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Asthma check-ups needed more frequently for urban kids




A new study from researchers at Johns Hopkins Children's Center suggests that current guidelines on intervals between visits to the doctor might not be good enough.

In the US current guidelines for kids with asthma suggest a single check-up one to six months after diagnosis. Doctors and researchers are now realising however that asthma amongst children living in polluted inner-city areas is more unpredictable than it has been thought so more frequent follow-up visits to the doctor may be required to avoid dangerous asthma attacks.

If a child's asthma isn't managed effectively it can result in frightening symptoms and possibly a trip to the emergency department at the hospital.

Kids living in urban areas are particularly at risk as they are exposed to more potential triggers in the environment and have less access to healthcare. These children suffer increased exposure to sources of allergens such as mold and dust mites as well as to major pollutants such as cigarette smoke and vehicle exhaust.

Researchers from the Children's Center at Johns Hopkins are now recommending that check-ups are scheduled every three months for the first year after diagnosis to make sure the condition is under control. Their study is published in the November issue of the Pediatrics journal.

The researchers studied 150 asthmatic children between ages 2 and 6 living in Baltimore City. The team expressed their surprise at discovering that the health of almost half of the kids who initially presented with the mildest asthma had deteriorated significantly after only three months.

The changes seen at the follow-up consultation were so bad that many of the children had to be given more powerful drugs or have their dose of the current treatment increased.

Hemant Sharma, M.D., a pediatric allergist at the Children's Center and researcher on the study said: "We know asthma is an unstable disease, but we underestimated just how unpredictably it could behave over time, especially in inner-city kids."”

"Doctors and parents need to be more vigilant and schedule at least three-month check-ups even if the child appears to be doing fine."”

The researchers also noted that the results from their study provide a clear indication that pediatricians, rather than focusing on the severity of a child's asthma at the time of disagnosis, should plan for the long-term management of the condition so that treatment is more effective and the child can be spared unneccesary suffering.

Gregory Diette, M.D., M.H.S., a lung specialist at the Johns Hopkins School of Medicine and lead researcher on the study said: "Asthma control appears to be a better barometer of a child's risk for a flare-up than is initial assessment of symptoms, a staple that many doctors use as their yardstick for treatment and follow-up."”

Other information from the study included the finding that children whose asthma was poorly controlled were up to three times more likely to end up at the hospital or doctor's surgery after sufffering a severe asthma attack than those kids whose condition was well managed.

To best study differences between kids affected to different degrees by the condition, the researchers first defined each child's asthma severity as - mild intermittent, mild persistent, moderate persistent and severe persistent. These definitions were based on the frequency of coughing, wheezing, shortness of breath, waking up at night, use of rescue medications to stop an asthma attack and the degree to which physical activity was restricted due to symptoms.

It was found that each higher level of severity doubled a child’s risk of emergency medical care.


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