Overcoming 'I'm In Control Syndrome'

Two studies that offer new insights to help adolescents and younger children improve their asthma control will be presented by researchers from Cincinnati Children's Hospital Medical Center at this year's annual meeting of the Pediatric Academic Society (PAS) in Honolulu, Hawaii.

One stud found that teens with asthma dramatically overestimate their ability to control the condition, according to Maria Britto, M.D., MPH, a physician in the Division of Adolescent Medicine at Cincinnati Children's and study co-author.

"We've known that adolescent asthma patients tend to have poorer outcomes than younger children with the condition, and this study shows that teens tend to think they're in control when they may be having difficulty," Dr. Britto said.

The researchers reported that 74 percent of adolescents dramatically overestimated their ability to control asthma, especially compared to the teens' own reports of symptoms, use of rescue medications and limitations they placed on their activities. The study included 201 adolescents with an average age of 16.2 years who were observed during clinical visits. The findings suggest that adolescents' perception of being in control may impact whether or not they follow treatment regimens and avoid situations that trigger their condition.

"For those of us who treat teens with asthma, these findings will help us address with patients their perceived control versus what is actually going on," Dr. Britto said. "As we have this dialogue with them, our hope is that it will improve their ability to manage their asthma and improve their health."

Improved care for asthma patients was also the subject of a second study at Cincinnati Children's to be presented at PAS on May 6. This study found that a creative approach referred to as "unplanned planned asthma visits" resulted in young patients having fewer emergency room and hospital visits. The approach involves physicians discussing asthma with patients every time they come for an office visit, even if those visits are scheduled for totally unrelated reasons.

"Having regular, planned physician appointments to manage a child's asthma is an integral part of the chronic care model," said Greg Szumlas, M.D., a physician in the Division of General Pediatrics at Cincinnati Children's and study co-author. "Unfortunately, many patients don't always keep these appointments, so the planned opportunity for education of patient and parent is lost. We also know patients see their physicians for other acute problems, so we developed a system to capture these opportunities and turn them into what we call the 'unplanned planned' asthma visits."

During these visit, patients undergo asthma control screening, condition assessment and receive education on asthma self-management. The visit is turned into an opportunity to assess and manage the patient's asthma. Correct medications and effective self management result in an overall improvement in asthma quality measures and patient outcomes. In a study group of 230 asthma patients followed during the program, the researchers noted a 30-percent increase in patients with established asthma treatment action plans. The program also led to a 50-percent reduction in asthma hospitalizations and a 47-percent decrease in asthma related emergency room visits over a one-year period.