This bibliography was prepared for the ICIC Collaborative on Asthma, and it includes clinical trials on asthma management, behavioral and self-management support literature, as well as publications describing the Chronic Care Model. Links to the National Library of Medicine PubMed citations are provided if the article appears in the NLM online database. 

Articles referencing clinicial guidelines may not reflect current standards.  For up-to-date clinical guidelines, please consult the National Guideline Clearinghouse (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality.
Fuhlbrigge AL, Adams RJ, Guilbert TW, Grant E, Lozano P, Janson SL, Martinez F, Weiss KB, Weiss ST. The burden of asthma in the United States: level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines. Am J Respir Crit Care Med. 2002 Oct 15;166(8):1044-9. [Link]
This large cross-sectional survey highlights the relative prevalence of persistent asthma. Classification according to the guidelines depends on the exact method used.

NHLBI NEP. Guidelines for the diagnosis and management of asthma: highlights of the expert panel. Report 2 NIH Pub No. 97-4051A. Guidelines for the Diagnosis and Management of Asthma: Highlights of the Expert Panel. Report 2 NIH Pub No. 97-4051A 1997; 1-153. [Link N/A]

This largely evidence-based report is the foundation of current asthma care. Figures and tables on severity classification and controller choice are suitable for dissemination.

Wolfenden LL, Diette GB, Krishnan JA, Skinner EA, Steinwachs DM, Wu AW. Lower physician estimate of underlying asthma severity leads to undertreatment. Arch Intern Med 2003; 163(2):231-6. [Link]

Accurate and current severity assessment is a key first step in appropriate management.

Yeatts K, Davis KJ, Sotir M, Herget C, Shy C. Who gets diagnosed with asthma? Frequent wheeze among adolescents with and without a diagnosis of asthma. Pediatrics 2003; 111(5 Pt 1):1046-54. [Link]

Undiagnosed frequent wheezing may lead to under-treatment of asthma in adolescents.
Agertoft L, Pedersen S. Bone mineral density in children with asthma receiving long-term treatment with inhaled budesonide. Am J Respir Crit Care Med 1998; 157(1):178-83. [Link]
Three to six years of treatment with inhaled budesonide does not appear to diminish bone mineral density in children.

Chou KJ, Cunningham SJ, Crain EF. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch Pediatr Adolesc Med 1995; 149(2):201-5. [Link]

Metered-dose inhalers with spacers are as effective as nebulizers in treatment of acute asthma in children.

de Benedictis FM, Teper A, Green RJ, Boner AL, Williams L, Medley H. Effects of 2 inhaled corticosteroids on growth: results of a randomized controlled trial. Arch Pediatr Adolesc Med 2001; 155(11):1248-54. [Link]

Fluticasone may be more effective than beclomethasone for long-term treatment of childhood asthma and has similar rates of adverts events.

Diette GB, Wu AW, Skinner EA et al. Treatment patterns among adult patients with asthma: factors associated with overuse of inhaled beta-agonists and underuse of inhaled corticosteroids. Arch Intern Med 1999; 159(22):2697-704. [Link]

Incorrect use of asthma medication is common among adults. Overuse of inhaled beta-agonists may be caused by symptom severity. Underuse of corticosteroids is associated with lower symptom severity.

Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA 1997; 277(11):887-91. [Link]

Controllers, especially inhaled steroids, are associated with lower asthma hospitalization rates in this retrospective cohort study.

Ducharme FM. Inhaled glucocorticoids versus leukotriene receptor antagonists as single agent asthma treatment: systematic review of current evidence. BMJ 2003; 326(7390):621. [Link]

This systematic review of randomized controlled trials found inhaled glucocorticoids to be more effective than leukotriene receptor antagonists in adults.

Ducharme FM, Chabot G, Polychronakos C, Glorieux F, Mazer B. Safety profile of frequent short courses of oral glucocorticoids in acute pediatric asthma: impact on bone metabolism, bone density, and adrenal function. Pediatrics 2003; 111(2):376-83. [Link]

This retrospective study found no difference in bone density among children who were and were not exposed to bursts of oral glucocorticoids.

Finkelstein JA, Lozano P, Farber HJ, Miroshnik I, Lieu TA. Underuse of controller medications among Medicaid-insured children with asthma. Arch Pediatr Adolesc Med. 2002 Jun; 156(6):562-7. [Link]

This cross-sectional survey found widespread underuse of controllers. Risk factors for underuse include lower parental education and racial minority. Action plans and outpatient care appeared to be protective.

Haahtela T, Jarvinen M, Kava T et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994; 331(11):700-5. [Link]

This trial of 74 patients supports early treatment and sustained treatment with inhaled budesonide.

Jones A, Fay JK, Burr M, Stone M, Hood K, Roberts G. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002; (1):CD003537. [Link]

This is a systematic review of bone metabolism effects of inhaled corticosteroids in asthma and COPD.

Kamps AW, van Ewijk B, Roorda RJ, Brand PL. Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol 2000; 29(1):39-42. [Link]

This evaluation of children’s inhalation technique revealed numerous deficiencies, even after instruction.

Lozano P, Finkelstein JA, Hecht J, Shulruff R, Weiss KB. Asthma medication use and disease burden in children in a primary care population. Arch Pediatr Adolesc Med. 2003 Jan; 157(1):81-8. [Link]

This cross-sectional study documents overuse of relievers and underuse of controllers in a managed care population.

Lynd LD, Guh DP, Pare PD, Anis AH. Patterns of inhaled asthma medication use: a 3-year longitudinal analysis of prescription claims data from British Columbia, Canada. Chest 2002; 122(6):1973-81. [Link]

This large population-based study found decreasing use of inhaled corticosteroids. 

O'Byrne PM, Barnes PJ, Rodriguez-Roisin R et al. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 2001; 164(8 Pt 1):1392-7. [Link]

 This trial examines adding formoterol to a budesonide regiment.

Pauwels RA, Pedersen S, Busse WW et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet 2003; 361(9363):1071-6. [Link]

This randomised trial shows improved asthma control and reduced exacerbations in patients with mild persistent asthma.

Spooner CH, Saunders LD, Rowe BH. Nedocromil sodium for preventing exercise-induced bronchoconstriction. Cochrane Database Syst Rev 2002; (1):CD001183. [Link]

This systematic review supports the use of nedocromil in exercise-induced bronchoconstriction.

van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, Duiverman EJ, Pocock SJ, Kerrebijn KF. Effects of 22 months of treatment with inhaled corticosteroids and/or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. The Dutch Chronic Non-specific Lung Disease Study Group. Am Rev Respir Dis 1992; 146(3):547-54. [Link]

This multi-center randomized controlled trial evaluates the effect of long-term budesonide treatment. Outcomes include a variety of pulmonary function parameters.

Corren J, Adinoff AD, Buchmeier AD, Irvin CG. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma. J Allergy Clin Immunol 1992; 90(2):250-6. [Link]
This small trial suggests that nasal steroids reduce bronchial responsiveness to pollen in patients with both asthma and allergic rhinitis.

Watson WT, Becker AB, Simons FE. Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness. J Allergy Clin Immunol 1993; 91(1 Pt 1):97-101. [Link]

This small study suggests a benefit from nasal steroids in terms of asthma clinical scores in patients with comorbid allergic rhinitis.
Smoking Avoidance
Hovell MF, Meltzer SB, Wahlgren DR et al. Asthma management and environmental tobacco smoke exposure reduction in Latino children: a controlled trial. Pediatrics 2002; 110(5):946-56. [Link]
Coaching to reduce environmental tobacco smoke appears to enhance asthma management education.

Precht DH, Keiding L, Madsen M. Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study. Pediatrics 2003; 111(5 Pt 1):E562-8. [Link]

Danish teens with asthma appear to smoke more than their peers in this national cross-sectional study.

Winickoff JP, Hillis VJ, Palfrey JS, Perrin JM, Rigotti NA. A smoking cessation intervention for parents of children who are hospitalized for respiratory illness: the stop tobacco outreach program. Pediatrics 2003; 111(1):140-5. [Link]

A smoking cessation program for parents of children hospitalized for respiratory illness was feasible and well accepted by participants.
Effectiveness of routine self monitoring of peak flow in patients with asthma. Grampian Asthma Study of Integrated Care (GRASSIC). BMJ 1994; 308(6928):564-7. [Link]
This randomized trial failed to demonstrate a benefit to routine peak flow monitoring.

Bailey WC, Richards JM Jr, Brooks CM, Soong SJ, Windsor RA, Manzella BA. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med 1990; 150(8):1664-8. [Link]

This self-management program for adults with asthma appears to enhance adherence and functional status.

Clark NM, Evans D, Zimmerman BJ, Levison MJ, Mellins RB. Patient and family management of asthma: theory-based techniques for the clinician. J Asthma 1994; 31(6):427-35. [Link]

This paper explores health behavior constructs in asthma care. 

Gallefoss F, Bakke PS. How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication? Am J Respir Crit Care Med 1999; 160(6):2000-5. [Link]

This patient education program had differential effects on adherence to steroid inhalers in adults with asthma and COPD.

Gibson PG, Powell H, Coughlan J et al. Limited (information only) patient education programs for adults with asthma. Cochrane Database Syst Rev 2002; (2):CD001005. [Link]

This systematic review shows limited benefit of information-only programs.

Gibson PG, Powell H, Coughlan J et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2003; (1):CD001117. [Link]

This systematic review of education programs that teach self-management skills found beneficial effects on health outcomes in adults, especially when written action plans are used.

Haby MM, Waters E, Robertson CF, Gibson PG, Ducharme FM. Interventions for educating children who have attended the emergency room for asthma. Cochrane Database Syst Rev 2001; (1):CD001290. [Link]

This systematic review fails to find clear evidence of benefit from asthma education in the emergency department.

Ignacio-Garcia JM, Gonzalez-Santos P. Asthma self-management education program by home monitoring of peak expiratory flow. Am J Respir Crit Care Med 1995; 151(2 Pt 1):353-9. [Link]

This randomized controlled trial found improved outcomes among patients who engaged in long-term peak flow monitoring.

Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics 2003; 111(3):503-10. [Link]

This randomized controlled trial describes a multimedia home management system for children with asthma.

Lieu TA, Quesenberry CP Jr, Capra AM, Sorel ME, Martin KE, Mendoza GR. Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits [see comments]. Pediatrics 1997; 100(3 Pt 1):334-41. [Link]

This case controlled study identified written care plans as a factor associated with reduced risk of acute asthma events.

Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev 2003; (1):CD004107. [Link]

This systematic review found equivalent effects for symptom-based and peak flow based monitoring.

Thoonen BP, Schermer TR, Van Den Boom G et al. Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial. Thorax 2003; 58(1):30-6. [Link]

 This randomised trial of a peak flow based monitoring program showed mixed results.

Toelle BG, Ram FS. Written individualised management plans for asthma in children and adults. Cochrane Database Syst Rev 2002; (3):CD002171. [Link]

This systematic review failed to find firm evidence of the effect of written case plans.

Wolf FM, Guevara JP, Grum CM, Clark NM, Cates CJ. Educational interventions for asthma in children. Cochrane Database Syst Rev 2003; (1):CD000326. [Link]

Self-management education programs for children appear to be effective.
Decision Support
Zeiger RS, Heller S, Mellon MH, Wald J, Falkoff R, Schatz M. Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. J Allergy Clin Immunol 1991 Jun; 87(6):1160-8. [Link]
This controlled trial found that facilitated referral to an asthma specialist from the emergency department reduced return visits to the emergency department.

Delivery System Design
Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of Integrated Care (GRASSIC). BMJ 1994; 308(6928):559-64. [Link]
This randomized controlled trial of a multifaceted intervention with formal assessment, planned visit and decision support failed to demonstrate a benefit in adults with asthma.

Fay JK, Jones A, Ram FS. Primary care based clinics for asthma. Cochrane Database Syst Rev 2002; (1):CD003533. [Link]

There is limited evidence to support use of primary care based asthma clinics; a dearth of studies in this area was found.

Kropfelder L. A case management approach to pediatric asthma. Pediatr Nurs 1996; 22(4):291-5. [Link]

An asthma nurse describes her multifaceted asthma program. [See comments].
Lozano P, Finkelstein JA, Carey VJ, Wagner EH, Inui TS, Fuhlbrigge AL, Soumerai SB, Sullivan SD, Weiss ST, Weiss KB. A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. Arch Pediatr Adolesc Med. 2004 Sep;158(9):875-83. [Link]

Moullec G, Gour-Provencal G, Bacon SL, Campbell TS, Lavoie KL.Respir Med. Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: impact of using components of the chronic care model. 2012 Sep;106(9):1211-25. Epub 2012 Jul 5. [Link]

Pinnock H, Bawden R, Proctor S et al. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ 2003; 326(7387):477-9. [Link]

Telephone consultation was found to be as effective and more efficient than face-to-face visits for follow-up of adults with asthma in this randomised controlled trial.

Zorc JJ, Scarfone RJ, Li Y et al. Scheduled Follow-up After a Pediatric Emergency Department Visit for Asthma: A Randomized Trial. Pediatrics 2003; 111(3):495-5022. [Link]

This randomized trial to enhance follow-up after emergency department visits found many barriers to follow-up. Follow-up was enhanced for children for whom an appointment was made.

Systems of Care
Greineder DK, Loane KC, Parks P. A randomized controlled trial of a pediatric asthma outreach program. J Allergy Clin Immunol. 1999 Mar; 103(3 Pt 1): 436-40. [Link]
Asthma case management decreased resource use in children with asthma in this randomized trial.

Heinrich P, Homer CJ. Improving the care of children with asthma in pediatric practice: the HIPPO project. Helping Improve Pediatric Practice Outcomes. Pediatr Ann 1999; 28(1):64-72. [Link]

The HIPPO project demonstrates the use of quality improvement principles in improving asthma care in a primary care pediatric clinic.

Lozano P, Lieu TA. Asthma in managed care. Pediatr Ann 1999; 28(1):74-80. [Link]

Asthma programs in managed care use many elements of the Chronic Care Model. 

Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma [see comments]. Ann Intern Med 1990; 112(11):864-71. [Link]

This randomized trial of an intensive education program for adults reduced readmissions.

Wissow LS, Warshow M, Box J, Baker D. Case management and quality assurance to improve care of inner-city children with asthma. Am J Dis Child 1988; 142(7):748-52. [Link]

This before-after study shows promise for interventions using case management and quality assurance technique in inner-city children with asthma.

Butz AM, Malveaux FJ, Eggleston P et al. Use of community health workers with inner-city children who have asthma. Clin Pediatr (Phila) 1994; 33(3):135-41. [Link]

This home-visiting program trained lay members of the community to do asthma outreach.

Evans R 3rd, Gergen PJ, Mitchell H et al. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. J Pediatr. 1999; 135(3):332-8. [Link]

This study found improved health outcomes in children served by an asthma counselor. This intervention differs from others in that the counselors were MSW-trained.

Stout JW, White LC, Rogers LT et al. The Asthma Outreach Project: a promising approach to comprehensive asthma management. J Asthma 1998; 35(1):119-27. [Link]

This paper describes the experience of a clinic serving a low-income African-American community following the implementation of a multi-level asthma program that incorporated a community health worker (lay), a registry and planned asthma visits.  
Socioeconomic Factors
Crain EF, Kercsmar C, Weiss KB, Mitchell H, Lynn H. Reported difficulties in access to quality care for children with asthma in the inner city. Arch Pediatr Adolesc Med 1998; 152(4):333-9. [Link]
This cross-sectional study reports on the various barriers to acute and chronic asthma care, including medication, experienced by inner city families.

Eggleston PA, Malveaux FJ, Butz AM et al. Medications used by children with asthma living in the inner city. Pediatrics 1998; 101(3 Pt 1):349-54. [Link]

This cross-sectional study finds that inner city children with asthma use fewer asthma medications, particularly controllers.

Evans D, Mellins R, Lobach K et al. Improving care for minority children with asthma: professional education in public health clinics . Pediatrics 1997; 99(2):157-64. [Link]

This quasi-randomized trial found that a clinic-level intervention improved processes of care for children with asthma in public health clinics. [See comments]

Riekert KA, Butz AM, Eggleston PA, Huss K, Winkelstein M, Rand CS. Caregiver-physician medication concordance and undertreatment of asthma among inner-city children. Pediatrics 2003; 111(3):E214-20. [Link]

In separate interviews, parents of children with asthma and their providers often disagreed as to whether a controller was prescribed. This disagreement contributes toward patient non-adherence and suggests that communication between the provider and the patient/parent should be a focus of interventions to enhance patient adherence to controllers.

Bibliography Editor
Paula Lozano, M.D., M.P.H.
Dr. Lozano is an Associate Investigator at the Group Health Research Institute and an Associate Professor of Pediatrics at the University of Washington. She received her M.D. from Harvard Medical School and completed a Pediatrics Residency and M.P.H. at the University of Washington. Dr. Lozano's research focuses on evaluating and improving the quality of care delivered to children in outpatient settings. She was a faculty member for the asthma portion of BTS 3, and provides scientific input in research work associated with ICIC. Dr. Lozano practices pediatrics and teaches residents at Harborview Medical Center.