March 2009 issue

Patients with chronic illness must learn to recognize signs, symptoms, and triggers that exacerbate their condition. Then, they must proactively implement self-care techniques to best manage those symptoms and crises.  While physicians prescribe medicines, draw up plans of care and provide instructions for these plans, low health literacy among many patients combined with time compressed office visits often leave patients bewildered when it comes to effectively managing their disease.   In a randomized controlled study, Dr. Fisher and his colleagues at UNC at Chapel Hill used asthma coaches in a population of African American children with asthma to bolster health literacy and improve clinical outcomes.  Community health workers familiar with the medical terms of an action plan, with good communication skills and the ability to work effectively with parents, served as asthma coaches.  Using a coaching style that was both cooperative and supportive, home visit and phone call interventions were tailored to parents’ readiness to adopt the management practices.  A coach’s job was to reinforce basic asthma education and encourage key behaviors for managing the disease.  Through randomization, the patients received usual care or usual care with the addition of an asthma coach.  Over the 24 months of the study, coaches averaged 21.1 contacts with the families.  Among the asthmatics receiving this care, 36.5% were hospitalized subsequent to an emergency department visit compared to the 59.1% hospitalized subsequent to an emergency department visit for the asthmatics receiving usual care, a statistically significant difference between the two groups. In the March edition of the Archives of Pediatrics and Adolescent Medicine, Fisher and his colleagues published their findings,

“An asthma coach can reach low-income parents of African American children hospitalized for asthma and reduce rehospitalization among the children.”

As health care professional continue to excel in working effectively as a team in the delivery of care, the use of asthma coaches may be one option for improving health literacy and self-care while reducing the morbidity caused by asthma.

Read the Abstract:

Fisher EB, Strunk RC, Highstein GR, Kelley-Sykes R, Tarr KL, Trinkaus K, Musick J.  A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Arch Pediatr Adolesc Med. 2009 Mar;163(3):225-32.   Available at http://www.ncbi.nlm.nih.gov/sites/entrez

First Friday in First Person. Asthma, which affects about 20 million

asthmatics must beware of drug's potenially dangerous side effects

people throughout the world is defined by the National Heart, Lung and Blood Institute as a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness (or bronchospasm), and an underlying inflammation. There have been a number of success stories in the management of asthma, such as Olympic champions Jackie Joyner-Kersee and Dara Torres whose are highlighted as a part of the Asthma All-Stars, an innovative campaign by the Breathe Easy Play Hard Foundation.  Yet, the fact remains that asthma is becoming more and more common.  According to the Centers for Disease Control and Prevention,  its prevalence in US children has increased from 3.6% in 1980 to 9% in 2001, driving families on repeated trips to the emergency room while patients in the crisis of an asthma attack, struggle to breathe.  Recently, I had the opportunity to become acquainted with Melissa, a blogging mother who has two special needs children.  For this month’s personal look inside disease, I’d like to share an experience she and her daughter, Ava had with a drug to treat her asthma.  It not only demonstrates some of the challenges of managing the disease but the type of proactive, informed advocacy that ensures the best care for patients.

Ava has asthma and in October of 2007, after a hospital stay, she began taking Singulair.  Singulair is a daily asthma controller medication and for Ava, it has been a wonder drug. She went from visiting the ER one to two times per month for her asthma to going a few times a year.  Over the past six weeks or so, Ava has been incredibly weepy. She will cry every evening saying that she has no friends, etc…[T]he past week she’s been saying some pretty disturbing things, especially for a five-year-old.

Ava was subsequently taken off of the drug because she was experience side effect symptoms of depression.  In her update after ending the Singulair, Melissa writes:

[W]e don’t have an increase in asthma symptoms (yet). I can’t help myself by saying yet because in October or November she was without Singulair for about a week and picked up a respiratory bug at school – her asthma symptoms were through the roof. Hopefully with her Flovent 3x/day we’ll be able to avoid it this time.

Asthma is a complex disease that is both costly to the health care system and a challenge for many patients to manage.  Throughout the month we will continue to examine the research and other aspects related to this chronic disease.

Read:

Melissa and Ava’s experience in full in Asthma, Singulair and Depression at mindlessmommy.com

About the Breathe Easy Play Hard Foundation

Today is the first day of May and all is enBloom here in Washington, DC.  While many of us are continuing to enjoy the beauty of spring and get excited about the arrival of summer, there are many others out there who suffer from allergies and asthma.  May is National Asthma and Allergy Awareness Month.  All month, we will focus our attention on asthma, air quality and air pollutants, including tobacco, in addition to the normal banter around health policy, politics, health reform and ARRA.  Look out for ways to educate yourselves and participate in this month’s featured health observances.

• May 1-31. National Asthma and Allergy Month
• May 1-31. Clean Air Month
• May    31.  World “No Tobacco” Day