National Jewish Program Controls Severe Ashtma in Children

Regular medical treatment helps most of the nearly 5 million children with asthma lead active lives. But for those with severe asthma, visits to the doctor or emergency room can eat up vast amounts of time and money for both the children and their parents-- often without any long term hope of controlling the disease.

But a new study shows that an extended, multi-disciplinary treatment program, such as the Pediatric Day Program at National Jewish Medical and Research Center, can dramatically improve a child's condition. National Jewish pediatric allergist Donna L. Bratton, MD, and her colleagues reported in the March 2001 Pediatric Pulmonology that pediatric patients who attended the day program at National Jewish cut their annual medical bills on average from $16,250 to $690. They also enjoyed reductions in emergency-room visits, days in the hospital, and use of oral corticosteriods. (See table for additional data)

"In the day-program setting we provide extended, direct observation by a multi-disciplinary team, which then develops interventions, including behavior management for both the patient and family," said Dr. Bratton, who directed the program from 1994 through 1997. "Ultimately, our program focuses on family management of the disease. Our patients clearly benefited."

Although asthma care has improved in recent years, some patients fail to bring their asthma under control. These patients frequently come to the emergency room, must often be admitted to the hospital, and take high doses of oral corticosteroids. They also frequently have complicating conditions, such as steroid side effects, sinusitis, gastroesophageal reflux, obesity, and various emotional problems.

"These are seriously ill children," said Dr. Bratton.

The Pediatric Day Program at National Jewish Medical and Research Center offers treatment for these patients and their families, who come to the clinic five days a week during the day for an average of 10-12 days. A team of medical, psychosocial, dietary, and rehabilitative personnel observes the patient and family for extended periods under a variety of conditions, conducts a comprehensive diagnostic evaluation, and educates the patient and family about their condition and its management. Team members develop a treatment regimen, fine-tune it, then verify that it works and that the family can follow it.

For their study, Dr. Bratton and her colleagues followed 98 patients under age 19 for two years after they attended the program in 1995 and 1996. The patients and their families reported significant improvements in the severity of their asthma and their quality of life. Sixty-six percent of the children used oral corticosteroids when they entered the program. That dropped to 13% two years later, with an accompanying decrease in dosage. Visits to the emergency room dropped from an average of two per year to none, and days in the hospital also dropped from an average of seven per year to none. An overall score of medical utilization dropped 87% during the two-year period. (See table for additional data.)

Dr. Bratton attributes the success of the program to the multi-disciplinary nature of the team, its integrated effort and the extended observation. The multi-disciplinary team can recognize and address a wide variety of problems that contribute to the severity of the asthma. By constantly sharing information they develop a more comprehensive picture of the patient than do various specialists working alone. Extended, first-hand observation lets the National Jewish personnel see exactly what is happening with the patients and their families, and offers a chance for feedback on medications and management strategies.

Dr. Bratton believes that the Pediatric Day Program may also serve as a good model for other chronic childhood diseases, such as diabetes and cystic fibrosis.