By Dr. Paul Ehrlich
A study in the Netherlands concludes that “stable childhood asthma managed by an asthma nurse is not inferior to traditional management by primary or secondary care physicians.”
This should surprise no one. For the fact is that “stable childhood asthma” can be routinely managed at home without much in the way of medical intervention. That’s why we give our patients an Asthma Action Plan and a peak-flow meter in addition to a prescription. I don’t know much about the health care system in Holland, although it’s surely more orderly and socialized than it is here. This study mentions relying on a hospital-based nurse. That’s a big difference—hospital-centered treatment in this country is often highly bureaucratic and expensive; the fact that emergency rooms are de facto community health centers is a scandal. I can only surmise that Dutch hospitals may serve as community health centers.
But returning to the fact that management doesn’t require an MD, there is no magic here. “Stable childhood asthma” is only unmanageable if it’s unmanaged. Does regular oversight, provided by a qualified professional, help? Yes. It reinforces the message. And a periodic look by a nurse can serve as an early warning system about changes in either compliance or in the efficacy of a treatment regimen, which does happen. But you don’t have to send a Toyota back to the factory for oil changes, and you don’t have to call in an MD or a specialist to manage stable asthma. I wish we had more asthma nurses here, asthma counselors, and just plain conscientious, informed Moms, Dads, and patients. It would pay for itself over and over. By one estimate, 58% of asthma is uncontrolled. Way too many.