Is asthma patient leaving with misinformation?
You'll have a 'tremendous impact'
You might assume that caregivers of asthmatic children probably understand how to use inhaled corticosteroids, but a recent study shows this might not be the case.
Researchers surveyed 228 parents of children with asthma exacerbations who presented to two pediatric EDs, and they found that only 51% of children with persistent asthma were using inhaled corticosteroids.1
Many were using them only "as needed" instead of daily to prevent asthma exacerbations, with 29% of the parents having a misconception that inhaled corticosteroids would "immediately open the airways."
"Similar to prior studies, we found that many children with asthma were not receiving appropriate preventive asthma care," says Jamie N. Deis, MD, the study's lead author and an ED physician at Wake Forest University Baptist Medical Center in Winston-Salem, NC. He gives these recommendations:
Make sure parents of children with asthma understand the vital difference between immediate relief bronchodilators and inhaled corticosteroids.
"This is one area, in particular, where nurses could have a tremendous impact," says Deis.
Discussing common triggers of asthma, the importance of second-hand smoke avoidance, and the importance of the influenza vaccination.
"There is tremendous opportunity to provide this type of asthma education in the emergency department setting," says Deis.
Focus on the difference between inhaled corticosteroids and bronchodilators. Dies recommends these practices when reviewing the patient's medications at triage:
If the child is on an inhaled corticosteroid, ask if the child is using the medicine every day. If not, remind the patient and the parent that this medicine is a daily preventive medication designed to reduce the number of asthma exacerbations.
Reinforce the fact that inhaled corticosteroids will not provide immediate benefit if the child is having an acute asthma attack and that albuterol should be used as the rescue medication. (See clinical tip on a warning sign to watch for, below.)
Reference
- Deis JN, Spiro DM, Jenkins CA, et al. Parental knowledge and use of preventive asthma care measures in two pediatric emergency departments. J Asthma 2010;47:551-556.
Tell patients to watch for this warning sign Tell asthma patients to take note if they use an inhaler more than twice daily for two days, says Rena M. Rovere, RN, MS, FNP-C, a clinical nurse specialist/nurse practitioner for the Department of Emergency Medicine at Albany (NY) Medical Center. "This is a sign that asthma is becoming unstable," Rovere says. "The patient may need adjustment of their medications, which may include beginning inhaled steroids, nebulization treatments, evaluation for triggers or infection, or oral steroids." Emphasize that inhaled steroids are not rescue medications, she says. "While they may be the only medication left if the child has used up all of rescue medications too soon, it will be more dangerous to the child because of the delay in receiving the medication to open the airway," she says. Rovere tells patients to keep the inhaled corticosteroids in the bathroom to use twice per day before brushing their teeth. "This is order to remember the importance of rinsing the mouth after inhaled corticosteroids, to reduce the incidence of thrush," she says. |
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