Reducing Asthma Emergency Department Visits

Editor’s Note: Jenny is the mother of two children with special healthcare needs and a Patient and Family Advisor at her local children’s hospital. In addition to her lived experience, Jenny calls upon her professional experience as a social worker and ministry leader to help her write blogs from her home in Wisconsin. – Cara L. Coleman, JD, MPH, Associate Editor, Pediatrics

Family Connections with Pediatrics

I will never forget the morning my 4-year-old daughter looked up at me from her bed and said, “Mama, something is wrong. There is not enough air when I breathe.” That’s when I noticed that her tummy muscles seemed to be working extra hard and her nostrils were opening more than usual. We let her sleep, thinking this was just a very bad cold, but a brief time later she was barely moving, almost listless and lethargic. We called the on-call nurse who said to bring her in right away.

One of the scariest experiences you can have is seeing your child not get enough oxygen and rushing them to the emergency department (ED). The ED can be stressful and traumatic—for the child, of course, but also for the family. This month, Pediatrics is early releasing an article that addresses this topic titled, “A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits” (10.1542/peds.2023-061355).

According to the article, in 2019, over 5 million children had an asthma diagnosis in the US, and there were more than 760,000 visits to the ED for asthma. Let’s review this article to see how this affects families.

What was included in the quality improvement project?

• The authors described five tools that primary care providers can use to improve the quality of care for patients with asthma and decrease trips to the ED.
• The project took place over nine years in a primary care network of 11 primary care sites in Columbus, OH, with patients ages 2–18 years old.
• By the end of the project, ED visits for asthma-related symptoms had decreased by 33% within this primary care network.

What were the five tools they used to improve asthma care?

1. Asthma Action Plans – A document created for a child and kept in their electronic medical record that guides caregivers on what to do when asthma symptoms begin.
2. Asthma Specialty Clinics – Special clinics staffed by a pediatrician and designed to take care of children with extra asthma-related support needs.
3. Asthma Notes – Used during any medical visit to keep track of asthma-related topics such as asthma test scores, level of severity, how to assess risk, medication decisions, and future plans.
4. Asthma Control Tests – A test done at the start of an appointment to find out about a child’s asthma symptoms and how these symptoms affect their day.
5. Step-Up Therapy – The process of adding extra asthma medications, or increasing the strength of current medications, for children whose asthma is not well controlled.

What can you take away from this article?

1. If your child has asthma and you are not using one or more of these tools, talk with your medical team about this article. A good place to start is with an Asthma Action Plan. Once the plan is created, share it with your child’s daycare, school, and/or other caregivers.
2. Ask your medical team if they have an Asthma Specialty Clinic and how to access it. If they don’t, ask if they can help create an Asthma Note during the visit that includes a plan to reduce barriers, stick to medications, and find other resources in the community.
3. If possible, see if an Asthma Control Test can be done when you arrive for appointments with your regular provider. This can also be flagged in your child’s electronic medical record so that staff know to do this at future appointments as well.
4. Discuss Step-Up Therapy options if your child’s current medication does not seem to be working.

Asthma flare-ups can be scary, but with the right care and education, visits to the ED can be prevented. There is not one single solution that works best for all kids, and sometimes we must be our child’s biggest advocate. If we partner with our health care team and the tools they have available, we can avoid more trips to the ED and improve the quality of life for our kids with asthma.