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In reply
We appreciate Dr Weinberger's interest in our study. We agree with his conclusion that more effective outpatient management of children with severe asthma can be expected to decrease excessive asthma morbidity. Furthermore, we believe that coordinated management that involves families, primary care providers, specialists, schools, and other child care providers will best meet the needs of children with asthma. While the involvement of specialists is an important component, increased education and awareness for all persons responsible for the care of children with asthma is necessary.
Since the time of this study, our institution has implemented a critical pathway for children hospitalized for asthma. The pathway provides consistent direction for the treatment of such children including indications for specialty referral, contact with respiratory therapists, patient and family education, and nursing assessment and intervention. Early findings indicate that the pathway decreases the length of stay and β-agonist medication use without adverse outcomes in the first 2 weeks following hospitalization.1
More hospitals may adopt critical pathways if further studies report favorable outcomes and reduced costs. In the meantime, our study identifies select groups of children who may benefit from individual case management, including the use of referrals to specialists when indicated. The references Dr Weinberger provided regarding the effectiveness of asthma management directed by specialists were of particular interest. However, their generalizability to the population addressed by our study may be limited, as some of these studies focused on adults,2 - 4 non-US populations,2 or had a small sample size (N = 26).5 The important issue is not whether generalists or specialists should direct the care of children with asthma. Rather, we should focus on identifying the content and quality of the care provided and whether the needs of children and families are being met.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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