Evaluating Caregiver Management of Asthma Exacerbations at Home
CPS ePoster Library. Yeung T. Jun 22, 2016; 128197; 127
Telford Yeung
Telford Yeung
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Background: Effective management of asthma in the home setting requires asthma education from a health professional along with written plans for asthma exacerbations. These approaches can result in fewer acute asthma visits, fewer missed school days and better asthma control. Nevertheless, a large number of asthma exacerbations result in emergency department visits or hospital admission. Several studies suggest that caregivers may lack the knowledge, the skills, or the confidence to provide care for their child during an asthma exacerbation.

Objectives: The objective of this study was to determine the proportion of caregivers who appropriately manage their child's acute asthma at home (as per the 2014 Global Initiative for Asthma guidelines) and to identify factors that may be associated with deviations from these guidelines.

Methods: We studied caregivers of children who are known to suffer from asthma using a paper based questionnaire in a single-center outpatient asthma clinic. Caregivers of children aged 3 to 17 years with a physician made diagnosis of asthma greater than 6 months in duration were included. To avoid a diagnosis of bronchiolitis from our study group, new consultations for wheezing or cough without a prior diagnosis of asthma, and less than 3 years of age were excluded. For statistical analysis, we used Excel and STATA 11 for the z test of proportions and comparison of means with a one way ANOVA (a = 0.05).

Result: Among the 45 caregivers surveyed, most had children with well controlled asthma based on low scores from a standard asthma control test and a limited number of emergency room visits (1.5 ± 0.1 per year). Sixty-four percent of caregivers were able to correctly identify the initial treatment with 2 puffs of Ventolin; however, 54% did not choose repeating Ventolin treatment within 20 minutes for ongoing symptoms. Moreover, only 58% of caregivers had ever been given a written asthma action plan. Caregivers had a higher degree of confidence (reported on a scale of 1-10) in initiating management (8.9 ± 1.5) compared with stopping treatment (7.3 ± 2.5).

Conclusion: Despite a high degree of confidence in starting treatment for asthma attacks, half of the caregivers surveyed identified inappropriate steps to manage asthma exacerbations at home. Providing a written asthma action plan may improve caregiver confidence and knowledge in asthma exacerbation management. However, routine assessment and review by a healthcare professional is essential in reinforcing recommended behaviours for home asthma management.
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