Background/ Why Is This Important?
Pediatric asthma has been identified as a significant health issue in British Columbia (BC). It is the most common chronic disease impacting children and is a leading cause of missed school days and hospital visits.1 As there is no known cure for asthma; efforts are focused on the delivery of timely and appropriate management strategies to minimize the individual and community level impacts. Children and families can be supported to control their asthma and improve their overall quality of life.2 Provincial level planning allows for a coordinated approach and supports the development of evidence informed, up to date and accessible resources for all healthcare providers.
Prevalence data for pediatric asthma patients can provide useful information to support planning; however it is important to pay close attention to the specific age groupings and inclusion/exclusion criteria used in each report, as this can differ greatly across data sets. The Canadian Chronic Disease Surveillance System (CCDSS) reported that for the years 2010-2011, the prevalence of asthma in children and youth aged 19 years or less was 15.7%, with an incidence rate of 1141.3 per 100,000. This is considerably higher than the adult population which had a prevalence of 9.0%.3
The Canadian Community Health Survey, in 2010, showed that the prevalence of asthma in BC children aged 12-19 years was 8.8%. This is a decrease from the prevalence rate of 10.2% that was reported in 2005. It is also less than the national average which has remained more consistent at 11.7% (2005) and 11.1% (2010). It is important to note that unlike the CCDSS numbers reported above, the Canadian Community Health Survey excludes children under the age of 12. It also does not sample individuals living on reserves or crown lands. Therefore the prevalence rates do not present the complete picture of asthma prevalence in Canada.4
Recognizing that asthma is an important health issue in BC, Child Health BC (CHBC) and the Guidelines and Protocols Advisory Committee (GPAC) collaborated on the development of a new provincial pediatric asthma guideline. Current asthma guidelines in BC primarily focus on the adult population. This project was an opportunity to identify the care requirements for the pediatric population. In addition, a specific guideline for the diagnosis and management of children aged 1-5 years was identified as a population that had not been covered in previous guidelines. Pediatric guidelines are currently being used across the province; however practitioners are accessing this information from a variety of sources.
What Actions Have Already Been Taken?
Where did this work start? A review of existing national and international asthma guidelines was completed to identify areas of controversy. From this, key clinical questions were identified and an extensive literature review was completed to summarize evidence for recommendations. The evidence was brought forward to a 16 member working group, chaired by Dr. Connie Yang, Respirologist at BC Children's Hospital, which included representation from all of the geographic regions of BC, pharmacy, pediatrics, family practice, health promotion, prevention and primary care, allergy, asthma educator and nurse practitioner disciplines. This group, working closely with the chair and the research officer, through a series of meetings, reviewed evidence, provided feedback and actively participated in the development of the guideline.
Through the GPAC process, an external review of the guideline was completed by asthma providers across the province including physicians, asthma educators and specialists. This extensive external review not only evaluated the guideline but also identified barriers to implementation. This information was used to develop support tools that will be used to facilitate practice change.
Where Are We Now?
The guideline, which was approved by the Medical Services Commission in October 2015, is available on BC Guidelines website: http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/asthma-children
The guideline includes the following practitioner tools: an Asthma Patient Care Flow Sheet; a summary of the Key Recommendations; Patient Care Flow Sheets for Children aged <6 years and 6-18 years; and, Asthma Action Plans for Children aged <6 year and 6-18 years.
See an e-learning module with Dr. Yang and Dr. Tiffany Wong, pediatric allergist ( BC Children's Hospital) which presents 2 case studies that highlights the new guideline and demonstrates how the accompanying resources and tools can support asthma management in the community.
CHBC, together with the BC Health Authorities have also completed a provincial environmental scan of asthma outpatient services for children and youth. The purpose of this scan was to develop a more detailed provincial picture of the current pediatric asthma services, in order to better understand the distribution and delivery of care, and potential facilitators and barriers to accessing services. The scan was also able to identify opportunities for ongoing collaboration and resource development.
It is anticipated that having an evidence-based standardized approach to the diagnosis and management of children with asthma, and the information gathered in the environmental scan will support provincial services planning, which will facilitate earlier and improved care for these children, and their families leading to better health outcomes for children in BC.
- U.S National Library of Medicine. (2012). Asthma-children. Retrieved from (https://www.nlm.nih.gov/medlineplus/ency/article/000990.htm
- World Health Organization. (2013). Asthma fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs307/en/
- Public Health Agency of Canada. (2015). Chronic disease and injury indicator framework. Retrieved from http://infobase.phac-aspc.gc.ca/cdif/
- National Lung Health Framework. (2012). Asthma prevalence in Canada. PowerPoint Presentation. Retrieved from http://asthma.ca/adults/about/AsthmaStatPres.pptx