Integrated care can benefit pediatric asthmatics

Pediatric asthma patients realize improved health and reduced corticosteroid use when they receive integrated care that considers personal, familial, and environmental risk factors, according to the study published in the October 17, 2017, issue of World Allergy Organization Journal.

Rather than just physical factors, lead author Alyssa A. Oland, PhD, assistant professor of psychiatry at the University of Colorado School of Medicine, and colleagues found that a number of factors-lifestyle, social and psychological-affect outcomes in children with asthma. Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas, typically because children living in low-income households are more likely to experience less parental support and involvement, and to feel more of a lack of control over their environment, the authors wrote.

“Recent research has underscored the importance of multidisciplinary, collaborative, integrated care for pediatric asthma patients with promising results. Such a comprehensive approach is ideal for addressing the multitude of complex, inter-related psychosocial and wellness/lifestyle factors that play a role in childhood asthma,” the authors wrote.

Children from economically disadvantaged households may also experience less access to care and poorer quality of care. For example, it is estimated that 41% of children aged 2 to 17 years do not receive needed mental health services.

“As such, low-income, urban minority children have increased barriers to proper asthma management, including increased exposure to environmental triggers and reduced access to appropriate treatment,” the authors wrote.

However, it is not just income that impacts asthma morbidity and mortality rates. A variety of other risk factors include: treatment non-adherence, exposure to environmental triggers, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets, according to the study. “These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention.”

While there are now a range of psychosocial interventions for children with asthma, such as educational programs, behavioral interventions, cognitive-behavioral therapy, family interventions, and/or community-based interventions, research on the efficacy of psychosocial interventions is “limited, inconclusive, and plagued by concerns regarding methodological issues,” according to the authors.

Despite these problems, “Preliminary evidence suggests that psychosocial interventions can improve the quality of life and medical outcomes for children with asthma. Interventions that combine education with psychosocial interventions, such as behavioral, cognitive-behavioral, and/or family interventions show particular promise,” they wrote.

Self-management training and education are also well-established and essential parts of treatment for asthma patients. Studies have shown that children with asthma taking part in these programs have improved adherence, improved asthma symptoms, reduced energy room visits, fewer school absences, and other positive benefits.

“Similarly, education combined with family therapy resulted in benefits for children and for parents, resulting in reduced airway inflammation, improved physical health, and improved mental health,” the authors wrote.

Integrated care programs have demonstrated significant improvements in asthma symptoms, perceived competence in asthma management, reduced corticosteroid use, and improved quality of life for caregivers and children, according to the study.