Every Child, Every Time, Every Place

Hopefully, the title caught your attention and you’re wondering what the public health topic is this month. You would not be faulted for thinking that the title refers to immunizations (every kid needs them, physicians should update them at each appointment, and different models should be explored to reach adolescent patients where they are for their vaccinations) or even healthy eating (every child deserves nutritious food every day at home, in schools, and throughout their communities). But, in honor of World Asthma Day on May 5, the title is a reference to our jobs as physicians with asthma action plans.

Every child with asthma needs an asthma action plan. While children are the focus of this article, the truth is that every person with asthma needs an asthma action plan. That action plan needs to be updated every time you see the patient. A child with asthma needs an asthma action plan every place they spend time on a regular basis (whether that’s at home, school, or at Grandma’s house when she babysits).

Asthma action plans are but one aspect of caring for patients with asthma outlined in the “Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma,” from the National Heart, Lung, and Blood Institute (NHLBI: www.nhlbi.nih.gov). The guidelines cover assessment and monitoring, including assessment of asthma severity and control, as well as recommendations for follow-up; education (this is where the asthma action plan comes in); control of environmental factors and comorbid conditions; and medication use, with recommendations to step treatment up and down. Hopefully, all practicing physicians have incorporated these evidence-based guidelines, as well as recommendations from your respective professional organizations, into your care of patients with asthma.

So why the focus on the asthma action plan for children? It is one aspect of asthma care and treatment where we, as physicians, can impact multiple environments. Pediatricians and other physicians who care for children can assist patients (and their parents) with self-management of their illness and can facilitate improvement of care that children receive while at school and in other settings. To provide the best care for children with asthma, all of these environments must be impacted. This intersection of an individual’s health with multiple environments is one principle of public health. The more obvious intersection of asthma and environment are the multitude of environmental triggers that exacerbate patients’ asthma, including exposure to tobacco smoke, airborne allergens, and respiratory infections.

The causes of asthma, as well its diagnosis and treatment, are multi-factorial. Guidelines exist to help clinicians address this serious disease. Yet these guidelines are not always followed. Every day, many children with asthma attend school in San Diego County without asthma action plans. This article is written to remind physicians to examine one aspect of your asthma care (preparation, use, and distribution of asthma action plans) and strive to improve this feature.

While World Asthma Day also serves as this reminder, also endeavor to improve the asthma care of your patients for the same reason as other local health organizations. Staff from the American Lung Association, County of San Diego Health and Human Services Agency, Price Charities, Rady Children’s Hospital San Diego, San Diego Regional Asthma Coalition, and San Diego Unified School District have been meeting regularly in City Heights to determine what can be done to reduce the burden of asthma in the community. This area is faced with the highest emergency room discharges, hospitalizations, and deaths due to asthma in San Diego County. Also, in the fall of last year, a middle school student died from the disease. This tragedy should not happen again. All of us have to work together to improve care for children with asthma across all sectors of our community. One aspect of improving care that is needed, and that can be achieved, is more children attending school with asthma action plans. So please join champions in this cause (whether you practice in City Heights or National City; Vista or Chula Vista; Rancho Santa Fe or Rancho San Diego) and remember: Every child, every time, every place.