What is Asthma?  Asthma is a disease where the airways (tubes that carry air into and out of your lungs) become inflamed and narrowed from exposure to certain substances called irritants, resulting in less air flowing into the lungs.  This can cause attacks of wheezing, shortness of breath, chest tightness, and coughing.  Asthma can occur in anyone, at any age, but it usually starts in childhood. 

Pediatric asthma (asthma in children) is a common serious chronic disease of childhood, affecting nearly 5 million children in the United States.  The dramatic increase in the incidence of pediatric asthma led Baystate Children’s Hospital (BCH) to develop an integrated strategy for improving the care of children with asthma.  The development of inpatient and outpatient clinical practice guidelines and care sets, adoption of a pediatric hospitalist model, criteria for specialist referral, development of a basic asthma survival skills program, and a strong outpatient community focus have allowed for increased collaboration, effectiveness and efficiency in the delivery of pediatric asthma care.  Standardized asthma education is provided to all patients with asthma and their families, and referrals for outpatient programs are made for those who require extra attention.  This information is key to success in the self-management of asthma.

Additionally, the BCH is in partnership with the Pioneer Valley Asthma Coalition to lead a regional effort to improve the quality of life of children with asthma.  This work is funded by the Center for Disease Control (CDC) National Institute of Environment Health and the Environmental Protection Agency.  This effort has included participation in design and implementation of the pilot Massachusetts Department of Public Health  Asthma Disparity Initiative which includes: a community health worker, home environment assessment and modification, and asthma education program; a full service pediatric asthma clinic staffed by a pulmonologist and a community health worker in an urban primary care training clinic; regional training of school nurses; improvement of indoor air quality in school buildings; and securing an EPA Care grant with Springfield City Partners to sustainably address environmental causes of asthma.  Statewide and regional partners in research include the New England Asthma Regional Council, Massachusetts Asthma Advocacy Partnership, Massachusetts Department of Public Health Asthma Control Office, and Boston University Medical Center.

Highlights

Baystate Children’s Hospital 

• The use of reliever medications is currently 100%. 
• The use of systemic corticosteroids remains at 100%. 
• Home Management Planning (HMP) is the key to success in the self-management of asthma and in preventing readmission and frequent use of emergency departments.  Delivering a useful patient-centered HMP has been an important priority in the past year; there will be increased focus on successfully providing this information to patients and families.  The current rate is 80%, slightly below the national average of 83%.
• Our current composite score is 93%, representing how well we reliably provide all appropriate care.

Future Work

Intensive pediatric asthma management in partnership with BCH, the community, patients, and families has resulted in a number of substantial improvements in care.  By better coordinating the care of children with asthma, BCH has successfully integrated advances in medical therapy, educational programs and clinical care to improve outcomes.  We will continue to focus on education and self-management to help patient and families become successful in living with asthma.

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