Parents of Asthmatic Children Often Wait too Long to Treat Symptoms

November 12, 2012

Parents of Asthmatic Children Often Wait too Long to Treat Symptoms

A study recently published in the Annals of Allergy, Asthma and Immunology, says that many parents leave it too late when it comes to treating their children who are having an asthma attack. They say that parents can often see an attack developing but provide treatment too late which means that a visit to the emergency room for treatment becomes unavoidable. The researchers say that earlier intervention could stop the need for hospital visits.

The researchers from Washington University School of Medicine in St. Louis report that there are many occasions where parents fail to notice the signs that the child is starting to have an asthma attack. The also say that it is because home treatment is delayed that necessitates the hospital visit.

The study was carried out in response to comments made by two lay asthma coaches who work at the Washington University School of Medicine. Asthma coaches are people with experience of asthma, they either have it themselves or have family members suffering from it. They have been trained to give advice, information and social support.

When going about their duties the coaches noticed that many parents were uncertain of how to use or when to use albuterol, which is a bronchodilator. A bronchodilator is a drug which relaxes muscles in the airways and helps the lungs function normally. Many parents were leaving it too late before administering the albuterol. The study was commissioned to find out if these local findings were also true in the wider population.

In the United States every year 66% of children having asthma have at least one attack resulting in either, or all, of the following, missed school days, emergency room visits or hospitalizations. However the researchers believe that some of these cases could have been avoided if albuterol had been given at home earlier.

The study required the researchers to phone 101 parents of younger children, aged 2 to 12 years. These children had all been to the emergency department of St. Louis Children’s Hospital or their parents had contacted the hospital’s out of hours call center because of an asthma attack. The parents were asked how they recognized that an asthma attack was imminent or present and what actions they took to try to avoid a full blown attack or what they did to treat it.

The parents stated that they noticed a number of different general asthma related symptoms such as wheezing, coughing, shortness of breath, changes to breathing patterns. Some parents even noticed other less obvious signs like behavioral changes, for example a normally boisterous child becoming quiet or unpredictable.

Jane Garbutt, M.B., Ch.B. is an associate professor of medicine and of pediatrics, and is also director of the Washington University Pediatric and Adolescent Ambulatory Research Consortium. She says, “Every time the child had an exacerbation, many parents noticed the same medley of signs preceding it. But even though they noticed the signs consistently, they often didn’t do anything about it. If parents had known to give albuterol earlier, they may have been able to manage things at home and avoid a trip to the emergency room”.

Garbutt thinks that the reason for parents not administering albuterol is because of confusion over the doctor’s instructions. She explains, “The asthma plan from the doctor often says to start using albuterol when parents notice the child is wheezing or coughing or short of breath, but the doctor may have a different definition for those symptoms than the parent”.

The researchers also identified that some parents could not or did not see early signs of an oncoming exacerbation. A quarter of all of the parents interviewed said that they only saw the late signs of gasping for breath or the rib muscles dipping whilst breathing.

Of the situation Garbutt says, “Those kids have to go to the emergency department because they are too far along in their exacerbation to do anything at home. If we can talk to parents and find out that’s the issue, we can teach them to take action sooner”.

It appears that there is an issue with education and ensuring that the doctors and parents are communicating effectively. In some cases the researchers found that although the parents had the albuterol they did not know how to use it effectively or how often.

Garbutt goes on, “Parents varied in terms of how often they used it, if they used it with a nebulizer, how often they repeated it and how they determined if it was working. A careful assessment of exactly which medicines are used and how they are administered and dosed could identify problems. We think that is something that can be addressed with education”.

It was also found that many parents kept prednisone at home in case of an asthma attack. This is a corticosteroid used to curtail the release of chemicals within the body which causes inflammation within the body. Although the majority of parents said that they had the drug at home very few actually used it, preferring instead to go to the emergency room or call the doctor.

The study has led to a follow up to be conducted by Garbutt and her fellow researchers. The aim is get the coaches and physicians to work together to encourage earlier administration of albuterol, in addition to learning and using other self management techniques.

There will also be additional help for parents to ensure that they can identify the early signs of an oncoming exacerbation by use of a symptom diary which helps by showing parents any patterns of behavior which may develop.

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