TY - JOUR T1 - The importance of nurse-led home visits in the assessment of children with problematic asthma JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 780 LP - 784 DO - 10.1136/adc.2008.152140 VL - 94 IS - 10 AU - M Bracken AU - L Fleming AU - P Hall AU - N Van Stiphout AU - C Bossley AU - E Biggart AU - N M Wilson AU - A Bush Y1 - 2009/10/01 UR - http://adc.bmj.com/content/94/10/780.abstract N2 - 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 further investigations and consideration of off-label, potentially toxic, asthma therapies were not necessary.Results: Potentially modifiable 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. At the home visit house dust mite avoidance measures were found to be inadequate in 84% of those sensitised; medications were not easily available for inspection or were out of date in 23%; 74% of psychology referrals were made after the home visit. In 39 children (55%) the factors identified and the interventions recommended meant that further escalation of treatment was avoided.Conclusions: Nurse-led assessments including a home visit can help identify potentially modifiable factors for poorly controlled symptoms in children with problematic asthma. ER -