The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

IMPROVED ASTHMA MANAGEMENT BY PROVIDING TWICE-A-DAY IN-SCHOOL PREVENTIVE MEDICATION

D. Rebel1, M. Trevino1, G. Weinstein1

Introduction: The National Asthma Education and Prevention Program Resolution of November 2005 identified that asthma affects over 5 million school-aged children in the United States. It remains a leading cause of school absences. The following case study illustrates how providing in-school medications can assist the non-compliant child/family in meeting their self-management objectives.

Case Summary: Our outpatient Asthma Management Program (AMP) initiated a school based outreach initiative to diagnosis and/or assist children who suffer from asthma. Parents were asked to complete an asthma questionnaire and approve pulmonary function studies (PFTs) at the start of the school year. This case report describes a 12 year old obese African-American male student. The child had been previously diagnosed with asthma and was receiving albuterol and ipratropium bromide. He stated he had also been on Advair® and Flonase® in the past. He had 3 prior ER visits the previous year for exacerbation of his asthma. He was experiencing asthma related symptoms daily. His initial PFTs revealed an FVC = 47%, FEV1 = 39% and FEF25-75 = 27%. We provided the child and family with extensive asthma education at the beginning of the school year. A care plan was developed and the child was provided with Advair 250/50 and albuterol. Although PFTs at that time showed significant improvement, the child continued to exhibit symptoms of mild distress in excess of 10 times per month. He was scheduled for quarterly PFTs and after 3 months they were: FVC = 40%, FEV1 = 33% and FEF25-75 = 24%. It was determined the child/family was not compliant in their medication management initiatives. It was then decided the school nurse would administer the Advair twice daily and the child/family would be responsible for the use of the quick-relief bronchodilator. At one month follow-up, he had an FVC = 105%, FEV1 = 97% and FEF25-75 = 90%. By the end of the school year he was able to live a normal active childhood lifestyle and had year end PFTs of FVC = 111%, FEV1= 100% and FEF25-75 = 93%. He had no school absences or ER visits during this time.

Discussion: This case study reflects the added benefits of utilizing the school nurse as part of an effort to improve medication compliance in the hard to control, non-compliant asthmatic. While not a long term solution to patient compliance issues, the benefits of “capturing” a patient’s time for a significant portion of the week, was advantageous in this case.

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