Twenty-three million Americans, including over six million children, suffer from asthma, a chronic disease described in Asthma (113.1) in our series on Respiratory Disorders (113).

New asthma guidelines have been released by the U.S. National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP). They emphasize ongoing monitoring and management of the chronic disease through enhanced patient-physician partnerships. Specific recommendations include:

• Asthmatics should be evaluated by physicians every one to six months. This includes all patients, no matter if they are symptom-free.
• Asthma management, which is based on severity, is now a six-step, rather than a four-step, process. Medications are increased during exacerbations and reduced when symptoms diminish.
• Every person with asthma should have a written asthma action plan developed by the healthcare professional in conjunction with the patient himself. It should contain instructions for daily care as well for exacerbations. This information should be shared with family members, teachers, coaches, and others who interact with the asthmatic on a frequent basis.
• All patient educational materials should be developed with consideration for the client’s cultural or ethnic background, literacy level, and language.
• Patients should take an active role in managing their disease.

These new guidelines also highlight the routine use of inhaled corticosteroids as the standard of care for most patients with chronic persistent asthma.

Research has shown, however, that children ages 5 to 11 may respond somewhat differently to medications than adults. Because of this, youngsters in this age range were singled out as a separate category. For them, their symptoms can be managed with a low daily dose of inhaled corticosteroid, rather than combination treatments, such as long-acting beta agonists, required by many adult asthma patients.

According to researchers at the University of Montreal, youngsters, who were born to mothers with minimal education, and in daycare 21 or more hours a hours a week were three times less likely to develop physically aggressive behavior than their homebound peers. Placing these children in daycare before age nine months nearly doubled the effects. On the other hand, when daycare and homebound children of mothers with advanced levels of education were compared, there was no statistical difference in their behaviors.

Although this study suggests a relationship between day care and a lower level of aggression, the rationale for the results has not been scientifically proven. Instead, the scientists only hypothesize that outside care gives at-risk children a structured and nurturing environment which they might not have in their homes. Previous research has suggested that children with mothers and fathers who have less formal education are more likely to be exposed to poor parenting, poverty, low levels of stimulation and a disorganized home and can ultimately lead to problems in adulthood such as unemployment, mental instability and continuing poverty. The sad thing is that the children who are most likely to benefit from care outside their homes were also the least likely to receive it. These issues are discussed in our series on Child Abuse (658) as well as many of our programs on Human Development including Birth to 2 ½ (670) and 2 ½ to 6 Years (620).

Breast cancer is the most common form of cancer in women with more than 178,000 new cases each year. The good news is that the treatment of breast cancer may be changing. According to one study, women treated with less toxic medications had better results than those who received the drug Adriamycin, which has been the standard therapy for years.

Another study noted that gene testing would best determine if chemo would benefit individual women. Oncotype DX, a test that measures the activity of 21 genes and gives a score to predict a woman's risk of recurrence, has been used for several years by physicians to help guide treatment for certain women with early breast cancers, especially those that have not metastasized. Results have shown, after a decade of following patients, that women with low scores gained no benefit from chemo while those with high scores had good results. These findings mean that many women may be treated efficiently without chemotherapy. Although this test is expensive, almost $3,500, many insurance companies are paying for it as chemo is more costly.

In a third study, scientists noted that a three-week course of radiation works just as well as the five-week schedule that is typically given to women after breast-conserving surgery. There no difference in rates of recurrence or survival.

Breast cancer is described in several series from our oncology library: Caring for the Patient with Breast Cancer (507), Basic Genetics for the Oncology Nurse (504), Chemotherapy Administration for the Oncology Nurse (512), Managing Physical Assessments and Supportive Cancer Care (505), Symptom Management for the Radiation Oncology Patient (513), Cancer as a Diagnosis: Supporting the Care Givers (515), Traditional Pain Management in the Oncology Patient (517), Alternative Pain Management in the Oncology Patient (516), and Guided Visualization (511).