 "For patients with pollen allergies, regular planned care means scheduling revisits 2-4 weeks before the pollen season."
- Len Fromer RESPONSES BY SUBJECT
 Are there any special problems in diagnosing asthma in children? Do they vary by age?
What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?
What questions do parents/carers and patients ask of you?
Which educational strategies work?
Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?
RESPONSES BY COUNTRY
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Responses by countryLen Fromer (USA):
Are there any special problems in diagnosing asthma in children? Do they vary by age?The biggest issue from our perspective is getting past the health system bias that you can't do skin testing for triggers on a young child. That's actually a non-issue because you can do the blood test, the CAP-RAST for specific IgE. All you need is 2 mL of blood; you get the result back in 24 to 48 hours. So teaching people that testing for triggers and learning what they are as a prevention approach to start with, along with appropriate medication, is a big issue. You can do the blood test down to the age of 3 months. Actually you can do a blood test on a 1-day old, and it will accurately measure the IgE, but it will be spurious because of placental transfer and swallowed amniotic fluid. The other issue that is an obstacle to making the diagnosis is part of the steroid phobia on the treatment side: parents are very phobic about the word 'steroids,' and inhaled corticosteroids being one of the treatments, they don't want to hear the word 'asthma.' They think, "I don't want to put my kid on this medicine that's going to stop him from growing. It's going to make my kid's adrenal gland shut down, it's going to give him cataracts, it's going to cause osteoporosis," all the steroid phobia associations. So we have to deal with that upfront. That's one of the beauties of empowering children and parents by doing trigger testing: they're really motivated as a family to get those triggers away from the asthmatic. To be able to reduce the burden or get off the steroids completely.What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?Getting to the point of recognizing asthma as an atopic disease, by and large. And then beyond that, that inflammation is the root of the problem. That we're dealing with one airway from the tip of the nose to the alveoli, so that if there is inflammation in the nose it will trigger a problem in the lung. So getting the families to link that and then getting people to focus on trigger avoidance and prevention in addition to regular planned care--not episodic rescue care. By using appropriate avoidance of triggers and controller medication. That's clearly the biggest challenge. People feel well in between attacks, so they say, "Why should I bother to take the medicine?!"Which educational strategies work?We try to make sure that 100% of the kids with asthma have an individualized written treatment plan. We use a template, which makes the process easier. For kids we use the green zone, yellow zone, red zone Asthma Action Plan that is based on symptoms, rescue medication use, and peak flow measurements. We give them trending sheets, which are forms on which they can record their peak flow readings, and we ask them to bring the trending sheets to their appointments, so the doctor can look them over and see their status at a glance. Moreover, the trending sheets empower and motivate the kids because we ask them to fill them out themselves. We believe in actively involving the patient and family in the treatment plan and soliciting their feedback on the care they're receiving.Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?
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