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The importance of nurse led home visits in the assessment of children with problematic asthma
  1. Marcella M Bracken (m.bracken{at}rbht.nhs.uk)
  1. Royal Brompton Hospital, United Kingdom
    1. Louise Fleming (l.fleming{at}rbht.nhs.uk)
    1. Imperial College London, United Kingdom
      1. Pippa Hall (p.hall{at}rbht.nhs.uk)
      1. Royal Brompton Hospital, United Kingdom
        1. Nicole Van Stiphout (n.vanstiphout{at}rbht.nhs.uk)
        1. Royal Brompton Hospital, United Kingdom
          1. Cara J Bossley (c.bossley{at}rbht.nhs.uk)
          1. Imperial College London, United Kingdom
            1. Elizabeth Biggart (e.biggart{at}rbht.nhs.uk)
            1. Royal Brompton Hospital, United Kingdom
              1. Nicola M Wilson (n.wilson{at}rbht.nhs.uk)
              1. Royal Brompton Hospital, United Kingdom
                1. Andrew Bush (a.bush{at}rbht.nhs.uk)
                1. Royal Brompton Hospital, United Kingdom

                  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.

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