Management of Children with Acute Asthma Attack: A RAND/UCLA Appropriateness Approach

Abstract

Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease.

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

“…The benefit of a short course of systemic corticosteroids in school-aged children and adolescents with asthma exacerbation is well established in the literature [ 10 ]. However, this therapeutic approach is widely debated in preschool children with asthma-like symptoms, since the evidence is unclear.…”

“…We set up a multidisciplinary panel of experts that included all the Heads of the Pediatric Units of the Emilia-Romagna Region Italy, the Heads of the outpatient clinics for pulmonology and allergology, a sample of primary care pediatricians (identified in each province based on the size of the pediatric population according to ISTAT 2018 data) and a patients’ association (Respiro Libero, Parma, Italy). This study group (named Emilia-Romagna Asthma Study Group and described in detail in a previous publication on management of children with acute asthma attack [ 10 ]), included members with previous experience in the development of documents and recommendations with the Grading of Recommendations Assessment, Development, and Evaluation [ 11 , 12 ].…”

Clinical practice guideline adaptation for risk-based caries management in 18–55 year-old Iranian adults

“…Regarding the AGREE II appraisal checklist, the cut-off points for acceptance were set based on previous similar studies [ 39 , 60 ]. The RAND-UCLA appropriateness method was preferred to informal consensus or classic Delphi since it offers a more systematic and reproducible approach [ 61 – 63 ].…”

Risk Factors Affecting Development and Persistence of Preschool Wheezing: Consensus Document of the Emilia-Romagna Asthma (ERA) Study Group

“…We set up a multidisciplinary panel of experts that included all the Heads of the Paediatric Units of Emilia-Romagna Region, Italy, the Heads of the outpatient clinics for pulmonology and allergology, a sample of primary care paediatricians (identified in each province based on the number of the paediatric population according to ISTAT 2018 data) and a patients’ association (Respiro Libero, Parma, Italy). This study group (named Emilia-Romagna Asthma Study Group and described in detail in a previous publication on the management of children with acute asthma attacks [ 8 ] included members with previous experience in the development of documents and recommendations with the Grading of Recommendations Assessment, Development, and Evaluation [ 9 , 10 ].…”