The children’s asthma conundrum

girl using asthma puffer

Pediatric asthma care in Australia remains disjointed, with marked differences in post-discharge care, management and knowledge, a new survey reveals  

A cross-sectional survey of 502 hospital nursing and medical staff found that use of asthma action plans was not universal, and there were significant differences across local health districts with a range of asthma clinical practice guidelines being used.

“We identified marked variations in post-discharge asthma care and management for children within
different health jurisdictions, different hospitals in same jurisdiction and different departments of same hospital in New South Wales, highlighting the lack of standardisation of care for children with asthma,” said the authors, from the Sydney Children’s Hospital and the University of NSW.

The findings demonstrated “significant gaps in post-hospitalization management pathway and substantial variations in care, including the use of asthma clinical practice,” the authors said.

Less than 50% of the survey respondents were aware of the existence of any asthma community
services for children, and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up, they said.

“It’s estimated that around one in 10 Australian children have a current diagnosis of asthma. It’s also a key cause of hospital admissions and emergency department (ED) presentations, which is clearly a marker of poorly controlled asthma,” said study co-author Dr Nusrat Homaira, senior lecturer with the Discipline of Paediatrics, School of Women’s and Children’s Health at UNSW.

“Children should not be dying from asthma. It’s not curable, but it’s a perfectly controllable disease.

“The New South Wales death report 2004-2013 showed there were 20 deaths in children in NSW alone from asthma. The majority, more than 50%, of these deaths were linked to a psychosocial issue, which means the children were not followed up properly.

“That’s what prompted our research; we wanted to know how these children were falling through the cracks,” she said.

One of the major findings from the research was that the majority of people didn’t know of the existing community-based asthma services.

“This clearly highlights the need to co-ordinate care and communication between acute, primary and community-based services for paediatric asthma and pharmacists can play a major role here,” said Dr Homaira.

“Children with asthma need regular medications so when parents or carers visit the pharmacy with a script, pharmacists can make sure the child has an updated Asthma Action Plan and that the parent or carer is aware of what is in the plan. Also, the most important thing is that children need a spacer to inhale the asthma medication. Children and parents or carers must know how to use it.

“A previous Australia-wide study showed that only in 25% of cases were children taught how to use a spacer device. So, when parents or carers come to fill their scripts it’s essential that pharmacists check whether they know how to use their spacer and, if required, provide a demonstration.

“Also, if they notice a child is coming into the pharmacy more frequently for asthma medication this should raise an alert and the pharmacist can link the child to a community nurse, helping to establish that co-ordination of care.

“Even just making people aware of where they can access information is useful. There are many resources available on the Sydney Children’s Hospital and Asthma Australia websites and pharmacists can guide parents or carers to these resources.”

The research was published in the Journal of Asthma and Allergy 

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