Evaluation of a program for the pharmacologic management of children with asthma

An evaluation of a program used for the pharmacologic management of asthma was conducted by a retrospective chart review of patients seen by the Pediatric Allergy and Pulmonary Service at the University of Iowa. A scheme for drug selection based on pharmacologic and physiologic principles had been used to determine the medication requirements needed to attain specified therapeutic goals. Explicit criteria, defined prior to the review, were used to confirm the diagnosis, characterize the patients as chronically or intermittently symptomatic, and grade the disease by severity prior to the initiation of therapy. Of the 25 patients with intermittent symptoms, none of the patients with the 2 least severe grades of asthma required more than as-needed bronchodilators for control of symptoms while 80% of the patients in the 2 more severe grades required corticosteroids (p = 0.002). Among the 172 patients with chronic symptoms, a single noncorticosteroid prophylactic drug (usually theophylline in optimal doses) was the final management requirement for nearly 90% of the 27 patients in the 2 least severe grades of chronic asthma, for 70% of 129 patients in grade III, and in only 30% of the 16 patients in grade IV, the most severe grade (p < 0.001). This method for evaluating a pharmacologic management program has implications both for physician education and identification of patients used in drug trials.