The importance of nurse led home visits in the assessment of children with problematic asthma

Marcella M Bracken ¹, Louise Fleming ², Pippa Hall ¹, Nicole Van Stiphout ¹, Cara J Bossley ², Elizabeth Biggart ¹, Nicola M Wilson ¹ and Andrew Bush ^1*

¹ Royal Brompton Hospital, United Kingdom
² Imperial College London, United Kingdom

^* To whom correspondence should be addressed. E-mail: a.bush{at}rbht.nhs.uk.

Accepted 2 June 2009

Abstract

Objective: To evaluate and identify potentially modifiable factors in children with problematic asthma by a nurse led assessment and home visit.

Design: Observational cohort study.

Setting: A tertiary paediatric respiratory centre.

Patients: 71 children, aged 4.5 - 17.5 years, with problematic asthma currently under follow up at a tertiary respiratory centre.

Interventions: A nurse led hospital visit followed by a home visit.

Main outcome measures: Identification and attempted change of exacerbating factors so that consideration of off-label, potentially toxic asthma therapies was not necessary.

Results: Potentially remediable factors were identified in 56 (79%) children. Many children had multiple causes for poor control. The most important were ongoing allergen exposure, 22 children (31%); passive or active smoking, 18 children (25%); medication issues including adherence, 34 children (48%); psychosocial factors, 42 families (59%). The home visit contributed valuable information to this assessment. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided.

Conclusions: Nurse led home visits can help identify potentially remediable factors for poorly controlled symptoms in children with problematic asthma.