Asthma Action Plans: ¿Qué Pasa?

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Friday, October 25, 2013
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Asthmatic children whose caregivers have limited English proficiency are significantly less likely to have and use an asthma action plan, a new study finds.

Sixty million households speak a primary language other than English at home, with roughly 60% of these households occupied by native Spanish speakers. In almost 30% of these homes, family members read, speak, write, or understand English only in a very limited way. In other words, household members have limited English proficiency (LEP). Many studies have associated LEP with serious health care disparities.
In particular, asthmatic Latino children who have LEP caregivers are at risk for suboptimal asthma care. Consequently, they make more frequent emergency department visits. They are also less likely to have and use daily inhaled corticosteroids, daily beta-agonists, and asthma action plans.
Researchers from Yale University, concerned about increased emergency department use by Latino children in Connecticut, examined action plan use rates in a population of 107 Latino patients with LEP caregivers seeking asthma care in an emergency department setting. They also examined several demographic factors of interest: health insurance status, level of caregiver education, and the type of medical home where asthma care was received. They published their results online on October 22, 2013, in the Journal of Asthma.
Using an 11-question survey, the researchers assessed patients’ demographic factors and the presence or absence of an action plan. Children whose caregiver had LEP were significantly less likely to have and use an asthma action plan. In fact, having a caregiver with LEP was the only demographic factor that significantly reduced the likelihood of having an asthma action plan.
By now, most advisory agencies agree that all people with asthma should have a written asthma action plan. These plans—developed by the patient, the patient’s caregiver, and the patient’s health care providers—reiterate daily treatments and how to take them. They describe how to control asthma and how to handle attacks. All of the patient’s caregivers—parents, babysitters, and workers at daycare centers, schools, and camps—need to be familiar with the plan. Language barriers are no excuse!
Given that the Latino population is growing throughout the country and that Latino children are at elevated risk for asthma, this study identifies a care gap that pharmacists can help fill. Don’t let low English proficiency be a barrier. Find ways to help Spanish-speaking patients acquire and use asthma action plans. Hiring bilingual staff, using a translation service, and referring patients to community health programs designed to improve access are a start. The Centers for Disease Control and Prevention offers basic information about asthma in Spanish. You can find it here for free. In addition, the Pediatric/Adult Asthma Coalition of New Jersey offers asthma action plans in Spanish. Find them here.
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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