Asthma Project Hoping to Cut Kids' ER Visits

Most of those hospital trips are preventable, experts say

SATURDAY, Nov. 10, 2001 (HealthDayNews) -- One-in-three American children with asthma is forced to visit a hospital emergency room each year because of an uncontrolled asthma attack.

Yet, many of those visits are entirely preventable, health experts say.

In an effort to cut the number of such visits, the Robert Wood Johnson Foundation of New Jersey has awarded almost $3.5 million in grants to establish projects at emergency rooms in four cities to better evaluate the problem and offer solutions.

The emergency rooms will basically be in urban areas that have large numbers of minority residents, who are the patients most likely to turn up at emergency rooms with asthma attacks. The American Academy of Allergy, Asthma, and Immunology (AAAAI) reports that asthma is 26 percent more prevalent in black children than in white children.

"There is a disproportionate share of people in urban areas and in racial and ethnic minorities with asthma, and sometimes emergency-room care is the only care they have," says Robin Mockenhaupt, senior program officer at the Robert Wood Johnson Foundation.

The grant program will involve equipping the emergency room staffs to better help young patients and their parents identify and manage the conditions that may trigger asthma attacks.

In addition, the program will track trends on asthmatic children visiting emergency rooms. And it will reach out to family doctors and pediatricians to help them better recognize and treat asthma so families are better able to help their children themselves.

"If kids are under better treatment at the primary care level, potentially we'll be able to reduce the number of hospital visits in the ER," Mockenhaupt says.

The program will take place during the next three years, in conjunction with AAAAI. Participating sites will include five or six emergency rooms in Honolulu, Houston, Milwaukee and Washington, D.C.

Because of the large numbers of preventable asthma visits, emergency rooms are often forced to spend resources and money on problems could have been taken care of at family doctors' offices.

"Of course there are always emergencies," says Mockenhaupt. "But in general, this is typically a primary care treatment that's being treated in emergency rooms."

Yet, Mockenhaupt adds, emergency rooms may be a powerful place to drive home the message of asthma control because of the heightened sense of urgency that parents and their children may not otherwise feel in a doctor's office when symptoms are not immediately present.

A big trigger for asthma symptoms and "attacks" is exposure to allergens ranging from pollution to dust mites. Treatment usually involves a combination of lifestyle changes to avoid allergens, and such medications as inhalers to keep the lungs clear.

About five million American children are estimated to suffer from asthma and between 15 percent and 17 percent of all emergency room pediatric visits are asthma-related, says the AAAAI.

The most common mistakes that patients make that force them to the emergency room include failing to take their medication; assuming the problem will go away on its own; and letting symptoms get too severe before seeking treatment.

Dr. Michael Schatz, chief of the Department of Allergy at Kaiser Permanente Medical Center in San Diego, says one of the most important components of the three-year program will be accumulating more data on the patients who show up at emergency rooms.

"All of the details involved in why patients wind up in the emergency room are still not as understood as one would like them to be," he says.

"We do know that emergency room visits, in most cases, represent a failure in either the patient getting the right medicine or taking the right medicine. So the better one understands everything about the patients who come into the ER, the more targeted and effective an intervention there can be," he says.

What To Do

You can read more about asthma, its triggers and treatments at the American Academy of Asthma, Allergy and Immunology's Web site on asthma.

The AAAAI also offers an informative page on childhood asthma.

And Allergy and Asthma Network: Mothers of Asthmatics is a helpful site for mothers helping their children with asthma.

SOURCES: Interviews with Robin Mockenhaupt, Ph.D., senior program officer, Robert Wood Johnson Foundation, Princeton, N.J.; Michael Schatz, M.D., chief of the Department of Allergy, Kaiser Permanente Medical Center, San Diego; Robert Wood Johnson Foundation press release
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