Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile

Publication date: Available online 27 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tricia Morphew, Stanley P Galant

Abstract

Background

Obesity is thought to be associated with poor asthma control, increased health resource utilization, and reduced responsiveness to inhaled corticosteroids.

Objective

Based on previous experience our hypothesis was that by improved access to comprehensive guideline care that outcomes in normal weight would be comparable in obese asthmatic children.

Methods

This was a retrospective cohort study of predominately Hispanic children (3-18 years of age), in underserved areas of Orange County, CA, who enrolled in the Breathmobile Program from 2003 -2012. Outcomes were examined using Cox regression and generalized estimating equations analyses, adjusted for potential confounding factors.

Results

Clinical outcomes in over 1200 children followed for a mean of 6 visits (SD=2.2) across 403 days (SD=112) were improved, on average, regardless of BMI. MOB patients were able to achieve significant reductions of approximately 60% or more in report of ED visits, hospitalizations, school absenteeism, usual exercise limitations, and exacerbations to levels that were comparable to NW patients. The importance of close follow-up, particularly for the MOB patient, was evidenced by achieving 80% cumulative probability of well control asthma by visit 3, similar to patients in lower BMI risk groups with good adherence, when the visit interval did not exceed 90 days. These outcomes were achieved across all BMI groups with similar mean step of therapy, adjusted for severity (p<.001).

Conclusion

Access to effective community-based care where trust, education, and continuity of care consistent with NAEPP guidelines is possible, as demonstrated by the Breathmobile Program, can provide an opportunity for asthmatic children in all BMI categories to achieve well controlled disease.

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