While guidelines have been available for years on managing pediatric asthma, a large gap has existed between what are considered best practices to provide quality care and the actual care provided to children.

To get a better handle on this issue, the federal Agency for Healthcare Research and Quality (AHRQ) combed through more than 3,800 articles in the published literature to get answers related to both pediatric and adult asthma.

It looked at four primary types of outcomes that were related to:measures of clinical status (e.g., asthma symptoms), functional status (e.g., days lost from school), health services utilization (e.g., hospital admissions), and adhering to guidelines (e.g., numbers of patients given prescriptions for inhaled corticosteroids).

This was crossed with types of quality improvement strategies, which included components of patient education, self-monitoring or self-management, and provider education. After sorting through the information, AHRQ found that:

• Young children with asthma benefit the most from quality improvement strategies that also include their parents or caregivers at some point of the process.

• School-based programs, which included patient education programs, reported “statistically significant improvements” in outcomes of care for children with asthma.

• The small number of educational programs aimed at teens — even those taught by peer teachers, health care providers, and nurse educators — did not show significant changes in asthma outcomes for most of the studies.

• Although only a small number of studies were available, expanding the usual asthma care with additional specialty asthma clinics staffed by specialty-trained nurses and pharmacists improved care — particularly with the increased use of inhaled corticosteroids and improved clinical outcomes.

Education for parents and caregivers of asthmatic children about asthma triggers in their homes and better asthma control on the home front were found to be effective in the many studies AHRQ scanned on the National Cooperative Inner-City Asthma Study, sponsored through the National Institutes of Health.

After the parents and caregivers were provided training in areas such as asthma triggers (e.g., dust mites, cockroaches) and environmental controls (e.g., vacuum cleaning, clean air filters), the number of symptom-free days rose while days lost from school and the number of asthma symptoms declined.