The importance of nurse-led home visits in the assessment of children with problematic asthma.
OBJECTIVE
To evaluate and identify potentially modifiable factors in children with problematic asthma by a nurse-led assessment and home visit.


METHODS
Observational cohort study.


METHODS
A tertiary paediatric respiratory centre.


METHODS
71 children, aged 4.5-17.5 years, with problematic asthma currently under follow-up at a tertiary respiratory centre.


METHODS
A nurse-led hospital visit followed by a home visit.


METHODS
Identification and attempted change of exacerbating factors so that further investigations and consideration of off-label, potentially toxic, asthma therapies were not necessary.


RESULTS
Potentially modifiable factors were identified in 56 (79%) children. Many children had multiple causes for poor control. The most important were ongoing allergen exposure, 22 children (31%); passive or active smoking, 18 children (25%); medication issues including adherence, 34 children (48%); psychosocial factors, 42 families (59%). The home visit contributed valuable information to this assessment. At the home visit house dust mite avoidance measures were found to be inadequate in 84% of those sensitised; medications were not easily available for inspection or were out of date in 23%; 74% of psychology referrals were made after the home visit. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided.


CONCLUSIONS
Nurse-led assessments including a home visit can help identify potentially modifiable factors for poorly controlled symptoms in children with problematic asthma.
Bracken
M
M
Department of Paediatric Respirology, Royal Brompton Hospital, London, UK.
Fleming
L
L
Hall
P
P
Van Stiphout
N
N
Bossley
C
C
Biggart
E
E
Wilson
N M
NM
Bush
A
A
D000293:Adolescent; D000485:Allergens / Q000009:adverse effects / Q000032:analysis; D001249:Asthma / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008131:London; D009730:Nursing Assessment / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000032:analysis
D000485:Allergens; D014028:Tobacco Smoke Pollution