Asthma affects over six million children under the age of 18 and is the leading cause of chronic illness among children in the United States. More than 4 million of these children suffered from an asthma attack or episode in 2002 alone. Asthma causes more lost days from school than any other chronic disease and is the third most common reason children under age 15 are hospitalized. Sutter Health treats more than 16,000 children with asthma system wide, and respiratory problems, including asthma, make up the largest proportion of emergency department visits and pediatric discharges throughout the Sutter Health system

Childhood Asthma Initiative

What is our Asthma Initiative? A team of Sutter Health asthma and pediatric experts created the Childhood Asthma Sutter Initiative (CASI) after studying an extensive body of scientific evidence. Their review of the literature and existing treatment guidelines revealed several key factors that can dramatically reduce asthma attacks and improve patient quality of life. These factors form the basis for the initiative’s approach to treating childhood asthma, as well as the performance measures used to evaluate the initiative’s progress.

Childhood Asthma Facts

What is Asthma?
Asthma is a chronic inflammatory disease of the lung’s air passages that can make breathing difficult. It is a lifelong (chronic) disease with symptoms that can range from mild to severe. Children born prematurely or those exposed to tobacco smoke are more likely to develop asthma. So are children with allergies or eczema or a family history of asthma, allergies or eczema. Asthma is neither an emotional illness or contagious.

Asthma affects over 20 million people in the United States. Six million are children under the age of 18. In 2002 alone, more than 4 million of these children suffered from an asthma attack or episode. Asthma sends hundreds of thousands of children to the emergency room each year and is the third most common reason children under age 15 are hospitalized. Despite the advancements in asthma medication and treatment over the past 15 years, the risk of sudden death from asthma has increased, nearly two-fold according to some figures.

Asthma has doubled over the last decade and become the leading cause of chronic illness among children. It also causes more lost days from school than any other chronic disease. The huge increase in the number of children and adults with asthma has greatly stressed the health care system and costs the U.S. an estimated $11.5 billion a year. Another $1.1 billion is lost on account of school days missed by children.

California leads the country in the prevalence of childhood asthma – 7.1 percent vs. a national average of 6.4 percent. More than 500,000 of children in California are diagnosed with asthma. Thousands more go undiagnosed and do not receive proper care, often because their asthma symptoms are mistaken for a cold, bronchitis or pneumonia.

Over-use of rescue medications and poor medical management have contributed to the childhood asthma crisis nationwide. There is no cure for the disease, but it can be controlled with proper medications and adherence to an Asthma Action Plan. New evidence also indicates that certain treatments are more effective than others. Improving diagnosis and educating physicians and parents about these treatment methods can help children keep their asthma under control and lead normal, healthy, active lives.

Project Goals

• Proper use of asthma control and rescue medications
• Avoiding or reducing asthma triggers
• Developing an Asthma Action Plan
• Patient education
• Regular follow up with a primary care provider

Care Guidelines

The CASI task force spent several months studying the proliferation of scientific-based evidence, including pediatric asthma treatment guidelines published by the Global Initiative on Asthma (GINA) and the National Heart, Lung, and Blood Institute (NHLBI). Their review of the literature and existing guidelines revealed several key factors that can dramatically reduce asthma attacks and improve patient quality of life. These factors form the basis for the initiative’s approach to treating childhood asthma.

Use of Asthma Medications Properly
Medications are one of the most important ways to treat or prevent asthma symptoms. There are two types of asthma medications: "control" medications and "rescue" medications. Control (maintenance) medications are used every day to help keep asthma under control, the most effective being inhaled corticoid steroids (ICS). They work by reducing inflammation (swelling and narrowing) in the lungs to prevent or lessen asthma symptoms.

Rescue (quick-relief) medications are taken at the first sign of asthma symptoms, such as wheezing, coughing, chest tightness, or shortness of breath. They work quickly to relax the muscles that tighten around the airways. Rescue medications are not meant to replace control medications. Overuse of rescue medications is a sign that a person's asthma is not under control. Overuse also increases the risk of sudden death from an asthma attack. Overuse also increases the risk of sympathomimetic related medications side-effects (tremor, increased heart rate, insomnia) which may be a problem in those with underlying cardiac problems, particularly coronary artery disease and arrythmias. Also, tachyphylaxis observed during chronic rescue use may increase the risk of sudden death from an asthma attack.

Avoid or Reduce Asthma Triggers
Asthma triggers vary from person to person and may include dust, pollen, air pollution, tobacco smoke, and other irritants. Some medications and certain foods may also trigger asthma symptoms. Identifying and avoiding or reducing asthma triggers, at home and elsewhere, can help control asthma symptoms and reduce the risk of asthma attacks.

Develop an Asthma Action Plan
Asthma Action Plans have been shown to help asthma patients control asthma symptoms and prevent or reduce the number of asthma attacks. Developed in conjunction with their healthcare provider, the plan details what asthma patients can do on a daily basis to prevent and control airway inflammation. It also uses three zones – green, yellow, and red like a traffic light – to describe what to do if asthma symptoms worsen, including which medications to take and when to take them.

Patient Education
Substantial research validates the importance of patient education in the treatment and management of asthma. As with other chronic diseases, extensive patient education provides asthma patients and their parents with the knowledge and tools they need to effectively manage their condition and enjoy a better quality of life. An effective patient education program includes the importance of drug therapy compliance, how to identify and avoid or reduce asthma triggers, and healthy lifestyle tips. Patients and their parents also need to be taught to recognize asthma signs and symptoms and treat them according to their Asthma Action Plan. Early recognition and intervention can help prevent unnecessary emergency department visits, hospitalization and even death.

Insure Regular Follow Up With a Primary Care Provider
Because asthma continually changes, patients need to be seen regularly by their healthcare provider to adjust their medications and Asthma Action Plan accordingly. Those who have their asthma under control should be seen be seen at least twice a year. Children whose asthma is out of control should be seen as frequently as needed to get their asthma under control. Children treated for asthma flare-ups in the emergency department, hospital or physician’s office need to be seen for a follow up visit in seven days.

---

Updated January, 2008