Tina is 5 years old and presents to the emergency department with a 2-day history of coryza and cough with intermittent low-grade fever. She developed an audible wheeze and respiratory distress that was initially responsive to albuterol via a pressurized metered-dose inhaler and small-volume spacer. However, symptoms have recurred within 2 hours of albuterol administration. On exam, she is in visible respiratory distress with a respiratory rate of 40 breaths per minute and has accompanying accessory muscle use. Her oxygen saturations are 92% in room air, and on auscultation of her chest there is widespread polyphonic wheeze and equal air entry. She has an audible moist cough. After discharge she follows up with her primary care physician to review her asthma symptoms and medications.1

Which Asthma Quality Measures Count for Stage 1 2013 Meaningful Use?

• Asthma Assessment (NQF# 0001)
• Asthma: Pharmacologic Therapy (NQF# 0047)
• Use of Appropriate Medications for People with Asthma (NQF# 0036)

Which Asthma Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

• Use of Appropriate Medications for People with Asthma (NQF# Not Applicable; CMS126v5)

Measuring & Improving Asthma Status: A Real Impact on Your Patients

• A double-blind study that followed use of the inhaled corticosteroid budesonide to treat mild persistent asthma in patients over 5 years found those who used budesonide:2
  • Were significantly less likely to require long acting beta agonists (9.3% vs. 6.3%)
  • Had 0.61 times the odds of experiencing one or more severe asthma-related event (an emergency intervention or hospitalization over the 5 years
• A cross-sectional survey of 2,429 children aged 4-17 years across 20 pediatric practices found:3
  • An overall weighted prevalence of 46% for uncontrolled asthma symptoms
  • Occurrence of one or more asthma exacerbation (including an ED visit or hospitalization) in the previous 12 months was higher in children with uncontrolled asthma compared with children with controlled asthma (50% vs. 33%)
  • More children with uncontrolled asthma had missed 1 or more school day in the previous 4 weeks (67% vs. 29%)
• A double blind placebo-controlled study found that of 306 randomized patients, those who took nedocromil sodium or cromolyn sodium had:4
  • Significant improvement in asthma severity within 2 weeks of treatment as compared with placebo. (P<0.001)

Conclusion

Assessing and managing Tina's asthma symptoms can help her breathe easier, avoid visits to the hospital, and significantly improve her quality of life. Even for mild persistent disease, doing an assessment to formally classify asthma then using appropriate controller medication makes a difference.

Clinical Quality Measure Information