Source: Annual Congress 2008 - Treatment and outcome of childhood asthma: new perspectives
Disease area: Airway diseases, Paediatric lung diseases

Abstract

Background:
The assessment of difficult asthma requires an inter-disciplinary approach. Our protocol involves a three stage assessment. Stage 1 is a nursing led hospital, general practice (GP) and home visit. Those without remedial factors progress to stages 2 and 3 involving bronchoscopy.
Aims:
To determine risk factors and interventions available at this first stage.
Methods:
Setting: A tertiary paediatric respiratory centre. The assessment addresses 4 areas: psychological/social issues; adherence (inhaler technique and prescription uptake); smoking; and allergen exposure.
Results
46 children (Male 21, median 12 yrs, range 5 to17) were visited. A structured mood questionnaire led to a 56% referral rate to a child psychologist. Poor adherence was thought to contribute to poor control in 33% based on inhaler technique, GP prescriptions and in-date medications. There was smoking in the home in 15% whilst 45% and 46% who owned a dog and cat respectively had a positive skin prick test (SPT) to them. Of 21 children SPT positive for house dust mite (HDM), only 7/21 had no HDM avoidance.
As a result, only 50% of those visited at home progressed to stages 2/3 of the protocol.
Conclusions:
Nurse led hospital/home visits can identify remediable factors in children with difficult asthma and reduces the requirement for invasive investigations.

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Citations should be made in the following way:
P. Hall, M. Bracken, E. Biggart, A. Bush, L. Fleming, N. Wilson (London, United Kingdom). Results of nurse led home visits for children with difficult asthma. Eur Respir J 2008; 32: Suppl. 52, 4598

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