title: A pediatric asthma management program in a low-income setting resulting in reduced use of health service for acute asthma.
abstract: BACKGROUND
  The effectiveness of pediatric asthma management programs in reducing health services utilization during exacerbations in developing countries is not widely studied. This study was carried out to assess the effectiveness of an asthma management program to reduce the overall health services utilization by acute asthma in children and adolescents.
  
  
  METHODS
  In this historical population-based real-life cohort study, we selected 582 patients with asthma aged 4-15 living in deprived areas in the town of Itabira, Brazil, of which 470 cases were assisted by the asthma management program and 112 were controls. The end point was the first physician-diagnosed asthma exacerbation occurring after study enrollment and within 12 months after admission. All 470 cases received a written plan about exacerbation self-management, including the use of inhaled albuterol at home. Three hundred and seventeen out of 470 cases (67.4%) were also treated with beclomethasone diproprionate (BDP).
  
  
  RESULTS
  Both groups were comparable regarding gender, age group, and place of residence. At the end of the study, only 5% of cases vs 34% of controls did seek health services because of acute asthma (P < 0.01). Statistical difference also remained when comparing the 112 controls with the 153 cases not treated with com BDP (Hazard Ratio = 0.04, 95% CI, 0.01-0.14, P < 0.01).
  
  
  CONCLUSIONS
  Results have demonstrated the effectiveness of the pediatric asthma management program in reducing dependence on the health services for acute asthma. Effectiveness was also observed in subjects with no use of BDP.
authors.affiliation: Municipal Health Authority, Pediatric Asthma Management Program Chairman, Itabira, Brazil.
authors.forename: W C C
authors.initials: WC
authors.lastname: Andrade
authors.forename: P
authors.initials: P
authors.lastname: Camargos
authors.forename: L
authors.initials: L
authors.lastname: Lasmar
authors.forename: J
authors.initials: J
authors.lastname: Bousquet
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000420:Albuterol / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000627:therapeutic use; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D011203:Poverty; D012648:Self Care / Q000379:methods
chemical_list: D018927:Anti-Asthmatic Agents; D001507:Beclomethasone; D000420:Albuterol