Editorial

Making A Difference For Children With Asthma

Philadelphians, healthcare institutions, insurers, and employers are increasingly affected by the morbidities and costs of chronic disease. Asthma is the most common chronic disease in children, and nationally, asthma remains at historically high prevalence levels. In Philadelphia, childhood asthma has reached epidemic proportions, with approximately 20 percent of Philadelphia children under 18 identified as having asthma—double the national rate.

Every fall, thousands of Philadelphia children show up at the City’s emergency rooms, seeking asthma care. Around the country, and here in Philadelphia, asthma visits are beginning to increase, the result of fall allergies, changes in the weather, exposure to viruses, and other environmental factors.

Children who suffer from asthma will have increased school absences, decreased ability to exercise, and potentially limited development due to experiences, images, and perceptions of the illness. In addition, their parents may miss work and experience financial strains because of the need for them to be available and pay for care, thus impacting the local economy.

For the Philadelphia business community, it’s important to emphasize that, as a whole, our health system has done a poor job in reducing the broad-based effects of chronic diseases like asthma. To better the health of the population, we will require innovative, system-wide approaches to chronic disease care.

Many factors can affect a family’s ability to manage a child’s asthma. To care for Philadelphia’s children with asthma, we not only need to educate and support immediate family members, we also need to involve, support and train teachers, caregivers, schools, and other community programs. We need to look beyond insurance and doctors’ offices to recognize the increasing evidence that system-wide approaches to caring for children with asthma and integrating efforts are effective and necessary.

Since 2001, when it was created with support from the Robert Wood Johnson Foundation, the Philadelphia Allies Against Asthma Coalition (www.pediatricasthma.org) has offered local children access to integrated community-based education programs and services that can help families manage asthma. Our major focus was to identify children with acute asthma, seen at local emergency departments, and link them to available care and services through the Child Asthma Link Line, a telephone coordinating service staffed by interacting asthma educators.

In addition, the region’s three Medicaid Managed Care Organizations were included in the coalition, and they worked with us to standardize a single plan for pediatric asthma care called the Asthma Action Plan. This standardized form helps to decrease confusion among providers, school nurses, health institutions, caregivers, and others by allowing a consistent means of communication regarding medications and approaches to a child’s asthma care. The form is now used in many City venues to help children and parents understand how and when to treat asthma symptoms at home and at school; it has also been adopted by Pennsylvania as part of its asthma strategic plan.

Preliminary results from our work demonstrate a reduction in the burden of children’s asthma in Philadelphia. Families linked to asthma education and services have reported decreased symptoms, fewer missed days of school and work, improved caregiver quality of life, and fewer emergency room visits—findings that not only benefit children with asthma, but also the society and economy at large.

Our Philadelphia programs and success, combined with the six other Allies Against Asthma sites nationally, have also contributed to collective thought regarding community-based approaches to care, which are part of the newly released national guidelines for asthma from the National Institutes of Health.

We believe that our successes are only a beginning. By working together, and by developing new models and innovative approaches to health care, we can continue to make inroads on the impact asthma has on our children’s lives and our economy.

For more information about what cities around the country are doing to combat pediatric asthma, visit www.PediatricAsthma.org.

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Dr. Michael Rosenthal, Professor and Vice Chair of Academic Programs, Department of Family and Community Medicine, Thomas Jefferson University, is a Co-Chair of the Philadelphia Allies Against Asthma Coalition.

Erin McCarville, MPH, is the Project Manager of the Philadelphia Allies Against Asthma Coalition. She works at the Health Promotion Council of Southeastern Pennsylvania, the lead agency for the Coalition.