Background: Asthma is one of the leading causes of illness among children in the United States and disproportionately affects racial/ethnic minorities and residents of cities. Factors in the home environment play a major role in effectively managing the condition.

Purpose: This study sought to examine the characteristics of children with asthma who received home care through the Visiting Nurse Service of New York (VNSNY); what triggered their asthma; if their illness was managed according to national guidelines; what kind of health care services they used; the level of knowledge that their family caregivers have about asthma; and whether there were any disparities between children who received care through VNSNY’s charitable care program and those who did not.

Study Design: This retrospective study examined the medical records of 1,007 children in New York City who received home care services from the Visiting Nurse Service of New York in 1999.

Summary Findings:

1. Most children were age five or younger (58%), male (61%), and members of racial/ethnic minority groups (63%). About one-quarter suffered from a variety of other illnesses in addition to asthma.
2. Most asthma triggers (42%) were related to seasonal factors, such as allergies and extreme temperatures. Other factors included dust (41%), cockroaches (35%), stuffed toys (33%), upholstery (28%), cigarette smoke (21%), and perfumes (21%). It appeared that family tensions acted as triggers as well.
3. Seventy-eight percent of children were referred to VNSNY from a hospital (either as an inpatient or through the emergency room) after having received care for an acute episode of asthma. Children received, on average, two home care visits.
4. Most family caregivers lacked adequate knowledge about the symptoms of asthma; what triggers it; and how to manage it, use medications properly, and correctly use asthma equipment.
5. No disparities in care were found between children who received charitable care from VNSNY and those who did not.
6. Data limitations made it difficult to determine whether children received care in compliance with national guidelines.

Conclusions: Most children with asthma who are cared for by VNSNY are young boys who are members of racial/ethnic minority groups, and they receive relatively few home visits for asthma management. They face many environmental triggers of asthma at home, and their family caregivers lack adequate knowledge about how to recognize and manage the disease. Home health care providers have unique opportunities to educate and train family caregivers about how to effectively manage their children’s asthma.

Publications: forthcoming.

Sponsor: The Charitable Care Coordinating Group, VNSNY.