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Am Fam Physician. 2003;67(3):621-622

Asthma is one of the most common chronic illnesses in children and is responsible for a high degree of morbidity and significant mortality in this age group (six months to 18 years). The National Asthma Education and Prevention Program (NAEPP) guidelines recommend first-line use of anti-inflammatory drugs to reduce the airway inflammation and hyperresponsiveness that underlie chronic asthma and use of beta-adrenergic agonists as “rescue” medications. Despite the availability of these guidelines, anti-inflammatory medications are still underused. T o address these issues, the Easy Breathing program was developed to improve asthma care. Cloutier and colleagues studied the program's impact on physicians' adherence to the NAEPP guidelines.

The study was a before-and-after intervention trial conducted at six urban primary care clinics. Participating health care workers included primary care physicians, mid-level providers, nursing staff, pediatric and family practice residents, and medical students. Knowledge about asthma diagnosis and treatment was established before the intervention, after the training program, and at 12 and 18 months after the intervention. The Easy Breathing program, which was designed for busy primary care physicians, consists of a screening survey that includes questions about asthma symptoms, triggers, previous asthma diagnosis, and family history. If the screening survey is positive and asthma is diagnosed, another survey focused on severity of illness is completed. A severity-specific treatment plan, with a daily sick plan and an emergency treatment plan, is developed.

Before implementing the program, clinicians received four hours of training. Clinical adherence to the NAEPP guidelines was determined by comparing the patient's actual treatment plan with severity-specific treatment guidelines. Clinicians' attitudes toward the Easy Breathing program also were assessed.

All three groups (physicians, mid-level practitioners, and nurses, residents, and students) showed significant improvement in the percentage of correct responses on the post-test. The results of the tests found that there was significant improvement of correct responses on the post-test for all three categories. Improvement for the factual and guideline responses disappeared at the 12- and 18-month tests, but improvement for the applied questions was sustained. Adherence to treatment guidelines was 93 percent or higher in the various groups. The use of inhaled corticosteroids increased threefold after the intervention. The physicians reported that they had integrated the program into their office practice but did not think it represented a substantial change.

The authors conclude that the Easy Breathing program increases clinicians' knowledge about the treatment of asthma and increases their adherence to the NAEPP guidelines for asthma management. They add that primary care physicians think they are adhering to the guidelines, even when they are not.

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