The importance of nurse-led home visits in the assessment of children with problematic asthma

• Published in: Archives of disease in childhood 2009-10, Vol.94 (10), p.780-784
• Main Authors: Bracken, M, Fleming, L, Hall, P, Van Stiphout, N, Bossley, C, Biggart, E, Wilson, N M, Bush, A
• Format: Article
• Language: English
• Subjects: Adolescent; Allergens; Allergens - adverse effects; Allergens - analysis; Asthma; Asthma - etiology; Asthma - nursing; Asthma - prevention & control; Asthma - psychology; Asthma in children; Biological and medical sciences; Bronchoscopy; Causes of; Child; Child, Preschool; Childhood asthma; Children & youth; Cohort Studies; Environmental Exposure - adverse effects; Environmental Exposure - analysis; Families & family life; Family Environment; General aspects; Guidelines; Health participants; Home care; Home Care Services, Hospital-Based; Home nursing; Home Visits; Hospitals; House dust; Humans; Inhalers; London; Medical sciences; Miscellaneous; Nurses; Nursing Assessment - methods; Observational studies; Outcome Assessment (Health Care); Patient Compliance; Pediatrics; Prescriptions; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Risk Factors; Self Management; Smoking; Spirometry; Tobacco Smoke Pollution - adverse effects; Tobacco Smoke Pollution - analysis
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2008.152140

Objective:To evaluate and identify potentially modifiable factors in children with problematic asthma by a nurse-led assessment and home visit.Design:Observational cohort study.Setting:A tertiary paediatric respiratory centre.Patients:71 children, aged 4.5–17.5 years, with problematic asthma currently under follow-up at a tertiary respiratory centre.Interventions:A nurse-led hospital visit followed by a home visit.Main outcome measures:Identification and attempted change of exacerbating factors so that further investigations and consideration of off-label, potentially toxic, asthma therapies were not necessary.Results:Potentially modifiable factors were identified in 56 (79%) children. Many children had multiple causes for poor control. The most important were ongoing allergen exposure, 22 children (31%); passive or active smoking, 18 children (25%); medication issues including adherence, 34 children (48%); psychosocial factors, 42 families (59%). The home visit contributed valuable information to this assessment. At the home visit house dust mite avoidance measures were found to be inadequate in 84% of those sensitised; medications were not easily available for inspection or were out of date in 23%; 74% of psychology referrals were made after the home visit. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided.Conclusions:Nurse-led assessments including a home visit can help identify potentially modifiable factors for poorly controlled symptoms in children with problematic asthma.