For children with asthma and their parents, a trip to the hospital for a severe asthma attack is often frightening and expensive. In 2000, the total cost of such visits was about $850 million, roughly $5,500 per visit, on trips to the emergency room when wheezing, shortness of breath, and chest constriction got out of control.

But recently, researchers from Wisconsin and Boston found that between 15 and 54 percent of such cases might be prevented if children could see their doctor, take their medications, and stay away from dust, pollen, and pet hair.

Researchers asked parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) questions about 234 cases in which children had gone to Boston Medical Center because of an asthma attack. The questions included whether the child's asthma attack could have been prevented, whether the child had proper access to healthcare, and whether the child had access to medications.

Twenty-six percent of parents, 38 percent of PCPs, and 43 percent of IAPs said their patient's hospitalization could have been prevented. In 15 percent of the cases, all three groups agreed that the hospital trip could have been prevented, while in 54 percent of cases, only one group of the three said prevention was possible.

The study suggests that asthmatic children could avoid between 29,400 and 105,840 trips to the hospital, according to lead author Glenn Flores, director of the Center for the Advancement of Underserved Children at the Medical College of Wisconsin and Children's Hospital of Wisconsin. By preventing these hospital visits, the United States could save an estimated $160 million to $581 million each year.

The key, says Flores, is education about the child's condition, medications, and known disease triggers. Attending doctor's appointments and calling the physician before leaving for the hospital can also help.

"That early contact could mean the difference between a hospitalization and taking care of it at home," Flores explains.

Most children, especially adolescents, could avoid the hospital by simply taking their medication. Studies have found that children take their medication only 46 to 60 percent of the time. This adherence is even worse for teenagers.

Flores acknowledges that this recent paper, which appears in the October edition of Pediatrics, might not apply to all regions of the country. Most of the children studied were poor, nonwhite, and had public or no health insurance. Nevertheless, the research does give insight into one of the most at-risk segments of the asthma population.

"This is the population that we are most interested in because we know they have the highest hospitalization, morbidity, and mortality rates," he says.