Asthma

Discussion Summary

Date of Discussion: May 2003
Discussion Moderator: Richard Mandsager, MD

In May the Special Interest Group sponsored a listserv discussion on asthma that drew over 20% participation from SIG members. Dr. Richard Mandsager, Director of Pediatrics at Alaska Native Medical Center, framed several questions to initiate the discussion. Asthma, now a significant problem in many Indian communities, was once actually considered rare. Dr. George Brenneman who worked the Yukon-Kuskokwim Delta Area in Alaska for several years in the 1960s and 1970s cannot recall a single case during that time. Dr. Rosalyn Singleton presented data that shows a current prevalence of asthma in those communities of around 11.9%. The YK Corporation has submitted an Asthma Disparities in Minorities NIH grant proposal with University of Arizona to study environmental and genetic determinants of excess asthma morbidity in Alaska Natives and evaluate effects of provider and parent interventions on asthma control. A 1995 study of asthma prevalence in a Southwestern Pueblo Community using a standardized questionnaire found a similar prevalence of 12.3%, and several other participants in their communities noted this 12%—more than twice the rate reported in National surveys such as NHANES.

There was a spirited discussion on the diagnosis and treatment of younger children less than two with recurrent wheezing episodes. Several participants suggested the “wheezing more than twice” rule for these younger children as it encouraged appropriate use of anti-inflammatory Rx including nebulized steroids. Drs Jon Jantz, Dean Effler, Matthew Clark and Jim Carson shared their clinical experience in treating younger children with nebulizers as well as clinical pearls for dealing with older children.

The discussion also touched on ways to improve quality of care in ambulatory settings, including a Powerpoint presentation of Anchorage experience shared by Dr. Mandsager. Dr. Cliff O’Callahan discussed effective education strategies and use of educational materials. His main message is to simplify, limiting use to four forms: a patient/parent completed assessment of symptoms, a severity scale with hints on what to do with each level in color, a dosing chart laminated in each room, and an asthma management plan. These tools are downloadable from http://ww.nichQ.org/intiatives, click asthma.