highly individualized, comprehensive follow-up asthma care. It sought to determine if
 such an intervention could decrease subsequent unscheduled visits for asthma while improving
 asthma quality of life.
Prospective, randomized clinical trial of a single visit to a specialized emergency
 department-based asthma follow-up clinic occurring 2-15 days after emergency department care
 for an acute exacerbation. All patients were followed for 6 months. Analysis was by
 intention-to-treat with adjustment for baseline differences. Our primary hypothesis was that
 this intervention would decrease subsequent unscheduled visits (both to EDs and other sources
 of urgent care) for asthma over a six-month follow-up period. We further hypothesized that
 the intervention would decrease hospitalizations for asthma, improve compliance with an
 individualized medical plan and with trigger control, increase scheduled primary care
 practitioner (PCP) visits for routine asthma care, and decrease asthma symptoms while
 improving asthma quality of life (QOL).
Inclusion Criteria:

 1. age between 12 months and 17 years, inclusive;

 2. prior physician-diagnosed asthma;

 3. ≥1 other unscheduled visit for asthma in the previous 6 months and/or ≥1
 hospitalization for asthma in the prior 12 months;

 4. a parent/guardian available for interview;

 5. residence in Washington, DC or a contiguous Maryland county; and

 6. requirement for ≥3 doses of nebulized albuterol in the ED at the time of enrollment.

 Exclusion Criteria:

 1. significant medical co-morbidities affecting the cardiorespiratory system;

 2. a visit to an allergist or a pulmonologist in the prior 6 months;

 3. ≥2 of the following: a current written asthma medical action plan, current use of >1
 controller medication, or a scheduled visit for asthma care with their PCP in the
 prior two weeks;

 4. enrollment in another asthma research study;

 5. unavailability for telephone follow-up; or

 6. primary language other than English or Spanish.