Chou KJ, Cunningham SJ, Crain EF. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Archives of Pediatrics and Adolescent Medicine. 1995;149(2):201-205.

Article describing a study which concluded metered-dose inhalers with spacers are as effective as nebulizers in treatment of acute asthma in children.

Agertoft L, Pedersen S. Bone mineral density in children with asthma receiving long-term treatment with inhaled budesonide. American Journal of Respiratory Critical Care Medicine. 1998;157(1):178-183.

This article describes a study which shows that three to six years of treatment with inhaled budesonide does not appear to diminish bone mineral density in children.

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):1046-1054.

In this article, the authors contend that undiagnosed frequent wheezing may lead to under-treatment of asthma in adolescents.

Wolfenden LL, Diette GB, Krishnan JA, Skinner EA, Steinwachs DM, Wu AW. Lower physician estimate of underlying asthma severity leads to undertreatment. Archives of Internal Medicine. 2003;163(2):231-236.

The authors of this article stress that accurate and current severity assessment is a key first step in appropriate management of asthma.

Fuhlbrigge AL, Adams RJ, Guilbert TW, et al. The burden of asthma in the United States: Level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines. American Journal of Respiratory Critical Care Medicine. Oct 2002;166(8):1044-1049.

This large cross-sectional survey highlights the relative prevalence of persistent asthma. Classification according to the guidelines depends on the exact method used.

Institute for Healthcare Improvement
Boston, Massachusetts, USA: Institute for Healthcare Improvement in partnership with the Bureau of Primary Healthcare; 2002

IHI, with support from the Bureau of Primary Health Care (BPHC), has developed training manuals to help health centers improve care for their patients with chronic illness. The manuals include key changes and measures for improving care, along with tips, tools, and other resources to assist organizations in this work. Click on the link below to view the PDF version of the Asthma manual.