Childhood Asthma

Childhood Asthma

Introduction

The bestpractice Childhood Asthma module assists clinicians in providing the most appropriate course of action for a patient depending on their symptoms and history. Individualised advice about what treatment to consider and when referral is appropriate is offered, as well as a personalised asthma action plan for each patient.

Background

New Zealand has one of the highest rates of childhood asthma in the world with 25 per cent of children aged 6-7 years and 30 per cent of adolescents 13-14 years reporting asthma symptoms. The prevalence has fallen in the last decade but significant challenges remain such as diagnosis, adherence and ethnic disparities.

Once a diagnosis of asthma is confirmed, management follows a stepwise progression depending on the success of pharmacological agents to bring symptoms under control. Once control of asthma has been achieved and maintained, children should be maintained on the lowest possible dose of inhaled corticosteroid.

How it works

The BPAC Inc web-based Decision Support system offers three customised options to users.

  • Progression through an initial consultation for a patient presenting with symptoms/risk factors for asthma. The probability of asthma is determined from this information and then management recommendations are provided.

    The initial assessment of asthma to confirm a diagnosis in children should focus on the presence of key features and clinical findings. Key features of asthma are:

    • recurrent wheeze and breathlessness with or without cough
    • variation in the intensity and duration of symptoms
    • symptom-free periods.

    The Childhood Asthma module allows the practitioner to record the symptoms of suspected asthma and provides information on alternative diagnoses. Various clinical factors increase or decrease the probability of asthma and, along with reversibility testing, help in confirming the diagnosis of asthma.

    • Probability of asthma
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    The probability of asthma is determined from the information provided, from which relevant management recommendations can be made.

  • Control and treatment of previously diagnosed asthma using a stepwise approach. This section includes information about appropriate choice of devices, dose, possible non-pharmacological management and when to refer.

    Once a diagnosis of asthma has been made, the bestpractice Decision Support Childhood Asthma module confirms if asthma is controlled before making recommendations for ongoing management. The options for managing each patient are listed along with the extent to which each would be recommended. These vary from Highly Recommended actions, i.e. those where failure to choose this action could strongly impact patient health, through to Strongly Discouraged actions where choosing this action could impair patient health.

    The recommendations follow a stepwise approach with add-on therapy and options for referral or review included if there is persistent poor control.

    Once control of asthma has been achieved and maintained, stepping down of treatment can be considered.

    • Control and treatment
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    Control and treatment of previously diagnosed asthma is facilitated by the module using a stepwise approach.

  • Use the module to create a personalised Action Plan which clearly illustrates to the patient and caregivers:

    • What inhaler to take
    • When to take it
    • How much to take
    • What to do in the event of an emergency
    • What might trigger the patient’s asthma.

    Two copies of the Action Plan are available:

    • A low resolution copy can be printed at the practice in black and white or emailed to the patient if desired
    • Two high resolution colour copies can be generated and posted directly to the patient at their address.
    • Action Plan creation screen
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    The completed Action Plan is an informative pamphlet customised to the patient and based on the information entered on this screen
    Customised Action Plan
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    The Action Plan is an informative pamphlet customised to the patient. The inhaler images illustrate the device that was selected on the Action Plan creation screen (see above). This provides the patient with a visual record of which device to use.

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