Monitoring asthma control in children: AAP recommendations for clinicians
Recent advances in measuring asthma control tools have enhanced ongoing assessment and monitoring of asthma.
The American Academy of Pediatrics has released a set of measures for clinicians to use in the routine ambulatory monitoring of asthma in children.
Because asthma control exhibits short-and long-term variability, healthcare providers need to be vigilant regarding the fluctuations in the factors that can create discordance between subjective and objective assessment of asthma control, according to Chitra Dinaker, MD, FAAP, and Bradley E. Chipps, MD, FAAP.
The following is a list of recommended measures for an initial consultation:
- The encounter between patient and healthcare provider may involve critical and empathetic listening to the patient and accurate elicitation of symptoms as indicators for asthma control, aided by validated asthma control tools such as the C-ACT/ACT. A complete environmental and social history should be obtained to evaluate for triggers.
- Airway obstruction and AHR can be assessed by measuring prebronchodilator and postbronchodilator FEV1. Some specialists may consider evaluation of airway inflammation by using FENO to be useful.
- Education and training regarding asthma and its management can be provided, taking into consideration the patient's personal preference and goals while creating an individualized action plan.
- Action strategies can be based on either symptoms or objective criteria, such as by monthly monitoring of the age-specific, validated asthma control instrument, or in individualized circumstances, by daily electronic FEV1 or conventional peak flow monitoring at home.
The following measures are recommended for subsequent visits:
- Symptom scores with validated control instruments and FEV1 can be monitored at subsequent visits along with serial healthcare utilization data to tailor the medication dose to degree of asthma control. The risk domain is validated by a history of systemic steroid prescription, emergency department visits, or hospitalizations.
- In individuals whose FENO was elevated at the initial visit and shows variation in response to therapy, repeat FENO monitoring may be considered.
- Education regarding asthma triggers, review of inhaler techniques, assessment and reinforcement of adherence, treatment of comorbidities (eg, gastroesophageal reflux, sinusitis, obesity), and encouragement and fortification of the collaborative provider-patient relationship can be provided at each follow-up visit.
- The need for continued assessment or reassessment by a pediatric allergist or pulmonologist can be considered when faced with challenges in attaining optimal asthma control.
- Information on appropriate coding for the asthma management tools and services provided can be found in the Asthma Coding Fact Sheet at the following link: https://www.aap.org/asthmacodingfactsheets.
“Familiarity with the properties, application, and relative value of these measures will enable healthcare providers to choose the optimal set of measures that will adhere to national standards of care and ensure delivery of high-quality care customized to their patients,” stated the researchers.
- Dinakar C, Chipps BE. Clinical tools to assess asthma control in children. Pediatrics. January 2017. doi: 10.1542/peds.2016-3438