Interprofessional Pulmocheck care pathway: An innovative approach to managing pediatric asthma care in the Netherlands

Figures & data

Figure 1. Flow chart Pulmocheck Asthma Care Pathway.

Table 1. Baseline patient characteristics. (N = 121).

Characteristic	Frequency	Not mentioned
5–9 years	62 (51.2%)
10–14 years	50 (41.3%)
15–17 years	9 (7.4%)
Men	65 (53.7%)
Women	56 (46.3%)
Shortness of breath	88 (72.7%)
Coughing	95 (78.5%)	1 (0.8%)
Wheezing	56 (46.3%)	3 (2.5%)
History of allergy	50 (41.3%)	35 (28.9%)
History of eczema	55 (45.5%)	5 (4.1%)
Smoking parents	35 (28.9%)
Pets	69 (57.0%)
Short-acting β2-sympathomimetics	71 (58.7%)
ICS	25 (20.7%)
Combined medications	15 (12.4%)
Antihistamine	18 (14.9%)
Corticosteroid nasal spray	12 (9.9%)

Table 2. Diagnoses established at Pulmocheck care pathway (N = 121).

Diagnosis	Frequency	Percentage
Asthma (all)	72	59.5
Allergic asthma	47	65.3
Non-allergic asthma	16	22.3
Exercise-induced asthma	4	5.6
Asthma combining two of the above	5	6.9
Asthma with co-morbidity	58	47.9
Asthma with one other diagnosis	52	89.7
Asthma with two other diagnoses	6	10.3
No asthma	49	40.5
One new diagnosis	32	65.3
Two new diagnoses	8	16.3
No diagnosis	9	18.4

Note. The italicized numbers and percentages are based on the bold above frequency.

Other or new diagnoses were for example: Allergy, tonsil/adenoid hypertrophy, faulty breathing technique, vocal cord dysfunction, nasal hyperreactivity, post-viral cough, tic or restrictive pulmonary impairment.

Table 3. Medication changes in subgroups with diagnosed asthma versus no asthma and with regard to receiving respiratory medication or not prior to the Pulmocheck (N = 121).

	Asthma +Rmed^** +(N = 54)	Asthma +Rmed^** −(N = 18)	Asthma −Rmed^** +(N = 24)	Asthma −Rmed^** −(N = 25)
Advice to changes in medication	39 (72.2%)	18 (100.0%)	14 (58.3%)	6 (24.0%)
Start respiratory medication^*	31 (57.4%)	18 (100.0%)	3 (12.5%)	1 (4.0%)
Short-acting β2-sympathomimetic	9 (16.7%)	9 (50.0%)	1 (4.2%)	1 (4.0%)
ICS	24 (44.4%)	15 (83.3%)	1 (4.2%)	—
Combined medication	3 (5.6%)	1 (5.6%)	1 (4.2%)	—
Other	2 (24.1%)	—	—	—
Stop R medication^*	9 (16.7%)	—	12 (50.0%)	—
Short-acting β2-sympathomimetic	5 (9.3%)	—	4 (16.7%)	—
ICS	2 (3.7%)	—	5 (20.8%)	—
Combined medication	3 (5.6%)	—	5 (20.8%)	—
Change of dose	4 (7.4%)	—	—	—

Note. ^*The italicized numbers and percentages overlap, due to advices for several types of medications per patient. Therefore, they do not add up to 100%.

^** Rmed+ = Respiratory Medications + meaning: already using β2-sympaticomimetic, ICS or combined medication (inhaled corticosteroid/β2-sympaticomimetic). Rmed− = not on respiratory medication.

Table 4. Frequency of follow-up visits with the general practitioner, in children with diagnosed asthma and advice of using ICS or combined medication (N = 42).

		Prior to Pulmocheck ICS or
Frequency of	ICS or combined medication	combined medication
follow-up	(N = 42)	(N = 15)
0	3 (7.1%)	2 (13.3%)
1	29 (69.0%)	13 (86.7%)^**
2	8 (19.0%)	—
3	—
4	2 (4.8%)	—

Note. ^*One patient had the advice to maintain ICS/combined medication, another patient had to switch to another type ICS/combined medicine.

^** Seven patients had the advice to maintain ICS/combined medication, two patients had to start another kind of ICS/combined medication and three patients had to increase the dose/frequency of the current prescribed ICS/combined medication.