Evidence-based pediatric asthma interventions and outcome measures in a healthy homes program: An integrative review.

OBJECTIVE: Asthma disproportionately impacts and has poorer outcomes in low-income, minority, and inner-city children. The home environment has a profound impact on a child's asthma. Home-based asthma visits have the potential to positively impact a child's asthma, especially in targeted populations. The purpose of this integrative review is 1.) to explore the effectiveness of home-based education and environmental measures and 2.) to explore specific indicators and tools to measure pediatric asthma control and program effectiveness. DATA SOURCES: Medline, CINHAL, and Ovid databases were searched from 2010 to 2017 utilizing the keywords healthy homes AND asthma and home based interventions AND asthma. STUDY SELECTIONS: A total of 71 articles were retrieved of which 27 articles met the inclusion criteria of English language, human subjects, and the inclusion of pediatric populations. Three additional articles were hand-searched from previous references. In total, 30 articles were reviewed. A quality appraisal was conducted utilizing standardized appraisal tools. RESULTS: Home-based asthma education and environmental interventions have proven to be effective. The programs reviewed varied in types of interventions, intensity and duration, the type of provider, length of follow-up, and outcome measures. Successful programs were patient-centered, included a home assessment and individualized education and interventions, and were collaborative. Multiple outcome indicators such as health care utilization, asthma control, missed days of school or productivity, asthma symptoms, and verification of environmental remediation have been utilized. CONCLUSION: Home-based asthma programs can be beneficial to children with poorly controlled asthma and have the potential to be cost-effective.

Pediatric obesity and its effects on asthma control.

PURPOSE: To explore if being overweight or obese influenced asthma control in pediatric patients ages 7-18 years with persistent asthma seen in an asthma specialty office. DATA SOURCES: A retrospective chart analysis of children with an asthma diagnosis seen within an asthma specialty practice from December 1, 2009 to May 31, 2010 was utilized. Normal weight, overweight, and obese children were compared. The following four variables were examined: the number of controller asthma medications prescribed; the number of systemic corticosteroids prescribed in 1 year for asthma exacerbations; FEV1 % of predicted; and FEV1 /FVC% of predicted. CONCLUSIONS: No statistically significant difference was found between the three weight groups for the number of controller medications prescribed, number of systemic corticosteroids in 1 year, or FEV1 /FVC. A statistically significant difference was found for FEV1 %, F (2,430) = 5.51, p = .004. Overweight children had the highest mean FEV1 %, 92.47 ± 16.74%. A statistically significant difference was found between the normal weight and overweight groups, p = .0104 and the overweight and obese groups, p = .0233. IMPLICATIONS FOR PRACTICE: In clinical practice, obese children often report more asthma symptoms. This inquiry did not show an objective decline in asthma control associated with overweight or obesity.

Safety of rush immunotherapy using a modified schedule: a cumulative experience of 893 patients receiving multiple aeroallergens.

Conventional immunotherapy (IT) is effective in treating allergic rhinitis, allergic asthma, and chronic rhinosinusitis. Disadvantages include poor compliance, delayed efficacy, and patient frustration. Rush IT, or rapid desensitization, offers the advantages of rapid response, improved compliance, and cost-effectiveness. Although premedication with corticosteroids and antihistamines dramatically reduces systemic reactions, safety remains a primary concern. Two separate half-day schedules with minor differences were used to rapidly desensitize 893 patients (aged 1.5-77 years) in two typical outpatient settings equipped to treat anaphylaxis. All patients exhibited positive skin-prick tests to perennial and seasonal allergens. Diagnoses included allergic rhinitis (857/96%), allergic asthma (505/57%), and chronic rhinosinusitis (384/43%). Five hundred sixty-eight patients were premedicated with prednisone and HI-antihistamine for 3 days. Three hundred twenty-five patients were premedicated for 3 days with prednisone and H1- and H2-blockade. The protocol's final dose ranged from 0.1 to 0.5 mL of a 1:1000 dilution of extracts manufactured by ALK and Greer Laboratories. Patients continued on to higher doses by resuming a conventional schedule. Eighteen patients (2.0%) experienced a mild systemic reaction. All responded to subcutaneous epinephrine and/or nebulized albuterol and were sent home after observation. One patient (0.1%) experienced true anaphylaxis and received appropriate treatment and observation. Our experience with rush IT confirms that maintenance IT can be reached quickly and safely under careful supervision. Caution must be exercised when using this procedure because anaphylaxis does occur. Systemic reactions occur less frequently using a lower targeted final dose than previously described in the literature.

Evaluating the response of patients undergoing both allergy skin testing and in vitro allergy testing with the ImmunoCAP Technology System.

PURPOSE: To evaluate the response of patients who underwent both skin and in vitro allergy testing, both of which are accepted methods. DATA SOURCES: Retrospective review of the case notes of 100 patients evaluated by both testing methods for allergic disease. CONCLUSIONS: A total of 62 patients (62%) tested positive to at least one of the tested allergens via the in vitro method. A total of 65 patients (65%) tested positive to at least one allergen via the skin-testing method. The most frequently elicited allergic response from the in vitro method was to white oak. Indoor mold and dust most frequently elicited response via skin testing. IMPLICATIONS FOR PRACTICE: Both in vitro and in vivo allergy testing have limitations. Practitioners should be aware of these when establishing a treatment plan based on the results of differing allergy testing methods. Due to differing responses to skin and in vitro testing methods, it may be prudent to perform both tests to obtain a definitive diagnosis for the allergic patient.