Because even mild asthma among young inner-city children appears to be more unpredictable than ever, four or more check-ups a year after diagnosis is a wise move as a hedge against dangerous flare-ups of wheezing and trips to the emergency room, according to a study from the Johns Hopkins Children's Center.
Current asthma guidelines call for follow-up of one to six months after diagnosis, but six months may be too long for many patients, researchers report in the November issue of Pediatrics.
Hopkins Children's researchers studied 150 Baltimore City asthmatic children 2 to 6 years of age and were “surprised” to find that nearly half of those with the mildest asthma at their first visit had worsening symptoms as early as three months later. The changes were so serious that they required either new drugs or new doses.
“We know asthma is an unstable disease, but we underestimated just how unpredictably it could behave over time, especially in inner-city kids,” said researcher Hemant Sharma, M.D., a pediatric allergist at Hopkins Children's. “Doctors and parents need to be more vigilant and schedule at least three-month check-ups even if the child appears to be doing fine.”
The findings also suggest that pediatricians should shift their focus away from disease severity at diagnosis to disease control.
“Asthma control appears to be a better barometer of a child's risk for a flare-up than is initial assessment of symptoms, a staple that many doctors use as their yardstick for treatment and follow-up,” said lead investigator Gregory Diette, M.D., M.H.S., a lung specialist at the Johns Hopkins School of Medicine.