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Konradsen JR, Selberg S, Ödling M, Sundbaum JK, Bossios A, Stridsman C. Treatable traits and exacerbation risk in patients with uncontrolled asthma prescribed GINA step 1-3 treatment: A nationwide asthma cohort study. Respirology 2024. [PMID: 38859634 DOI: 10.1111/resp.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Uncontrolled asthma in patients treated for mild/moderate disease could be caused by non-pulmonary treatable traits (TTs) that affect asthma control negatively. We aimed to identify demographic characteristics, behavioural (smoking) and extrapulmonary (obesity, comorbidities) TTs and the risk for future exacerbations among patients with uncontrolled asthma prescribed step 1-3 treatment according to the Global Initiative for Asthma (GINA). METHODS Twenty-eight thousand five hundred eighty-four asthma patients (≥18 y) with a registration in the Swedish National Airway Register between 2017 and 2019 were included (index-date). The database was linked to other national registers to obtain information on prescribed drugs 2-years pre-index and exacerbations 1-year post-index. Asthma treatment was classified into step 1-3 or 4-5, and uncontrolled asthma was defined based on symptom control, exacerbations and lung function. RESULTS GINA step 1-3 included 17,318 patients, of which 9586 (55%) were uncontrolled (UCA 1-3). In adjusted analyses, UCA 1-3 was associated with female sex (OR 1.34, 95% CI 1.27-1.41), older age (1.00, 1.00-1.00), primary education (1.30, 1.20-1.40) and secondary education (1.19, 1.12-1.26), and TTs such as smoking (1.25, 1.15-1.36), obesity (1.23, 1.15-1.32), cardiovascular disease (1.12, 1.06-1.20) and depression/anxiety (1.13, 1.06-1.21). Furthermore, UCA 1-3 was associated with future exacerbations; oral corticosteroids (1.90, 1.74-2.09) and asthma hospitalization (2.55, 2.17-3.00), respectively, also when adjusted for treatment step 4-5. CONCLUSION Over 50% of patients treated for mild/moderate asthma had an uncontrolled disease. Assessing and managing of TTs such as smoking, obesity and comorbidities should be conducted in a holistic manner, as these patients have an increased risk for future exacerbations.
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Affiliation(s)
- Jon R Konradsen
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stina Selberg
- Department of Public Health and Clinical Medicine/The OLIN-Unit, Umeå University, Umeå, Sweden
| | - Maria Ödling
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Apostolos Bossios
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine/The OLIN-Unit, Umeå University, Umeå, Sweden
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Stridsman C, Martinsen Ø, Selberg S, Ödling M, Konradsen JR. Uncontrolled asthma in school-aged children-a nationwide specialist care study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100227. [PMID: 38439947 PMCID: PMC10910119 DOI: 10.1016/j.jacig.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 03/06/2024]
Abstract
Background Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment. Objective Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care. Methods We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma. Results UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P = .001]). Conclusion UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.
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Affiliation(s)
- Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Øyvind Martinsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Selberg
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Maria Ödling
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jon R. Konradsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Ödling M, Andersson N, Janson C, Melén E, Bergström A, Kull I. Health-related quality of life decreases in young people with asthma during the transition from adolescence to young adulthood: a birth cohort study. BMC Pulm Med 2023; 23:34. [PMID: 36694146 PMCID: PMC9872377 DOI: 10.1186/s12890-022-02259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND During the transition from paediatric to adult healthcare there is a gap between asthma guidelines and actual management with decreased healthcare consultations and dispensations of asthma medications after the transition to adult healthcare among young people with asthma. How health-related quality of life (HRQoL) develops during the transition from adolescence to young adulthood is unclear. Our aim was therefore to investigate HRQoL among young people with asthma during the transition to adulthood. Further, to assess if level of asthma control and physical activity influence any potential association between asthma and HRQoL. METHODS The study population consisted of 2268 participants from the ongoing Swedish population-based prospective birth cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology). HRQoL was measured using the instrument EQ-5D-3 L and three general questions. The EQ-5D-3 L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The EQ-5D-3 L instrument and questions on general health, symptoms and treatment of asthma, and lifestyle factors were based on data from follow-ups at 16 and 24 years. Cross-sectional analyses were made. RESULTS At the 24-year follow-up, the adjusted median values of EQ VAS were lower compared with at the 16-year follow-up; among both participants with asthma (80 vs. 85, p < 0.01) and those without asthma (80 vs. 87, p < 0.01). At the 24-year follow-up, participants with uncontrolled asthma had a lower adjusted median EQ VAS score than peers with controlled/partly controlled asthma (75 vs. 80, p = 0.03). Further, young adults with asthma who did not fulfil the WHO recommendations on physical activity had lower EQ VAS scores than peers who did (70 vs. 80, p < 0.01). CONCLUSION HRQoL is lower in young adulthood than in adolescence. Young adults with asthma having uncontrolled disease or who are physically inactive appear to be particularly vulnerable.
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Affiliation(s)
- Maria Ödling
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.425979.40000 0001 2326 2191Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
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Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M. Quality of life in patients with asthma: Medical indicators and psychological variables. J Pediatr Nurs 2023; 69:e136-e144. [PMID: 36609027 DOI: 10.1016/j.pedn.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quality of life (QoL) is a widely studied term concerning asthma because it allows the impact of the disease on the patient's life to be assessed through the patient's perception. The study aims to analyze which asthma-related, psychological, and family variables affect the QoL of adolescents with asthma. DESIGN AND METHODS This cross-sectional design involves 150 patients diagnosed with asthma aged between 12 and 16 years. The patients' emotional symptomatology, the threat of illness, self-esteem, bonds, quality of life, family, and disease variables were assessed. Statistical analyses were performed using QCA models. RESULTS The results indicate that girls have a poorer QoL, and age is negatively associated. QCA models found that the variables that best explained the quality of life of these patients, in the case of the medical indicators, were control, good compliance, shorter diagnosis times, and improvement. Regarding psychological variables: a lower threat of illness, less emotional distress, and better parental mood explained the high QoL. CONCLUSIONS AND PRACTICAL IMPLICATIONS Adolescent QoL is affected by variables related to their asthma that are beyond their control and other psychological and family variables that may increase the perception of their QoL.
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Affiliation(s)
- Selene Valero-Moreno
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain.
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Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M. Family styles and quality of life in adolescents with bronchial asthma: The important role of self-esteem and perceived threat of the disease. Pediatr Pulmonol 2023; 58:178-186. [PMID: 36193795 PMCID: PMC10091749 DOI: 10.1002/ppul.26178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/30/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Analyze the relationship between family styles and quality of life (QoL) in adolescents with bronchial asthma and study the influence of self-esteem as a protective factor and threat perception as a risk factor. METHODS Family styles, QoL, perceived threat of the disease, and self-esteem were assessed in a total of 150 adolescents diagnosed with bronchial asthma with ages ranging from 12 to 16 years (M = 13.28; SD = 1.29), 60.7% being male. Descriptive statistics and mean comparisons were conducted according to the level of self-esteem. Relationships between variables were also studied using Pearson's correlations, and finally, the mediating role of self-esteem and the perceived threat of the disease was assessed using PROCESS. RESULTS Adolescents shown healthy family characteristics (high scores on affect and parental mood and low scores on psychological control) and high scores on QoL. Thirty-five percent of adolescents showed low self-esteem and a tendency to underestimate the disease. There are existing relationships between family styles and QoL; thus, healthy family characteristics (affection, parental mood, autonomy promotion) were positively associated with QoL, while psychological control was negatively associated with QoL. Disease threat and self-esteem mediated the relationship between family styles and adolescent QoL. Disease threat was negatively, and self-esteem was positively associated with QoL. CONCLUSIONS Self-esteem and family support are protective factors for the well-being of adolescents with bronchial asthma; however, the high perceived threat of the disease can have negative consequences for the adolescent's health and negatively impact their QoL.
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Affiliation(s)
- Selene Valero-Moreno
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
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Effects of Adherence to Once-Daily Treatment on Lung Function, Bronchial Hyperreactivity and Health Outcomes in Adolescents with Mild-to-Moderate Asthmoka: A Twelve-Month Survey. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121854. [PMID: 36553298 PMCID: PMC9776553 DOI: 10.3390/children9121854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o.d. in affecting lung function, bronchial hyperreactivity, and health outcomes over a twelve-month survey of a group of non-smoking adolescents with mild to moderate asthma. Methods: Age, gender, BMI and atopy, forced expiratory volume in 1 s (FEV1), maximum mid-expiratory flow (MMEF), and maximum expiratory flow at 25% of lung filling (MEF25) were assessed via a Boolean selection process from the institutional database at recruitment, as well as after 6 and 12 months, together with the incidence of exacerbation, school days that were taken off, GP and specialist visits, and systemic steroid and/or antibiotic courses. Adherence was checked monthly via a direct telephone call. Statistics were calculated with an ANOVA trend analysis, assuming p < 0.05. Results: Two well-matched sample groups of 54 subjects each were obtained. The mean annual adherence to treatment ranged from 48.2% doses ± 10.9 sd to 79.3% doses ± 8.8 sd (p < 0.001), regardless of age and gender. Only adolescents that adhered to the o.d. ICS/LABA inhalation regimen progressively achieved complete control of all lung function parameters (FEV1: 0.001; MMEF: p < 0.002; MEF25 < 0.001; <0.001), minimized their bronchial hyperreactivity (p < 0.001), and optimized all health outcomes (p < 0.001—p < 0.002) over the survey duration. Discussion: A good adherence to treatment is essential for asthma management, particularly in young patients. Factors that are totally independent of the complexity of the therapeutic regimen adopted (namely, only a once-daily inhalation in the present survey) probably represent the major reasons limiting the adolescents’ adherence. Cultural, educational, behavioral, and psychological factors are frequently involved, are difficult to control, and can present barriers to adolescents’ asthma management. Further studies aiming to deeply understand and possibly remove the reasons for such adolescents’ attitudes are needed, in cooperation with actions oriented in this direction by families, educators, and health professionals.
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7
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Asthma control, social jetlag, and sleep impairment in high school adolescents. Sleep Med 2022; 99:34-40. [DOI: 10.1016/j.sleep.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022]
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Melén E, Nwaru BI, Wiklund F, de Fine Licht S, Telg G, Maslova E, van der Valk RJP, Tran TN, Ekström M, Janson C. Short-acting β 2 -agonist use and asthma exacerbations in Swedish children: A SABINA Junior study. Pediatr Allergy Immunol 2022; 33:e13885. [PMID: 36433853 PMCID: PMC9828275 DOI: 10.1111/pai.13885] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In adults and adolescents with asthma, use of ≥3 short-acting β2 -agonist (SABA) canisters/year is associated with increased exacerbation risk. Whether this association is present in younger children remains unknown. In this SABA use IN Asthma (SABINA) Junior study, we assessed the association of SABA collection with exacerbation risk in the general Swedish pediatric asthma population. METHODS This population-based cohort study utilized linked data from the Swedish national healthcare registries involving patients with asthma (<18 years) treated in secondary care between 2006-2015. Exacerbation risk, by baseline SABA collection (0-2 vs. ≥3 canisters, further examined as ordinal/continuous variable) and stratified on comorbid atopic disease (allergic rhinitis, dermatitis and eczema, and food/other allergies), was assessed for 1-year follow-up using negative binomial regression. RESULTS Of 219,561 patients assessed, 45.4%, 31.7%, and 26.5% of patients aged 0-5, 6-11, and 12-17 years, respectively, collected ≥3 SABA canisters during the baseline year (high use). Collection of ≥3 SABA canisters (vs. 0-2) was associated with increased exacerbation risk during follow-up (incidence rate ratios [95% confidence interval]: 1.35 [1.29-1.42], 1.22 [1.15-1.29], and 1.26 [1.19-1.34] for 0-5-, 6-11-, and 12-17-year-olds, respectively); the association persisted with SABA as a continuous variable and was stronger among patients without atopic diseases (32%-44% increased risk versus. 14%-21% for those with atopic disease across groups). CONCLUSIONS High SABA use was associated with increased asthma exacerbation risk in children, particularly in those without comorbid atopic diseases, emphasizing the need for asthma medication reviews and reformative initiatives by caregivers and healthcare providers on SABA use.
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Affiliation(s)
- Erik Melén
- Department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs Children's Hospital, Stockholm, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | | | - Magnus Ekström
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Zhang A, Fagnano M, Frey SM, Halterman JS. The relationship between teen-reported nocturnal asthma symptoms and daily functioning. J Asthma 2022; 59:1878-1884. [PMID: 34424114 PMCID: PMC8898318 DOI: 10.1080/02770903.2021.1968426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to identify associations between nocturnal asthma awakenings and functional health outcomes in a cohort of teenagers with asthma. METHODS We analyzed baseline data from teenagers enrolled in SB-ACT, an NIH-funded RCT. During an at-home baseline survey, teenagers with asthma answered questions about demographics, recent asthma symptoms, and functional health outcomes. We conducted regression analyses to explore the relationship between persistent nocturnal asthma symptoms (≥2 nights of nocturnal asthma awakenings in the past 14 days) and functional health measures. RESULTS Of the 430 teens enrolled (Participation rate = 79%, Mean Age = 13.4), 30% reported persistent nocturnal asthma symptoms. Compared to teens with intermittent nocturnal asthma symptoms, teens with persistent nocturnal asthma symptoms were more likely to report physical limitation during strenuous activities (OR = 1.9, 1.3-3.0), moderate activities (OR = 1.9, 1.2-3.1), and school gym (OR = 2.4, 1.5-3.8). They were also more likely to report depressive symptoms (OR = 2.3, 1.5-3.6), more asthma-related school absenteeism in the past 14 days (0.81 vs 0.12, p < 0.01) and poorer quality of life (4.6 vs 5.9, p < 0.01). These findings remained significant when controlling for daytime asthma symptoms, weight status, race, ethnicity, gender, age, and smoke exposure. CONCLUSIONS In this cross-sectional study, persistent nighttime asthma symptoms were associated with poor functional health outcomes among teens, independent of day-time symptoms. Identifying nighttime symptoms and improving asthma control at night may positively impact daily functioning for these teens.
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Affiliation(s)
- Anne Zhang
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Sean M. Frey
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
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Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
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Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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11
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Robinson PD, Jayasuriya G, Haggie S, Uluer AZ, Gaffin JM, Fleming L. Issues affecting young people with asthma through the transition period to adult care. Paediatr Respir Rev 2022; 41:30-39. [PMID: 34686436 DOI: 10.1016/j.prrv.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022]
Abstract
Asthma is among the most common medical conditions affecting children and young people, with adolescence a recognised period of increased risk, overrepresented in analyses examining recent increasing asthma mortality rates. Asthma may change significantly during this period and management also occurs in the context of patients seeking increased autonomy and self-governance whilst navigating increasing academic and social demands. A number of disease factors can destabilise asthma during adolescence including: increased rates of anaphylaxis, anxiety, depression, obesity, and, in females, an emerging resistance to corticosteroids and the pro-inflammatory effects of oestrogen. Patient factors such as smoking, vaping, poor symptom recognition, treatment non-adherence and variable engagement with health services contribute to difficult to treat asthma. Significant deficiencies in the current approach to transition have been identified by a recent EAACI task force, and subsequent asthma-specific recommendations, published in 2020 provide an important framework moving forward. As with other chronic conditions, effective transition programmes plan ahead, engage with adolescents and their families to identify the patients' management priorities and the current challenges they are experiencing with treatment. Transition needs may vary significantly across asthma patients and for more complex asthma may include dedicated transition clinics involving multidisciplinary care requiring input including, amongst others, allergy and immunology, psychological medicine, respiratory physicians and scientists and nurse specialists. Across different global regions, barriers to treatment may vary but need to be elicited and an individualised approach taken to optimising asthma care which is sustainable within the local adult healthcare system.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Dept of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart Haggie
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Department of Paediatrics, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Ahmet Z Uluer
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College, London UK; Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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12
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Deschildre A, Abou-Taam R, Drummond D, Giovannini-Chami L, Labouret G, Lejeune S, Lezmi G, Lecam MT, Marguet C, Petat H, Taillé C, Wanin S, Corvol H, Epaud R. [Update of the 2021 Recommendations for the management of and follow-up of adolescent asthmatic patients (over 12 years) under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2022; 39:e1-e31. [PMID: 35148929 DOI: 10.1016/j.rmr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- A Deschildre
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France.
| | - R Abou-Taam
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - D Drummond
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - L Giovannini-Chami
- Service de Pneumo-Allergologie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - G Labouret
- Service de Pneumo-allergologie pédiatrique, Hôpital des Enfants, CHU Toulouse, 31000 Toulouse, France
| | - S Lejeune
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France
| | - G Lezmi
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - M T Lecam
- Service de pathologies professionnelles et de l'environnement. Centre Hospitalier Inter Communal de Créteil, 94000 Créteil, France
| | - C Marguet
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - H Petat
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - C Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des maladies pulmonaires rares ; Inserm UMR1152, Paris, France
| | - S Wanin
- Service d'allergologie pédiatrique, hôpital universitaire Armand Trousseau, 75012 Paris, France; Unité Transversale d'éducation thérapeutique Sorbonne Université, Paris, France
| | - H Corvol
- Service de pneumologie pédiatrique, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMRS938, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Trousseau, Paris, France
| | - R Epaud
- Centre hospitalier intercommunal de Créteil, service de pédiatrie générale, 94000 Créteil, France; Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; FHU SENEC, Créteil, France
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13
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Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
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Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
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14
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Stridsman C, Konradsen JR, Vanfleteren L, Pedroletti C, Binnmyr J, Edfelt P, Fjällman Schärberg K, Sjöö Y, Nyberg F, Lindberg A, Tunsäter A, Ekberg-Jansson A. The Swedish National Airway Register (SNAR): development, design and utility to date. Eur Clin Respir J 2020; 7:1833412. [PMID: 33224453 PMCID: PMC7594834 DOI: 10.1080/20018525.2020.1833412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Swedish National Airway Register (SNAR) was initiated in 2013 to ensure and improve the quality of care for patients with asthma and COPD. AIM To describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care. METHODS SNAR includes data from patients with asthma (both children and adults) and COPD from primary, secondary and tertiary care, and also, for COPD inpatient care. Data on diagnostic investigations (e.g. spirometry, blood sample, skin prick test), symptom-scores, comorbidities and prescribed treatments are registered. The registrations are entered manually by healthcare professionals, or directly transferred from electronic medical records to a web-based platform. RESULTS In 2019, 1000 clinics participated and data were directly transferred by about 88% of them. The register included data on 205,833 patients with asthma and 80,372 with COPD (of these, 5% had both diagnoses). Registrations of new patients and follow-up visits from primary and secondary/tertiary care in 2019 were completed for 75,707 patients with asthma (11,818 children <12 yr, 6545 adolescents 12-17 yr, and 57,344 adults >17 yr) and 38,117 with COPD. Depending on age and disease group, 43-77% had performed spirometry, 36-65% Asthma Control Test, and 60% COPD Assessment Test. The prevalence of current smoking was about 2% in adolescents, 10% in adults with asthma, and 34% in COPD. For these, smoking cessation support was offered to 27%, 38% and 51%, respectively. Overall, limited data were available on investigation of allergy, 6-min walk test, patient education and written treatment plans. Regarding asthma, sex-differences in disease management were evident. CONCLUSION SNAR has cumulatively registered data from over 270,000 individuals, and the register is important for patients, caregivers, authorities, politicians and researchers to evaluate the effect of treatment and to ensure high and equal quality of care nationwide.
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Affiliation(s)
- C Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, the OLIN-unit, Umeå University, Umeå, Sweden
| | - JR Konradsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - L Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - C Pedroletti
- Department of Woman and Child Health, Uppsala University, Uppsala, Sweden
- Södertälje General Hospital, Sweden
| | - J Binnmyr
- The Swedish Asthma- and Allergy Association, Stockholm, Sweden
- The Swedish Asthma- and Allergy Research Foundation, Stockholm, Sweden
| | - P Edfelt
- The Swedish Heart and Lung Association, Stockholm, Sweden
| | | | - Y Sjöö
- The Swedish National Airway Register, Gothenburg, Sweden
| | - F Nyberg
- School of Public Health and Community, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - A Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, the OLIN-unit, Umeå University, Umeå, Sweden
| | - A Tunsäter
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - A Ekberg-Jansson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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15
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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16
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Stridsman C, Axelsson M, Warm K, Backman H. Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health - a report from the OLIN adult asthma cohort. J Asthma 2020; 58:586-595. [PMID: 31910044 DOI: 10.1080/02770903.2020.1713150] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.Methods: In 2012-2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32-92 years) and were included in the study.Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.
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Affiliation(s)
- Caroline Stridsman
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Malin Axelsson
- Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Katja Warm
- Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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17
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Selberg S, Hedman L, Jansson SA, Backman H, Stridsman C. Asthma control and acute healthcare visits among young adults with asthma-A population-based study. J Adv Nurs 2019; 75:3525-3534. [PMID: 31441107 DOI: 10.1111/jan.14174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 07/04/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIMS To study asthma control and acute healthcare visits among young adults with asthma. BACKGROUND Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare. DESIGN A population-based cohort study. METHODS In 2015, as a part of the OLIN paediatric cohort I (recruited in 1996 at age 7-8 years), N = 2,291 young adults (27-28 years) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N = 280 (12%) were identified as having current asthma and were further studied. RESULTS Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one-fourth had uncontrolled asthma and acute healthcare visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days, and acute healthcare visits. Acute healthcare visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma. CONCLUSION The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute healthcare visits. IMPACT Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced-based nursing interventions, contributing to a more efficient asthma management in primary care.
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Affiliation(s)
- Stina Selberg
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden
| | - Linnea Hedman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Sven-Arne Jansson
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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18
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Kansen HM, Le TM, Meijer Y, Uiterwaal CSPM, Knulst AC, van der Ent CK, van Erp FC. Perceived triggers of asthma impair quality of life in children with asthma. Clin Exp Allergy 2019; 49:980-989. [PMID: 31038823 PMCID: PMC6851977 DOI: 10.1111/cea.13407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 12/29/2022]
Abstract
Background Data on the impact of the number and nature of perceived asthma triggers on health‐related quality of life (HRQL) in children are scarce. Objective To investigate the impact of perceived asthma triggers on both asthma‐specific and generic HRQL in children. Methods A cross‐sectional study was conducted among children (7‐18 years) with asthma in secondary and tertiary care. Children were screened with electronic questionnaires regarding respiratory and allergic symptoms. Asthma‐specific HRQL was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) (score range 1‐7) and generic HRQL using the RAND questionnaire (score range 7‐32). The Kruskal‐Wallis test and one‐way ANOVA were used to test the difference of, respectively, the PAQLQ and RAND scores across the number of perceived asthma triggers (0, 1‐2, 3‐4, or ≥ 5). Univariable and multivariable linear regression analyses were performed to evaluate the association between individual triggers and HRQL. Results A total of 527 children with a mean (SD) age of 12.1 (2.9) years were included. Children with a higher number of perceived triggers had significantly lower PAQLQ and RAND scores (ie poorer HRQL). The difference in PAQLQ scores was clinically relevant between children with 0 versus 3‐4 or ≥ 5 triggers and 1‐2 versus ≥ 5 triggers (mean difference 0.66, 1.02 and 0.63, respectively). Especially, non‐allergic triggers (physical exercise, the weather, (cigarette) smoke and emotions) were significantly associated with reduced PAQLQ scores. Emotions and food/drinks were associated with reduced RAND scores. Conclusion and Clinical Relevance A higher number of perceived triggers of asthma were associated with reduced HRQL in children with asthma. Especially, non‐allergic triggers were associated with reduced HRQL.
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Affiliation(s)
- Hannah M Kansen
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Francine C van Erp
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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19
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Sombans S, Lohana P. Finding a Better Solution for Asthma Control in Children. Cureus 2018; 10:e3344. [PMID: 30473977 PMCID: PMC6248683 DOI: 10.7759/cureus.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Asthma is a chronic respiratory condition that is very common among children. With proper management and follow-ups, this condition can be easily controlled in a child. However, there are several factors that are negatively influencing a proper care of asthmatic children throughout the world. In this mini-review, the roles of the parents, the schools and the child himself were analyzed and several possible solutions to improve those hurdles were discussed.
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Affiliation(s)
- Shaheen Sombans
- Internal Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, IND
| | - Petras Lohana
- Internal Medicine, Liaquat University of Medical and Health Sciences Hospital, Karachi, PAK
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20
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Ren CL, Muston HN, Yilmaz O, Noah TL. Pediatric Pulmonology year in review 2017: Part 3. Pediatr Pulmonol 2018; 53:1152-1158. [PMID: 29806188 DOI: 10.1002/ppul.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022]
Abstract
Pediatric Pulmonology publishes original research, reviews, and case reports related to a wide range of children's respiratory disorders. We here summarize the past year's publications in our major topic areas, in the context of selected literature in these areas from other journals relevant to our discipline. This review (Part 3 of a 5-part series) covers selected articles on asthma, physiology/lung function testing, and respiratory infections.
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Affiliation(s)
- Clement L Ren
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Heather N Muston
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lenney W, Bush A, Fitzgerald DA, Fletcher M, Ostrem A, Pedersen S, Szefler SJ, Zar HJ. Improving the global diagnosis and management of asthma in children. Thorax 2018. [PMCID: PMC6035489 DOI: 10.1136/thoraxjnl-2018-211626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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Affiliation(s)
- Warren Lenney
- Department of Child Health, Keele University, Stoke-on-Trent, UK
- Department of Child Health, Royal Stoke University Hospital (RSUH), Stoke-on-Trent, UK
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
| | - Andrew Bush
- Paediatrics, Imperial College London, London, UK
- Paediatrics, National Heart and Lung Institute, London, UK
- Paediatrics, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dominic A Fitzgerald
- Sydney Medical School, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Monica Fletcher
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
- Asthma UK Centre for Applied Research (AUKCAR), University of Edinburgh, Edinburgh, UK
| | | | - Soren Pedersen
- Pediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
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