Wednesday, March 18, 2015

To Air Is Human: New Tools In At Home Asthma Treatment


By: Kathleen Walsh  MD, MS; Editorial Board Memeber
 
      When I ask my adolescent daughter about her asthma care goals, she replies “I don’t have any,” with a sarcastic tone and a charming, braces-filled grin.  However, I know her goals include placing well in cross country races, passing her taekwondo tests, and getting good grades in school.
       All of these require excellent control of her asthma.  When she was a baby, my goals for her asthma were to minimize exacerbation frequency and duration both for her happiness and so I could finish residency.  While achieving my goals for my daughter’s asthma care has always been my primary motivation for adhering to her treatment, only recently have our goals become a part of our discussions with her clinicians.
       In this week’s Pediatrics, the MyAsthma intervention described by Fiks et al. (doi: 10.1542/peds.2014-3167) takes an important early step toward parent and physician shared decision making regarding asthma treatment at home.  MyAsthma is a portal-based intervention, where parents enter information about their child’s asthma, including their goals and their child’s current symptoms, several times a month.  The portal uses evidence-based protocols to support decisions by the family and clinician about when they need to communicate further and when to change the home treatment plan.
      Although the study was relatively small, with twenty-six children in the treatment arm and a 57% participation rate, the authors found statistically significant improvements in some outcomes.  Specifically, children in the treatment group had significantly larger improvements in ACT scores over the study period compared to controls.  In addition, parents in the treatment group reported significantly less missed work than controls.  While other portal-based asthma interventions exist, this is the first to ask parents about their asthma management goals.
      The identification of family care goals is a key step in the parent and clinician co-management of chronic disease.  The portal-based intervention described by Fiks provides decision support for asthma management when and where the patient needs it- at the family’s convenience and at home.  It also enables a partnership between families and clinicians through goal setting, enhanced communication, and early identification and mitigation of changes in health status.  The spread of promising interventions such as this one will provide the necessary support so that families and clinicians can collaborate to improve chronic disease outcomes.  For pediatricians, this is the kind of collaborative care we would like to provide to all of our patients and their families.  

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