Commentary
Seventeen Years of Asthma Guidelines: Why Hasn't the Outcome Improved for Children?

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Application of the Guidelines

There are several reasons that can be suggested for the paradox of 16 years of authoritative guidelines and the absence of apparent benefit for children with asthma.9 First is the problem of implementing the guidelines in primary care, where most children with asthma receive care.13 A second and related problem is the length and complexity of the EPR, which inhibits effective integration into primary care practice.

Acknowledging that the efficacy of the EPR Guidelines had not been demonstrated

What Should Be Done?

Since the success of asthma care in specialty programs demonstrates the feasibility of improving outcome, an argument can be made that high-risk patients, that is, those who have had a previous history of recurrent urgent care or hospitalizations, should have their subsequent care managed by an asthma care program with a demonstrable track record for successful outcomes. Such programs can be directed by any physician, specialist, or generalist, with an interest and experience in managing

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      In the few pathways that insisted on corticosteroid administration within 60 minutes, adherence to this recommendation is approximately only 40% of targeted children.8,9 Because patients with moderate to severe asthma account for the majority of potentially preventable hospital admissions,10,11 the effect of, and factors associated with, delayed administration of systemic corticosteroids must be specifically explored in these 2 severity groups. The primary objective of this study was to explore in children with moderate and severe asthma the effect of adherence to the recommendation of early administration of systemic corticosteroids on patient health outcomes in the actual setting of a busy pediatric ED.

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    The author declares no external funding or conflicts of interest.

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