Childhood Asthma Control Test and spirometry values in school-age children.

OBJECTIVE: To determine the relationship between child and parent reports of asthma control using the Childhood Asthma Control Test (C-ACT) and spirometry. METHODS: This descriptive study included 648 children ages 5-11 years from a school-based asthma program. Not well-controlled asthma was defined as forced expiratory volume in 1 s (FEV1) and by FEV1/forced vital capacity (FVC) of 80% predicted or lower. Sensitivity and specificity of C-ACT scores for low FEV1 and FEV1/FVC levels were calculated. Logistic regression was used to obtain the area under the receiver operating characteristic curve (AUC) for C-ACT score categories by FEV1 level. RESULTS: Mean child age was 8.2 years, mean C-ACT score was 20.3 (SD = 3.96), mean FEV1 was 94.3% (SD = 17.1), and mean FEV1/FVC was 81.3 (SD = 8.5). Children with an FEV1 of 80% or less had significantly lower C-ACT scores than those with an FEV1 > 80% (p = .023, t = -2.015, df = 167); 95% CI [. -1.79 to -0.018]). The sensitivity and specificity of a C-ACT score of 19 or less for an FEV1 of 80% predicted or lower were 44.9 and 66.4%. With a C-ACT score of 22 or less, sensitivity and specificity for low FEV1 were 67.7 and 30.9%. The AUC for a C-ACT score of 19 or less and FEV1 of 80% or lower was .444 while the AUC was higher at .507 for a CACT score of 22 or less. CONCLUSION: The C-ACT is a useful screen but spirometry should be performed in children with persistent symptoms to assess current asthma control.

Pediatric nurse practitioners effective in teaching providers the Asthma Action Plan using simulation.

Despite traditional education regarding the Asthma Action Plan (AAP), providers in the inpatient setting of a pediatric hospital reported lack of knowledge regarding the AAP and lack of confidence in teaching the AAP to patients and families. The purpose of this study was to assess the effect of a pediatric nurse practitioner (PNP)-led class incorporating simulation on resident physician knowledge of the AAP and confidence in teaching families the AAP. The study setting was a 250 bed Midwest academic pediatric hospital. The 26 participants were second year residents completing a four-week pediatric pulmonary rotation. The class consisted of a brief didactic component regarding the AAP, simulation to teach a patient/parent actor the AAP based on PNP-developed scenarios, and debriefing of the experience. The average composite score on the pre- and post-simulation knowledge assessment showed improvement from 44.8% to 80.4% (p<0.001). All participants answered favorably on questions regarding perceived benefit of the class and 80.8% strongly agreed that they felt more confident teaching the AAP after the class. This study demonstrates that resident physician knowledge of the AAP and confidence in teaching the AAP improved after a PNP-led simulation class.

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma.

OBJECTIVES: Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS: A retrospective record review was conducted for children admitted to the hospital with asthma in 2012. Charts were reviewed for evidence of recognition, diagnosis, and treatment of overweight and obesity. Subjects were classified into age-adjusted Centers for Disease Control and Prevention weight categories based on BMI percentile and chronic asthma severity categories according to National Asthma Education and Prevention Program guidelines. RESULTS: A total of 510 subjects aged 3 to 17 years were studied. Obesity was present in 19.6% and overweight in 13.3% of subjects. BMI percentile was recorded in only 3.3% of all charts, in only 11% of subjects with obesity, and in 0% of subjects with overweight. BMI percentile was documented more often in subjects with severe obesity (P = .013) and with moderate to severe persistent asthma (P = .035). Only 9 of 168 subjects who were overweight or obese (5.6%) were given a discharge diagnosis indicating overweight or obesity, and 14 (8.3%) received treatment. Chronic asthma severity differed by BMI weight category (P < .001), with a significant relationship between obesity status and chronic asthma severity in older subjects (P = .033). There were no differences in severity of acute episodes based on weight group. CONCLUSIONS: Overweight and obesity were underrecognized, underdiagnosed, and undertreated in children hospitalized for asthma.

Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program.

INTRODUCTION: In 1994, pediatric nurse practitioners (PNPs) at St. Louis Children's Hospital developed a program to improve the care of children admitted with asthma. In the Asthma Intervention Model, PNPs directly manage the care of children hospitalized with asthma and are instrumental in hospital-wide education. An evaluation study was conducted to measure effectiveness of this inpatient PNP role. METHODS: Attending physicians, interns, nurses, and families were surveyed regarding their perceptions of the PNPs as care manager and educator. A 16-item asthma knowledge test was administered to interns at the start and conclusion of their intern year. Length of stay, readmission rate, and cost were evaluated. RESULTS: PNPs were found to be effective in the inpatient asthma role by all participants. Significant gains were noted in intern knowledge and confidence in caring for asthma. Interns identified the PNPs as important contributors to their education. No significant differences occurred between interns and PNPs in length of stay, cost, readmissions, or severity of the condition of the asthma patients. DISCUSSION: PNPs in the inpatient asthma setting are effective care managers and educators.

The school nurse role in asthma management: can the action plan help?

Asthma is the most common chronic disorder in American schoolchildren, and school nurses play a valuable role in its management. A study was conducted in which school nurses were asked to describe their role in caring for students with asthma and their use of Asthma Action Plans (AAPs). The nurses indicated that they frequently provided direct care and education. They were comfortable with providing care to students with asthma and familiar with AAPs. Having an AAP increased their confidence in managing students with asthma. This emphasizes the need for continued education regarding the AAP and the development of policies that direct care and encourage use of an AAP at school.