Achieving and maintaining asthma control in an urban pediatric disease management program: The Breathmobile Program

Background

National guidelines suggest that, with appropriate care, most patients can control their asthma. The probabilities of children achieving and maintaining control with ongoing care are unknown.

Objective

We sought to evaluate the degree to which children in a lower socioeconomic urban setting achieve and maintain control of asthma with regular participation in a disease management program that provides guideline-based care.

Methods

Interdisciplinary teams of asthma specialists use mobile clinics to offer ongoing care at schools and county clinics. A guideline-derived construct of asthma control is recorded at each visit.

Results

Two thousand one hundred eighty-five enrollees were eligible to evaluate the time to first achieve control, and 1591 patients were eligible to evaluate subsequent control maintenance. Depending on severity, 70% to 87% of patients with persistent asthma achieved control by visit 3, and 89% to 98% achieved control by visit 6. Subsequent control maintenance was highly variable. Thirty-nine percent of patients displayed well-controlled asthma (control at >90% of subsequent visits), whereas 13% displayed difficult-to-control asthma (<50% of subsequent visits). Patients from each baseline severity category were found in each group. Maintenance of control was influenced by physician-estimated compliance with the treatment plan, baseline severity, and the interval between clinic visits.

Conclusions

Many children can achieve asthma control with regular visit intervals and guideline-based care; however, long-term control can be highly variable among patients in all severity categories.

Clinical implications

These findings highlight the need and feasibility for systematically tracking each patient's clinical response to individualize therapy and guide the use of population management strategies.

Key words: Asthma, asthma control, Breathmobile, children, inner city, urban, disease management, schools

Abbreviations used: AAFA, Asthma and Allergy Foundation of America, DTCA, Difficult-to-control asthma, ICS, Inhaled corticosteroid, LAC+USC, Los Angeles County+University of Southern California Medical Center, NHLBI, National Heart, Lung, and Blood Institute, OR, Odds ratio, PADMAP, Pediatric asthma disease management program, WCA, Well-controlled asthma