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  Lunedì 14 Ottobre 2019 21:42

EAACI-WAO Congress 2013

Using the expanded chronic care model in an international initiative to address the chronicity of pediatric asthma

Facchetti S.1, Gretter V.1, D’Agata E.1, Pluda A.1, Brioni A.1, Colombo D.1, Arietti V.1, Zanardini A.1, Gennari A.2, De Leonardis C.3, Brivio A.1, Pecorelli G.1, Hawkins M.4, Holliday C.5, Masiello M.5, Guarnaccia S.1
1Spedali Civili Trust, Laboratorio Clinico Pedagogico e Ricerca Biomedica, Brescia, Italy, 2Spedali Civili Trust, Dietetica e Nutrizione Clinica, Brescia, Italy, 3Spedali Civili Trust, Pneumologia e Fisiopatologia Respiratoria, Brescia, Italy, 4University of Pittsburgh, Department of Epidemiology, Pittsburgh, United States, 5Windber Research Institute, Center for Health Promotion & Disease Prevention, Windber, United States
Background: Asthma is a leading chronic condition among youth, causing disability as well as direct and indirect health-related costs. Given the international burden of pediatric asthma, Italian and American clinicians and public health professionals designed a clinical health promotion initiative to monitor and address the medical, social, and psychological issues impacting the health of children and adolescents with asthma. 
Method: An intervention was designed to explore the correlation between poor health outcomes and asthma in order to appropriately manage and reduce the use of asthma-related medications in youth through intervention and tracking patients’ determinants of health with a clinical informatics system. A questionnaire was administered to asthma patients, ages 5-18, included in the Diagnostic, Therapeutic and Educational branch of the "Io e l’Asma" center to identify health adversities. Contingent on patients’ self-reported conditions, individuals were referred to one or more interventions that address physical activity, nutrition, tobacco exposure, behavior, and well-being. Clinical data concerning asthma control is recorded before and after the intervention.
Results: 338 pediatric asthma patients were evaluated. Fifty six percent did not enter the study for these reasons: were under five years old (56%); lack of time (25%); did not suffer from asthma (8%), language barriers (7%); cognitive barriers (2.5%); refused (1.5%). The remaining148 patients consented to the study, 60% of which reported health adversities. Specifically, 32% reported behavioral and relationship issues, 29% were sedentary, 22% had poor nutrition, and 0.01% had a smoking habit. All patients received a motivational interview and consultation with a physician. Based on the physician’s referral, 19 patients started the neuropsychiatric intervention, nine began the physical activity and the nutrition intervention, and two were enrolled in the smoking cessation intervention. 
Conclusion: Many asthmatic children exhibit problems with behavior and friendship, physical activity, nutrition and tobacco. A holistic approach to healthcare is needed to successfully address these chronic conditions. This pilot project demonstrates the benefits of developing a database and health promotion tools in a clinical setting. Our long term goal is to see an improvement in the management of asthma by integrating clinical and pharmacological treatment with an educational intervention.

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