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Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up
  1. A W A Kamps1,
  2. P L P Brand1,
  3. J L L Kimpen2,
  4. A R Maillé3,
  5. A W Overgoor-van de Groes1,
  6. L C J A M van Helsdingen-Peek1,
  7. R J Roorda1
  1. 1Department of Paediatrics, Isala Klinieken, Zwolle, The Netherlands
  2. 2Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
  3. 3Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
  1. Correspondence to:
    Dr A Kamps, Department of Paediatrics, Isala Klinieken, Weezenlanden Hospital, P O Box 10500, 8000 GM Zwolle, The Netherlands;
    a.kampszonnet.nl

Abstract

Background: Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician.

Methods: Seventy four children referred because of insufficient control of persistent asthma were randomly allocated to 1 year follow up by a paediatrician or asthma nurse. The main outcome measure was the percentage of symptom-free days. Additional outcome measures were airway hyperresponsiveness, lung function, daily dose of inhaled corticosteroids (ICS), number of exacerbations, number of additional visits to the general practitioner, absence from school, functional health status, and disease specific quality of life.

Results: There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days (mean difference 2.5%; 95% CI −8.8 to 13.8), airway hyperresponsiveness (log10 PD20 0.06; −0.19 to 0.32), functional health status (10.1; −0.3 to 19.8), disease specific quality of life of patients (0.08; −0.9 to 0.7), and disease specific quality of life of caregivers (0.09; −0.2 to 0.3), nor in any other outcome parameters. Most outcome parameters improved considerably over the 1 year study period. These improvements were achieved although the daily dose of ICS was reduced by a mean of 26% compared with the dose received by children at referral. All parents were satisfied with the asthma care received.

Conclusions: After initial assessment in a multidisciplinary clinic, childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician. During close follow up by paediatrician or asthma nurse, asthma control improved despite a reduction in ICS dose.

  • asthma
  • children
  • outpatient management
  • paediatricians
  • asthma nurses

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Footnotes

  • Sponsored by GlaxoSmithKline.

  • A Kamps was supported by an unrestricted educational grant from GlaxoSmithKline. Both P Brand and RJ Roorda have been involved in clinical trials sponsored by GlaxoSmithKline. None of the other authors has any conflict of interest.

  • A Kamps was the overall study coordinator and was involved in the protocol design, data analysis and interpretation, and in writing the report. P Brand and RJ Roorda were involved in protocol design, data analysis and interpretation, and in writing and editing the report. RJ Roorda and P Brand were also responsible for clinical care and patient recruitment. A Overgoor and L van Helsdingen-Peek provided clinical care and were involved in editing the report. J Kimpen contributed to the protocol design and was involved in editing the report. A R Maillé was involved in analysis of quality of life data and interpretation, and in editing the manuscript.