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Winter, 2012

Asthma Research into Action

A Single Word Can Make a World of Difference

“The difference between the almost right word and the right word is really a large matter—'tis the difference between the lightning-bug and the lightning.”—Mark Twain

Michelle M. Cloutier, M.D., a pediatric pulmonologist at the Asthma Center of the Connecticut Children's Medical Center in Hartford—where novelist Mark Twain once lived—knows firsthand the importance of choosing the right words when creating asthma materials for patients. That is why she and her team field-test their asthma messages, to ensure that patients and families are interpreting them as intended.

Dr. Michelle Cloutier helps patients improve asthma care and control with asthma action plans Dr. Michelle Cloutier helps patients improve asthma care and control with asthma action plans.

As she found out, while testing a draft version of an asthma action plan (AAP), interpretation sometimes hinges upon a single word.

"When we asked our families what an asthma action plan is, they responded that it was a legal document—a document that you use to take legal action against your doctor," said Cloutier. "It was the word 'action' that led to that interpretation."

That's why the Asthma Center now refers to its asthma action plans as asthma treatment plans, instead, and has seen great success with the change.

"What has happened is that repetition of the word 'treatment'—with which patients and families are familiar because it's already used in clinical settings—drives home the point of the plan," said Cloutier.

Trading out one word for another is not the only change that Cloutier’s team made to the Asthma Center’s Asthma Treatment Plan.

They reduced the number of words in the plan to 75.

Why? Because populations that carry the greatest asthma burden often have lower literacy rates.

"Putting too much onto one page is overwhelming if you don't read well," said Cloutier.

Cloutier notes that it is especially important to have easy-to-read instructions with a disease such as asthma, where flare ups can be sudden and time is of the essence.

Easy Breathing

Time is also of the essence for clinicians. To help them easily recognize and treat asthma—and ultimately improve the daily lives of Connecticut's children with asthma—Dr. Cloutier developed a program called Easy Breathing in 1998. The program provides an hour-long free training, as well as a standardized survey and other materials, including the Easy Breathing Asthma Treatment Plan.

Initially developed for clinicians in Connecticut's busy urban clinics, the program is now active in multiple settings across nine states. In Connecticut alone, 450 clinicians at 150 practices participate in it.

Easy Breathing has adopted the National Asthma Education and Prevention Program's (NAEPP) guidelines for determining asthma severity and improving asthma care and control. To gauge whether Easy Breathing is helping clinicians improve asthma outcomes in Connecticut, Dr. Cloutier and Dorothy B. Wakefield, M.S., undertook a study of the program effectiveness. Funded by the State of Connecticut, "Translation of a Pediatric Asthma-Management Program into a Community in Connecticut" examined whether pediatric offices in six Connecticut communities could improve asthma care and control for local children by using the program.

Findings showed that the answer is "Yes." Of the nearly 10,500 children with asthma enrolled in the study from 2002 to 2007, children with persistent asthma experienced decreases in hospitalizations and emergency room visits. There was also a doubling in prescriptions for inhaled corticosteroids, the preferred long-term treatment for controlling persistent asthma. Altogether, 96% of the children with persistent asthma were prescribed anti-inflammatory medication, mainly inhaled corticosteroids. For study details, visit the January 2011 edition of Pediatrics.

As Cloutier notes, however, the responsibility for improving asthma care and control through a written asthma treatment plan (coupled with other key measures) doesn't just rest on the shoulders of the clinician. Patients and caregivers must play an active role.

"What I tell patients and families is to insist on getting the instructions—whatever they may be—in written form, to read them before they leave the office, and to repeat back to the clinicians their understanding of what they just read," said Cloutier. "This will go a long way toward improving asthma care and control."

To find out more, visit the Asthma Center’s Easy Breathing program on the Connecticut Children’s Medical Center’s Web site. You can also download or order your own copy of the NHLBI’s Asthma Action Plan.

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Last Updated February 2012

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