Managing Pediatric Asthma: Emergency Department Demonstration Program

Field of Work: Improving emergency department care of pediatric asthma

Problem Synopsis: The American Lung Association calls asthma the most common chronic disorder of childhood, affecting 6 million children. Four million children experience at least one asthma attack or wheezing episode a year, according to CDC survey data. These conditions take a heavy toll on the ability of young patients to lead active, normal lives. Asthma affects all populations but has a disproportionate impact on economically disadvantaged, urban and minority groups. African Americans experience asthma-related hospitalizations and death at almost triple the rate of whites, according to the CDC.

One out of every three children with asthma visits an ED in a 12-month period, according to a 1998 national survey ("Asthma in America") funded by the pharmaceutical company GlaxoSmithKline. Asthma was the cause of more than 727,000 ED visits by patients 17 and under in 2002.

Synopsis of the Work: The Managing Pediatric Asthma: Emergency Department Demonstration Program, a national program of the Robert Wood Johnson Foundation (RWJF), developed and tested emergency department-based systems to improve pediatric asthma care. The RWJF Board of Trustees authorized it in July 1999 for up to $3.5 million as part of a major effort to improve management of pediatric asthma in high-risk populations. Two other programs made up the effort: Improving Asthma Care for Children, and Allies Against Asthma.

During 2001–2005, project teams at four sites—Honolulu, Houston, Milwaukee and Washington—implemented data systems to track emergency department pediatric asthma patients and educational interventions to help patients and parents manage the disease.

Key Results

  • The project teams reported their findings in articles published in the the April 2006 supplement to Pediatrics.

    • Although results were not uniform, the projects as a group demonstrated that emergency departments can deliver effective asthma education and management programs to pediatric asthma patients and their families.
    • The projects demonstrated that emergency department-based patient tracking systems can produce data to enhance understanding of the local pediatric asthma population and inform clinical and educational interventions.
    • The projects found that children with the mildest chronic asthma severity classification—mild intermittent—constituted an unexpectedly large proportion of emergency department pediatric asthma patients.