The just launched Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines take a new holistic approach to improving asthma outcomes for children.
A quick reference guide to the new Guidelines was published last week in the latest New Zealand Medical Journal (NZMJ) and stated that the new guidelines were informed by recent New Zealand reports describing the growing impact of asthma – especially on children – in New Zealand and the inequities suffered by Māori, Pacific peoples and low-income families.
Dr Stuart Jones, Medical Director of the Asthma and Respiratory Foundation NZ, said he agreed that addressing issues of social inequities was of paramount importance “if we are going to address the disparities in childhood respiratory illnesses and set all New Zealanders up with good lungs for life”.
“I think every child in New Zealand should have the right to be raised in a warm, dry, well ventilated house, free of cigarette smoke and have good access to medical care,” said Jones.
The Guidelines are designed to help nurses, doctors and other health professionals – delivering asthma care in the community to emergency departments – to provide simple, practical and evidence-based guidance for the diagnosis and treatment of asthma in children and adolescents up to 15 years of age.
The 33 page Guidelines (see below for link to full document) not only include diagnostic pathways, asthma control tests and risk assessment factors for severe asthma but also a ‘top ten’ list of how health professionals – apart from prescribing – can help families’ better manage their children’s asthma.
Top 10 ways health professionals can help – apart from prescribing:
Encourage the continuity of care with doctors and nurses in your practice and secondary care, and make follow-up appointments—relationships help. Easy access to a trusted nurse and telephone follow-up is recommended.
Work with families to attain and maintain wellness, and not accept sickness as the norm.
- Smoke exposure
Ask about smoke exposure, encourage reducing tobacco smoke exposure in the child’s environment (home and car) and recommend smoking cessation. If appropriate, give advice and refer to a local smoking cessation service or Quitline. Provide Health Sponsorship Council’s pamphlet A Guide to Making Your Home and Car Smokefree.
A lot of New Zealanders live in unhealthy housing, and conditions are worse in private rental housing. Some families are homeless. Therefore ask about housing and unhealthy features (crowding, cold, damp, mouldy, unflued gas heater). Provide the family with information about having a healthy, insulated home and share the Tips for healthy homes and, if relevant, refer for healthy housing assessment if available in your region.
Assume that most families struggle with income and ask about it. Inquire about the ability to access the doctor, the pharmacy and paying for prescriptions. Does the child have partly or uncontrolled persistent asthma and meet criteria for Child Disability Allowance? It is important for all family members to use the same pharmacy because once patients and their families have collected 20 new prescription items in a year, they won’t have to pay any more prescription charges until 1 February the following year.
6. Health literacy
Assume little health literacy, and use steps described in He Māramatanga Huangō: Asthma Health Literacy for Māori Children in New Zealand. Specifically ask the child and whānau what they understand, what they want to know, and use simple language to explain about asthma. For example, use the term ‘asthma flare-up’ rather than ‘asthma exacerbation’.
Firstly, assume inhaler device technique is poor and check it. Secondly, assume adherence is imperfect and don’t judge. Ask questions in an open way, such as “Many people take less preventer than the doctor prescribes—about how many times a week do you take your asthma preventer?”14–16
8. Asthma action plan
Develop an appropriate asthma action plan with the child and family and check on each visit. Plans should be made available to schools and child care facilities where appropriate.
Help the family to understand how to access care appropriate to asthma severity, and identify any barriers they have. Consider referral to asthma educator, Māori providers or paediatrician where available and appropriate.
Ensure the family know when and how to call an ambulance. In some regions this service may incur a charge.
*The new guidelines were developed by a team of health professionals under the guidance of Professor Innes Asher. They are a complete update of the Paediatric Society of New Zealand’s Management of Asthma in Children aged 1–15 years, published back in 2005.