U.S. News & World Report 2011-12 edition of “Best Children’s Hospitals” ranks pediatric pulmonology care at Nemours/Alfred I. duPont Hospital for Children among the best in the country.
Nemours Pediatric Pulmonology Ranks Among the Best
Asthma Resources for Families
Find valuable resources on asthma - including links to articles from Nemours KidsHealth.org, national and regional organizations, patient handouts, and more.
Asthma
Asthma is generally a chronic (long-term) disease that makes breathing difficult when parts of a child’s airway become swollen and inflamed, and may be plugged with thick mucus. Asthma is the number-one reason kids miss school and the number-one reason they visit hospital emergency departments.
At Nemours, we treat nearly 30,000 children with asthma each year. Our teams – comprised of pulmonologists, allergists, pediatricians, nurse practitioners, respiratory therapists, and nurses – can make an initial diagnosis of asthma and provide the care children need to successfully manage the disease. We can also provide hospital care if that is required.
Making an initial diagnosis of asthma includes obtaining a complete medical and family history, and performing a comprehensive physical examination. Testing is individualized and may include a chest X-ray and pulmonary function testing to see how well the lungs are working, and allergy testing.
After the diagnosis is made, good asthma care requires continuous effort at home and in school. We spend lots of time with children and families one-on-one and in groups to teach them about the disease and how to use their medications. Our primary goal is to minimize the symptoms of asthma and help children and families to reduce the number of times they’ll need to go to the hospital for emergency care.
An important part of our program involves detecting and treating under-diagnosed asthma so that children receive a correct care plan and can improve their quality of life. We strive to minimize the side effects of asthma medications, prescribing the least amount of medication needed to control symptoms and prevent asthma flare-ups. We will also address any underlying medical conditions that may contribute to asthma.
For children with mild to moderate asthma, we work toward the goals of keeping them symptom free and able to participate in sports and other activities. For children with moderate to severe asthma, our goals are to keep them out of the hospital and to help them be consistent in taking their medications and sticking to their personalized treatment plan (also known as an “asthma action plan”).
Communication is central to that process, and we work to build close relationships with our patients and families. Additionally, all of your child’s Nemours caregivers, and many primary care doctors, will have “real-time” access to information about your child’s asthma management plan and any medical care your child receives through our electronic medical record system, NemoursOne.
Nemours’ Top-Notch Asthma Plan of Care
As experts in asthma care, at Nemours we know that the condition is the No. 1 reason why kids miss school and visit hospital emergency departments each year. At Nemours/Alfred I. duPont Hospital for Children, our goal is to provide the treatment and guidance both you and your child need to successfully manage the disease—and avoid asthma emergencies.
Part of that goal is offering top-notch preventive care and education—making sure that if children do have to be hospitalized for asthma that they don’t need to be admitted to the hospital again within a certain time frame (this is called “readmission”). That means we send families home with the tools and knowledge they need to keep kids from having additional, often preventable asthma attacks. And we track how we’re doing by looking at the number of kids who are readmitted for asthma within 7 days (a week) or 30 days (a month) after they stayed with us overnight.
What we’ve found: Very, very few of the children with asthma who are admitted here end up coming back again within a week—just two children were readmitted within 7 days in 2008 and eight in 2009 (a year when many hospitals saw an increase in asthma hospital admissions and readmissions because of the H1N1 flu virus).
And, over time, we’re getting better and better at keeping our asthma readmissions down. From 2007 to 2009, less than 1% (.91%, to be exact) of our asthma patients had to come back to the hospital overnight within a week after being admitted. By the first half of 2010, we had absolutely no readmissions—versus the .31% national average of other children’s hospitals.
We’re also proud to say that in the first half of 2010 we were able to keep our asthma readmission rates almost nonexistent at both 1 week and 1 month. From January through June 2010 we had zero readmissions within 7 days and only one within 30 days.
Plus, all of the children with asthma who are admitted to duPont Hospital for Children receive the nationally recommended medications for treatment of acute asthma (that is, “asthma flare-ups”—also known as “asthma attacks”). In fact, we help set the standards when it comes to asthma medicines—Nemours was instrumental in bringing this medication use into the national forefront as a guideline.
How We Do It
To keep kids from having to come back to the hospital—whether that means our emergency room or having to stay overnight—we put a lot of effort into encouraging an asthma “Plan of Care” after hospitalization.
Our asthma care team—pulmonologists, allergists, pediatricians, nurse practitioners, respiratory therapists, and nurses—adhere to evidence-based national standards for asthma management. For starters, each child gets a thorough assessment about their asthma symptoms and environmental triggers.
Every child—and their family—also receives comprehensive asthma education during the visit from a respiratory therapist. We make sure kids with asthma and their parents understand how:
- asthma affects the body
- to keep symptoms under control
- to manage triggers and symptoms
- asthma medicines work when used the right way—and regularly
Plus, we ensure that children go home with the supplies that they need (like spacers and nebulizers). And we make sure that children are discharged only when both the treating team and the parent mutually agree that the child is stable enough for the condition to be managed at home.
To reduce or prevent asthma flare-ups and hospital visits, we strive to have each child discharged with a personalized, written “asthma action plan” (or “asthma management plan”) to keep your child healthy not just today, but every day.
Keeping Asthma in Check at Home
Of course, no matter where a child with asthma is treated or admitted, no health care professional or health system can prevent all asthma attacks from happening once the child is sent home. Although every parent and guardian whose child is hospitalized with us is given instructions on what to do after their child is released from the hospital, some may not stick to the plan after discharge.
In order to keep kids with asthma from experiencing asthma attacks, it’s always important to:
- Keep children with asthma out of daycare for the recommended 2 to 3 days after being discharged from the hospital.
- Fill and refill all prescription medications—including rescue and controller medicines—and use them exactly as directed.
- Stop smoking in the home, car, or anywhere around children with asthma.
- Keep children’s triggers in mind (like dust mites and pets) and try to reduce or eliminate their exposure as much as possible.
Sticking to your child’s asthma care plan and avoiding known triggers can help you take control of your child’s condition—and keep it from getting worse. Whether your child is being taken care of at our hospital or at home, we’ll treat your child as if they were our own and help your family do whatever it takes to avoid asthma emergencies.
Learn More
Get information about our comprehensive, top-quality asthma care at Nemours.
Learn all about asthma from Nemours’ experts at KidsHealth.org:
The Nemours Research Lung Center uses progressive diagnostic and therapeutic procedures and techniques in its quest to help ease the work of breathing for infants and children challenged by acute and chronic lung disease. The Center takes a proactive role in developing and fostering opportunities for research in neonatal and pediatric lung disease.
The Center includes specialized respiratory testing provided by the Nemours Non-Invasive Pulmonary Evaluation Laboratory (NIPEL), useful in the diagnosis of respiratory disease. The Center frequently collaborates with the departments of Pulmonology, Orthopedics, Pediatric Critical Care, Bone Marrow Transplant, Cardiology and Neonatalogy.
Members of Nemours Center for Clinical Pediatric Pharmacology and Center for Pharmacogenetics are leading efforts for the Nemours Asthma Clinical Research Center (ACRC), one of 20 American Lung Association-sponsored clinical centers across the U.S. The main focus of research within the ACRC network is conducting broad clinical trials to determine the best therapies for people with asthma.
In addition, asthma trials conducted at Nemours have led to three articles published in the prestigious New England Journal of Medicine and have improved the care for asthmatics worldwide.
For children with asthma, Nemours researchers offer an advanced program dedicated to understanding asthma and providing advanced clinical care. Our research nurses, coordinators and study physicians provide in-depth one-on-one attention to our research participants to better understand the disease. Our scientists are also expanding the understanding of some types of asthma related to obesity and nutrition.
Obesity and Asthma Research
Obesity in children increases both the risk for developing new asthma and for making existing asthma harder to manage. Nemours is conducting several investigator-originated studies funded though the Nemours Foundation and from external agencies to learn more about both of these important scientific questions.
Research studying the impact of nutrition on asthma control - Recent research suggests that diet can influence inflammation within the body and may impact asthma. Children with asthma may have low levels of antioxidants within the body and this may contribute to asthma symptoms. Nemours is studying the impact of dietary supplements such as antioxidant vitamins and omega-3 fatty acids on the control of asthma symptoms.
The Nemours Aerosol Research Laboratory in Orlando was founded in 1999 to evaluate delivery of inhaled therapies. The delivery of drugs directly to the lungs by the inhaled route improves efficacy and reduces side effects for treatment of lung diseases such as asthma.
Nemours Aerosol Research Lab and Clinical Studies include:
- In vitro assessment of the aerosol characteristic of TOBI® and Pulmozyme® delivered by the sidestream plus and PARI LC PLUS Nebulizers, sponsored by Philips.
We also have an active asthma clinical research program for children:
- Our team is affiliated the American Lung Association’s Asthma Clinical Research Centers Network (ACRC). The ACRC promotes clinical research and advances in asthma care for children, adolescents, and adults among diverse populations. Nemours Children’s Clinic, Jacksonville, has been a leading site for both recruitment and scholarly activity. Asthma trials conducted at Nemours have led to three articles published in the prestigious New England Journal of Medicine and have improved the care for children with asthma all over the world.
- We are conducting several investigator-originated studies funded though the Nemours Foundation and other external agencies to learn more about the way obesity in children increases both the risk for developing new asthma and for making existing asthma harder to manage.
- Because recent research suggests that diet can influence inflammation in the body and may affect asthma, we are studying the impact of nutrition on asthma control. Children with asthma may have low levels of antioxidants and this may contribute to asthma symptoms. Nemours is studying the impact of dietary supplements, such as antioxidant vitamins and omega-3 fatty acids, on the control of asthma symptoms.