A pilot study to improve provider adherence to NAEPP guidelines.

Unlabelled: The prevalence and morbidity of Asthma in the United States has increased since the 1991 National Asthma Education and Prevention Program (NAEPP) and updated Expert Panel Report -3 (EPR-3) guidelines in 2007 were published. To improve provider adherence to the NAEPP EPR-3 guidelines Children's Hospital of Orange County (CHOC) in California integrated the HealtheIntent Pediatric Asthma Registry (PAR) into the electronic medical record (EMR) in 2015.

Methods: A serial cross-sectional design was used to compare provider management of CHOC MediCal asthma patients before 2014 (N = 6606) and after 2018 (N = 6945) integration of the Registry with NAEPP guidelines into the EMR.

Are you comfortable with over-the-counter intranasal steroids for children? A call to action.

The early expression of allergic rhinitis in children is a potential red flag for lifelong problems and comorbid conditions. However, treating pediatric allergic rhinitis in the United States is trending toward a self-management or parental management model with little clinical supervision, which reflects changes in the delivery of health care. Of particular concern are the recent approval of an over-the-counter intranasal steroid to treat nasal allergy symptoms in adults and children as young as age 2 years and the push for a retail model of health care as exists in some other countries.

A control model to evaluate pharmacotherapy for allergic rhinitis in children.

Importance: Although the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.

Objective: To conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.

Evidence Acquisition: We searched the MEDLINE and EMBASE databases (January 1, 1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in children with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.

Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers.

Background: School-based asthma education programs targeting disadvantaged youth and teens with asthma are lacking.

Objectives: To assess the impact of the Fight Asthma Now (FAN) educational program among 2 populations of predominantly low-income minority students: youth (3(rd)-6(th) graders) and teens (7(th)-8(th) graders).

Methods: Chicago-area elementary schools were invited to participate in this stratified 2-arm study.

From the page to the clinic: Implementing new National Asthma Education and Prevention Program guidelines.

The National Asthma Education and Prevention Program's (NAEPP) revised guidelines, the Expert Panel Report 3 (EPR-3), published in 2007, represents a shift in the approach to asthma: the EPR-3 recommends that clinicians think of asthma as a chronic disease with an inflammatory basis. EPR-3 guidelines also represent a shift in the treatment paradigm for asthma in line with the shift in approach: although symptomatic relief is still necessary, the primary goal of asthma treatment is now long-term control, with the aim of minimizing exacerbation frequency and severity and limiting possible permanent airway damage that can result from frequent asthma exacerbations. To help clinicians implement the new EPR-3 guidelines into daily practice, the NAEPP's Guidelines Implementation Panel has identified 6 key action-focused recommendations.

Inhaled corticosteroids and asthma control in children: assessing impairment and risk.

Objective: To review the use of inhaled corticosteroids on asthma control in children by using the new therapeutic paradigm outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.

Methods: A systematic review of the literature was performed by using the Medline and Embase databases (January 1996 to October 2007).

Results: A total of 18 placebo-controlled, clinical trials in >8000 children (aged 0-17 years) with asthma met the criteria for evaluating monotherapy with inhaled corticosteroids: 13 double-blind studies of inhaled corticosteroids versus placebo and 5 controlled studies that compared inhaled corticosteroids to a nonsteroid antiinflammatory agent.

Obtaining utility estimates of the health value of commonly prescribed treatments for asthma and depression.

Background: Comparing the costs and health value associated with alternative quality improvement efforts is useful. This study employs expert panel methodology to elicit numerical estimates based on a 0 to 1 utility scale of the health benefit of usual treatment patterns for 2 medical conditions.

Method: The approach includes development of clinical profiles and derivation of treatment benefit estimates via the elicitation of utility ratings before and after treatment.

Screening and familial testing of patients for alpha 1-antitrypsin deficiency.

alpha(1)-Antitrypsin deficiency (AATD) is an autosomal-codominant genetic disorder that predisposes individuals to the development of liver and lung disease. AATD is greatly underrecognized and underdiagnosed. Early identification allows preventive measures to be taken, the most important of which is the avoidance of smoking (including the inhalation of second-hand smoke) and exposure to environmental pollutants.

Issues in the diagnosis of alpha 1-antitrypsin deficiency.

Alpha 1-antitrypsin deficiency is a relatively common genetic disease that is underrecognized and underdiagnosed. Early diagnosis in the asymptomatic patient helps modify lifestyle choices to reduce the risk of emphysema. In 2003, the American Thoracic Society and the European Respiratory Society issued guidelines to improve standards in diagnosing alpha(1)-antitrypsin deficiency.

One gets so afraid: Latino families and asthma management--an exploratory study.

Introduction: This study explored Latino family experiences, issues, and needs in caring for a child with asthma as expressed by Latino parents of children with asthma.

Methods: Eight families represented by 7 women and 2 men, primarily of Mexican descent, participated in the study. All families had at least one child enrolled in preschools in the East Los Angeles area.

Impact of inhaled corticosteroid-induced oropharyngeal adverse events: results from a meta-analysis.

Background: Oropharyngeal adverse events associated with inhaled corticosteroid (ICS) use can affect adherence; however, these effects have been studied less extensively than those that occur systemically.

Objective: To calculate the risk of ICS-induced oral candidiasis, dysphonia, and pharyngitis among currently available therapies and to determine related effects of dose and device.

Methods: A computerized search in MEDLINE (January 1966 to June 2004) and EMBASE (January 1974 to June 2004) was conducted using indexed MedDRA terms for oropharyngeal adverse events.

Identification of preschool children with asthma from low-income families in Los Angeles, CA.

Background: Few studies have addressed asthma screening in the preschool age group. Early asthma recognition and intervention in preschool children may reduce costs related to unscheduled medical care and missed school and work.

Objective: To facilitate an early recognition and referral process for asthma in a preschool education program in Los Angeles, CA.