Back to Treating Childhood Asthma

 

Members of the IPCRG community were interviewed by a writer, about how they manage children with asthma, and their reactions to the recommendations of Professor Ulrich Wahn on guidelines for managing children. Below are the 21 questions that were put to the panel of experts in May 2006. These can be used as the structure for a local meeting, or as an interviewing guide.

A. Practice Set-Up

  1. Please describe the scheduling of asthma care for children in your practice, including length of appointments and who is responsible for the different aspects of asthma care and patient education.
  2. Do you see children with asthma for regular check-ups? Or only when they are having asthma attacks?
    1. Prompt as necessary (a-c): How long is the average asthma visit?
    2. Who manages children with asthma in your practice-- You? Specialists? Nurses?
    3. Who in the practice is responsible for each of the following aspects of patient education, and what do you tell the parents/carers and patients regarding them?
    1. What asthma is?
    2. What the medications are for?
    3. How to take the medications & the schedules?
    4. Inhaler technique?
    5. What to do if symptoms get worse?
    6. Responsibility of the patient/carers?
    7. Preventive actions at home, school, day-care [prompt if needed: Such as avoiding triggers i.e. second-hand smoke]?
    8. How to talk to and inform others the child is with about relevant aspects of asthma?
    9. The psychosocial aspects of asthma?

B. Diagnosis of asthma

  1. In your practice, what are the common presenting symptoms of asthma in children? Do they vary by age?
  2. Are there any special problems in diagnosing asthma in children? Do they vary by age?
  3. What is the earliest age at which you would normally make a diagnosis of asthma?
  4. When you think a child has asthma, what words do you use to tell the child and parents?
    [prompt if needed: Do you use the term "asthma"? "reactive airway disease"? If not, what wording do you use? Does it vary by age?]
  5. What co-morbidities do you see in children with asthma?
  6. How often do you diagnose concomitant allergic rhinitis in children with asthma? Does it vary by age?

C. Treatment and monitoring of asthma in children

  1. What are the medications you use most commonly for treating asthma in children? Do they vary by age?
    1. Which are by prescription and which are over the counter (OTC)?
    2. Are "alternative" and "complementary" remedies used by your patients?
  2. What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?
  3. Do children outgrow asthma?
    1. [prompt if necessary: Is it ever appropriate to remove the label of asthma? How do you know it is time to do so?]
  4. What questions do parents/carers and patients ask of you?
  5. In your practice, what percentage of children under 14 and 14-18 smoke?
  6. In your practice, what percentage of children do you estimate are subjected to passive smoking in the household?
  7. Which educational strategies work?
    1. Are there educational strategies that you would like to try but have not been able to? Why not?
  8. At what age would you generally expect the child to want to receive the education directly rather than through their parent/carer?
  9. Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?

D. Resources

  1. What resources do you have, as a physician, for guidance and information on dealing with asthma in children?
    [prompt with the following as needed:]
    1. Internet, library, professional association meetings?
    2. Guidelines/standards?
  2. What resources do you recommend to patients/parents/carers for guidance and information on dealing with asthma?
  3. 20. [prompt with the following if needed:] Are there any websites that you could recommend?
  4. 21. [prompt with the following if needed:] Can you recommend any practical resources, such as patient information leaflets, useful local guidelines, school policies, height charts?

Date of preparation: 3 May 2006
Author: Elizabeth V Hillyer, USA
Editors: Hilary Pinnock and Siân Williams, UK
Reviewers: John Haughney, Barbara Yawn, Ron Tomlins
This was used by the IPCRG to produce IPCRG Exchanges Children with Asthma, May 2006.
Copyright IPCRG. These questions are available for use in local meetings. The IPCRG encourages feedback to its Secretariat on its use.