title: How frequent are asthma exacerbations in a pediatric primary care setting and do written asthma action plans help in their management?
abstract: OBJECTIVE
  In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting.
  
  
  METHODS
  Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit.
  
  
  RESULTS
  Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations.
  
  
  CONCLUSIONS
  Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.
authors.affiliation: Department of Allergy, Asthma, and Immunology, Children's Mercy Hospital and Clinics, Kansas City, Missouri 64108, USA. cdinakar@cmh.edu
authors.forename: Chitra
authors.initials: C
authors.lastname: Dinakar
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Van Osdol
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wible
mesh_terms: D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D006701:Home Nursing; D006801:Humans; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents