Impacts of Community Pediatric Asthma Education Program on Asthma Outcomes in Alberta, Canada.

Abstract

Objective: Asthma affects about 10% of Canadian children, with significant impacts on the healthcare system. This study describes a cohort of children with asthma, exploring outcomes of targeted asthma education through a Community Pediatric Asthma Service (CPAS).

Methods: This retrospective cohort of children aged 1-17 years in Calgary, Alberta with asthma compares those who received CPAS 2016-2019 to the entire cohort. For CPAS recipients, rates of severe asthma exacerbations were evaluated biannually from 12 months before to 24 months after CPAS.

Results: Of 60,555 children with asthma, 3589 attended CPAS. Compared to the 56,966 controls, CPAS attendees were more likely to be male (60.2% vs. 58.4%), approximately 2 years younger at asthma diagnosis, and demonstrate poor asthma control (32.7% vs. 19.1% ED visits in the year following diagnosis). The incidence risk ratio (IRR) for asthma exacerbations for 2 years following CPAS was 0.85 (95% CI: 0.80-0.90). There was a reduction in ED visits (IRR: 0.82; 95% CI: 0.76-0.90) and oral steroid use (IRR: 0.86; 95% CI: 0.80-0.93). CPAS was not associated with reduced hospitalizations for asthma (IRR: 0.91; 95% CI: 0.68-1.22). A subset analysis demonstrated an 18-month decrease in severe exacerbations for CPAS recipients (985) compared to propensity-matched controls (985) that reached significance at 12-18 months with extinction of the positive CPAS effect by 2 years.

Conclusion: A targeted community asthma education service decreased severe exacerbations, with effect retention for at least 18 months. Educating children and their caretakers on asthma management thus provides an opportunity to improve pediatric lung health and should be considered for children at risk of asthma exacerbations.