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Evidence for Symptom-Based Medication Adjustment for Mild Persistent Asthma

By Nichole Bobo, MSN, RN posted 08-23-2022 15:26


NASN wants to call attention to an evidence update for Treating Mild Persistent Asthma in Children that could be added to your toolbox when supporting students and their families with decision-making about effective asthma management – especially for African American students who carry a disproportionate burden of morbidity and mortality from asthma. 

Daily use of an inhaled corticosteroid (ICS), often routinely prescribed for students with mild persistent asthma, can be under-used by students for a variety of reasons including lack of funds or insurance for an ongoing medication supply, transportation challenges to see a healthcare provider for follow-up care, or work/life imbalances at home leading to competing day-to-day priorities that lead to missed dosing – Social Determinants of Health (SDOH). 

  • What would it be like if this student did not need to take a daily asthma control medication?  
  • How would that impact their quality of life?
  • What if better asthma control could be reached when the student and family were taught to first recognize symptoms that would warrant treatment, allowing them to adjust their own ICS frequency?
  • What would that do for building student and family self-efficacy to be a full partner in self-management for this chronic disease? 

As-needed use of ICS followed by a short-acting beta-agonist such as albuterol is included in the 2020 updated NAEPP Asthma Management Guidelines for people 12 and older with mild persistent asthma; and is standard practice in Europe.  The Patient-Centered Outcomes Research Institute (PCORI) conducted a research study comparing daily use of ICS with “as-needed” ICS for African-American children and teens 6-17. The study found both groups had better asthma control at the end of the study; while those receiving the “as-needed” treatment used about one-fourth of the ICS as those children and teens receiving a daily dose of ICS and both children and their family felt they were taking charge of their asthma management. 

School nurses are trusted healthcare professionals in the community.

School nurses are trusted healthcare professionals in the community.  Integrating research findings into practice exemplifies the Standards of Professional Performance - Scholarship Inquiry - for school nurses.

  • Do you see the link between incorporating this PCORI evidence update and living up to this standard of professional practice? 
  • And does supporting student-centered care, student self-empowerment, and chronic disease management sound familiar to you?

These are some of the practice components of the Care Coordination principle of NASN’s Framework for 21st Century School Nursing PracticeTM.  Both of these guideposts for school nursing practice point to the importance of learning about and incorporating into practice this asthma management evidence update.

Most importantly, this evidence update can reduce health disparities among African American children with mild persistent asthma by providing another treatment option that may better fit the lived experience of these students and families.  Do you see how providing information about this evidence update is a way of advocating for their right to receive the approach to asthma management that is best for them? It equips students and families with evidence-based information, increasing their health literacy and ability to engage in conversation with their healthcare provider to make the best health care decisions.

School nurses are poised to address SDOH impacting the management of mild persistent asthma among African American students.  It is time to be aware of the evolving evidence for this group of students and incorporate it into practice so that students with mild persistent asthma are healthy, safe, and ready to learn.