Build Connections to Children With Asthma

Most asthma presents in childhood.

In 2015, the CDC found that pediatric asthma’s overall prevalence in the United States was 8.4% and was approximately 10% among school-aged children and adolescents aged 6 to 19 years.¹ Asthma often causes them to miss school or extracurricular activities and creates a burden for parents who must miss work when their children are having breathing difficulties.^2,3 Over the long term, 75% of children with asthma may accumulate abnormal lung growth patterns and irreversible airflow obstruction that follow them into adulthood. That impaired lung function can also alter their response to treatment.1 For approximately 60% of children with asthma, medication, primarily in the form of inhalers, can control the condition. For the rest, stepped-up care is needed.^4,5 Pharmacists can find teachable moments to help children help themselves.

Who Is In Charge?

Parents obviously should lead the charge when children have asthma. But pharmacists need to direct counseling about therapy’s cornerstone—inhalers—to all caregivers and the child.6 There are specific key points to cover as often as possible (Table^6-9).

Children Should Be Seen and Heard

When parents pick up medications, they frequently come by themselves. Pharmacists should strongly suggest that they would like to counsel the actual patients. Parents may say the child is too young, but most children can and should understand medication instructions by age 5 to 7.¹⁰ In situations where parents are not present for their children, such as school, children will need to know more than parents may think. Inhalers are the most common self-administered medications by school-aged children.¹¹ Anything that boosts children’s confidence and improves technique can improve asthma control and safety.

When working with pediatric patients, always use open-ended questions to determine the child’s cognitive level. Questions such as, “Can you tell me why you use this inhaler?” may elicit a variety of responses from a shrug (meaning ample opportunity for education) to “I have asthma, and this is the inhaler I use every day.” Once the child’s baseline knowledge is established, introduce medical and technical terms—not jargon, but simple terms such as asthma, inhaler, spacer, etc. Use short sentences and words with few syllables. Provide something for the child to take home, ideally a handout with illustration and text. Note that young children can retain 2 to 3 messages, whereas older children can retain 7 to 14.¹⁰

Follow the Rules

Familiarity with current guidelines is critical for pharmacists who see patients with asthma. The Global Initiative for Asthma (GINA) guidelines12 recommend treating adolescents similarly to adults, and there is a specific section for children 5 and younger.

The sheer number of inhalers makes it difficult to stay current. Assigning a technician to contact manufacturers and maintain an inventory of demonstration devices can be helpful. In addition, using the patient insert to review devices and their limitations and strengths ensures accuracy.

Conclusion

Few studies have looked at pharmacists’ interventions with children who have asthma.⁹ GINA guidelines promote pharmacist involvement in asthma care.¹³ Pharmacists can improve their work processes to counsel more and include children in demonstrations and discussions.

Jeanette Y. Wick, MBA, RPh, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES

1. McGeachie MJ, Yates KP, Zhou X, et al. Patterns of growth and decline in lung function in persistent childhood asthma. N Engl J Med. 2016;374(19):1842-1852. doi:10.1056/NEJMoa1513737
2. Asthma-related missed school days among children aged 5–17 years. CDC. Updated October 5, 2015. Accessed May 17, 2021. https://www.cdc.gov/asthma/asthma_stats/missing_days.htm
3. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15(3):348-356. doi:10.1513/AnnalsATS.201703-259OC
4. Zahran HS, Bailey CM, Damon SA, Garbe PL, Breysse PN. Vital signs: asthma in children - United States, 2001-2016. MMWR Morb Mortal Wkly Rep. 2018;67(5):149-155. doi:10.15585/mmwr.mm6705e1
5. Uncontrolled asthma among persons with current asthma. CDC. Updated September 15, 2014. Accessed May 17, 2021. https://www. cdc.gov/asthma/asthma_stats/uncontrolled_asthma.htm
6. Guidelines for the diagnosis and management of asthma 2007 (EPR-3). National Heart, Lung, and Blood Institute. September 2012. Accessed June 14, 2021. https://www.nhlbi.nih.gov/ health-topics/guidelines-for-diagnosis-management-of-asthma
7. Lampkin SJ, Maslouski CA, Maish WA, John BM. Asthma review for pharmacists providing asthma education. J Pediatr Pharmacol Ther. 2016;21(5):444-471. doi:10.5863/1551-6776-21.5.444
8. Chu R, Bajaj P. Asthma medication in children. In: StatPearls. StatPearls Publishing; 2021.
9. Macedo LA, de Oliveira Santos Silva R, Silvestre CC, Alcântara TDS, de Magalhães Simões S, Lyra DP Jr. Effect of pharmacists’ interventions on health outcomes of children with asthma: a systematic review. J Am Pharm Assoc (2003). 2021;61(3):e28-e43. doi:10.1016/j.japh.2021.01.002
10. Sleath B, Bush PJ, Pradel FG. Communicating with children about medicines: a pharmacist’s perspective. Am J Health Syst Pharm. 2003;60(6):604-607. doi:10.1093/ajhp/60.6.604
11. Ficca M, Welk D. Medication administration practices in Pennsylvania schools. J Sch Nurs. 2006;22(3):148-155. doi:10.1177/1 0598405060220030501
12. GINA 2021 report summary & World Asthma Day meeting of the GINA advocates. Global Initiative for Asthma. Accessed June 14, 2021. https://ginasthma.org
13. Global strategy for asthma management and prevention. Global Initiative for Asthma. Accessed May 17, 2021. https://ginasthma. org/wp-content/uploads/2021/04/GINA-2021-Main-Report_FI- NAL_21_04_28-WMS.pdf