Despite the evidence of efficacy in improving outcomes, their long-standing presence (>20 years) and their wide availability, there is extensive evidence that the NAEPP recommendations are not routinely being followed. In one study, only 34.2 percent of patients reported being given a written asthma action plan, while only 68.1 percent had been taught the appropriate response to symptoms of an asthma attack. In the same study, only about one-third of children or adults were using long-term control medicine such as inhaled corticosteroids. Additional evidence shows that clinicians are classifying asthma appropriately in only a few patients, resulting in substandard care. Suboptimal asthma outcomes, such as unplanned care (e.g., emergency room visits), also persist despite the NAEPP guidelines. In 2005, there were approximately 679,000 emergency room visits due to asthma in children under 15 years of age. Currently, asthma is the third leading cause of hospitalization among children in this age group.