Many Kids' Asthma Hospitalizations Preventable

WEDNESDAY, Oct. 5, 2005 (HealthDay News) -- Almost 200,000 American children are hospitalized yearly because of asthma attacks, but up to half of those hospitalizations are preventable, according to a new study.

Between 15 percent and 54 percent of childhood asthma hospitalizations could be prevented if kids with asthma, particularly teens, took their medications as scheduled, avoided asthma triggers and saw their doctor regularly, report researchers from the Medical College of Wisconsin in the October issue of Pediatrics.

"Being 11 and older and having no physician contact resulted in double the odds of a preventable hospitalization," said study author Dr. Glenn Flores, director of the college's Center for the Advancement of Underserved Children.

Nine million youngsters in the United States have been diagnosed with asthma, according to background information in the study. Symptoms of the disease include wheezing and shortness of breath. Each year, there are almost 15 million missed school days as a result of asthma, according to the U.S. Centers for Disease Control and Prevention (CDC), which estimates the cost of treating asthma in children under 18 at $3.2 billion annually.

"We've seen a concerning increase in morbidity and mortality in children with asthma," said Flores, who noted, "Not a lot is known about how to prevent hospitalizations in kids with asthma."

To learn more about what might be causing the hospitalizations, Flores and his colleagues interviewed the parents and physicians of 230 children hospitalized because of their asthma.

All were recruited from one urban hospital over a 14-month period. The average age of the children was 5, and most came from homes with an average family income of just over $13,000. Seventy percent of the children were black; 20 percent were Hispanic, and 7.4 percent were white. Three-quarters of the children had public health insurance; 14 percent had no insurance.

The researchers asked parents, hospital physicians and the child's primary care physician if they felt the hospitalization could have been prevented. When all three sources were combined, 15 percent of the visits were assessed as preventable. When any single source was considered, the preventable rate was as high as 54 percent, according to the study.

There were significant differences between the groups. About one-quarter of parents felt that their child's visit could have been prevented, compared to 38 percent of the primary care doctors, and 43 percent of the hospital doctors.

Being over 11 and not contacting the family doctor before going to the hospital were the most important factors in predicting a preventable hospitalization, reported the study.

Better asthma education, avoidance of triggers, adhering to medication schedules and visiting the doctor on a regular basis were cited as some of the ways to prevent hospitalizations.

"This study confirms formally what a lot of people who live with asthma and those who deal with asthma have already suspected," said Dr. Jacqueline Pongracic, the allergy division chief at Children's Memorial Hospital in Chicago. "Physicians and parents both know that there are barriers that continue to exist in asthma management."

"We need to educate people that asthma is not a disease that comes and goes," she added. "It's always there. It can be under control sometimes, but it's always there."

Both Flores and Pongracic said that education is key. If physicians don't have the time to really sit down with their asthma patients and make sure they're using their inhalers properly, etc., then they should try to integrate asthma educators into their practice, both said.

"Everybody needs to have a written asthma action plan," Pongracic added. This should clearly state what medicines the person takes and when, as well as what they need to do when asthma flares up.

"At a time of crisis, you may not remember clearly, so having something in writing is very helpful," she said.

And, Flores added, parents may need to be more assertive with their health care providers. For example, if they're not sure how to use an inhaler or a spacer, they can ask their physician or asthma educator to take a few minutes to instruct them in the proper use of these devices.

More information

The American Academy of Allergy, Asthma and Immunology explains what triggers asthma and how to manage the disorder.