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Abou Taam R, Labouret G, Michelet M, Schweitzer C, Lejeune S, Giovannini-Chami L. [Initial severity before treatment and control: Definitions and associated factors]. Rev Mal Respir 2024:S0761-8425(24)00243-2. [PMID: 39181755 DOI: 10.1016/j.rmr.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- R Abou Taam
- Service de pneumologie et d'allergologie pédiatrique, AP-HP, hôpital Necker, Paris, France
| | - G Labouret
- Service de pneumologie et d'allergologie pédiatrique, CHU de Toulouse, Toulouse, France
| | - M Michelet
- Service de pneumologie et d'allergologie pédiatrique, CHU de Toulouse, Toulouse, France
| | - C Schweitzer
- Service de médecine infantile et explorations fonctionnelles pédiatriques, hôpital d'enfants, université de Lorraine, faculté de médecine de Nancy, DeVAH EA 3450; CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - S Lejeune
- Service de pneumologie et d'allergologie pédiatrique, hôpital Jeanne de Flandre, université Lille, CHU de Lille, 59000 Lille, France.
| | - L Giovannini-Chami
- Service de pneumologie et d'allergologie pédiatrique, université Côte d'Azur; hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
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2
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Gao X, Long C, Zhang LF, Lin RJ, Liu XM, Zhang X, Jiang Y, Lin H. The effect of telephone and short-message follow-ups on compliance and efficacy in asthmatic children treated with inhaled corticosteroid: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37794. [PMID: 38701297 PMCID: PMC11062738 DOI: 10.1097/md.0000000000037794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND This study aims to evaluate the effect of telephone and short-message follow-ups on compliance and efficacy in asthmatic children treated with inhaled corticosteroids. METHODS A total of 120 children with moderate bronchial asthma who visited the Asthma Outpatient Department of the Affiliated Hospital of Qingdao University were enrolled in the study. They were divided randomly into 3 groups based on the type of follow-up given: a combined telephone and short-message service (Tel + SMS) group, a SMS group, and a control group. After being followed up for 12 weeks, each child's asthma control level was assessed and their lung function was measured. RESULTS The compliance rates of children in the Tel + SMS group and SMS group were 86.49% and 56.25%, respectively. The total effective rates of these 2 groups (94.59% and 75.0%, respectively) were significantly higher than the rate of the control group (P < .01). The lung function indicators of the children in all 3 groups were better than those before treatment, although only the Tel + SMS group and SMS group improved significantly (P < .05). The lung function indicators of the large and small airways in the Tel + SMS group and the SMS group were also significantly better than those of the control group (P < .01). The results of the study suggest that 1 of the causes of poor compliance in asthmatic children is fear of an adverse reaction to inhaled corticosteroids. CONCLUSION Telephone and short-message follow-ups can increase compliance with inhaled corticosteroid treatment and improve the asthma control levels and lung function of asthmatic children.
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Affiliation(s)
- Xiang Gao
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chao Long
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Feng Zhang
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rong-Jun Lin
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao-Mei Liu
- Department of Child Health Care, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xu Zhang
- Department of Clinical Psychology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Jiang
- Department of Otorhinolaryngology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hang Lin
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, China
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3
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Alyami MA, Alyami MM, Alasimi AH, Alqahtani JS, Alqarni AA, Aldhahir AM. The utility of the necessity-concerns framework (NCF) in explaining adherence and parental beliefs about controller medication in Saudi Arabian children with asthma. J Asthma 2024; 61:436-443. [PMID: 37997759 DOI: 10.1080/02770903.2023.2288320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/19/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study aims to assess beliefs about asthma controller medications among parents of Saudi Arabian children with asthma and the association between these beliefs and medication adherence using the Necessity-Concerns Framework. METHODS A cross-sectional survey was provided to parents of children with asthma when they brought their children to routine appointments at local public clinics between May 16 and July 10, 2018. Participants electronically filled out validated Arabic versions of the Medication Adherence Reported Scale (MARS) and Beliefs About Medications Questionnaire (BMQ). Descriptive statistics were used to characterize the study participants, while hierarchical linear regression analysis assessed associations between parental beliefs about controller medications and medication adherence. RESULTS A total of 381 parents of children with asthma completed the study survey. The vast majority (89%) of study participants were non-adherent to their children's prescribed medications while only 11% were adherent. Additionally, our study revealed a significantly positive association between adherence and parents' beliefs in the necessity of the medication (p < .001), with concerns about the adverse effects of medication being negatively associated with parental adherence. A higher mean score for medication adherence was reported among the ambivalent groups compared to the accepting, indifferent, and skeptical groups. CONCLUSIONS Medication adherence among parents of children with asthma was relatively low. In addition, necessity beliefs were significantly associated with parental adherence to controller medications for their children with asthma. Further studies are warranted to investigate potential factors contributing to poor parental adherence and develop tailored interventions that support parental medication adherence for their asthmatic children.
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Affiliation(s)
- Marja A Alyami
- Dhahran Long Term Hospital, Eastern Health Cluster, Ministry of Health, Dhahran, Saudi Arabia
| | - Mohammed M Alyami
- Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia
| | - Ahmed H Alasimi
- Department of Respiratory Therapy, GA State University, Atlanta, GA, USA
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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Tang J, Zhao Z, Guo R, Niu C, Zhang R, Wang L, Luo N. Preschool children's asthma medication: parental knowledge, attitudes, practices, and adherence. Front Pharmacol 2024; 15:1292308. [PMID: 38633619 PMCID: PMC11021651 DOI: 10.3389/fphar.2024.1292308] [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: 09/11/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction: As parents or legal guardians primarily care for children with asthma, understanding their knowledge, attitudes, and practices (KAP) barriers to treatment and medication adherence is of essential importance. This study aimed to analyze the KAP toward asthma medication and adherence among preschool-aged asthmatic children's parents and explore the factors influencing adherence. Methods: This cross-sectional study was conducted between February 2023 and April 2023. Parents of preschool children with asthma were asked to complete the questionnaire containing knowledge, attitude, practice dimensions, and demographic characteristics. The Morisky Medication Adherence Scale (MMAS) was used to investigate adherence. Results: A total of 632 valid questionnaires (154 male and 478 female) were included. Parents showed moderate knowledge (9.49 ± 2.86, 63.27%, possible range: 0-15) and moderate attitudes (26.18 ± 2.51, 74.80%, possible range: 7-35) towards asthma medication, while their practices (27.46 ± 5.26, 91.53%, possible range: 6-30) were proactive; however, medication adherence was low (4.84 ± 1.78, total score: 8). The attitude scores (OR = 1.10, 95% CI: 1.01-1.19, P=0.020), practice scores (OR = 1.16, 95%CI: 1.12-1.21, p < 0.001), and smoking (OR = 1.64, 95%CI: 1.14-2.37, p = 0.008) were associated with medication adherence. Discussion: Preschool-aged asthmatic children's parents showed moderate knowledge, attitudes, and proactive practice toward asthma medication. Continuous training and education programs should be provided for parents to improve asthma medication management in preschool children.
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Affiliation(s)
| | | | - Rong Guo
- Department of Respiratory, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, China
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5
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Bach LM, Rubak S, Holm-Weber A, Prahl J, Hermansen M, Hansen KS, Chawes B. Risk Factors for Non-Adherence to Inhaled Corticosteroids in Preschool Children with Asthma. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010043. [PMID: 36670594 PMCID: PMC9856475 DOI: 10.3390/children10010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted from the medical records for four years following diagnosis. At end of follow-up, 79 children had a prescription of inhaled corticosteroids (ICS) and were included in the analyses. Adherence was assessed in a two-year period through pharmacy claims using percentage of days covered (PDC) analyzed dichotomously with non-adherence defined as PDC < 80% and using adherence ratio (AR) defined as days with medical supply divided by days without. Of the 79 children, 59 (74.7%) were classified as non-adherent. In analyses adjusted for sex, age and exacerbations prior to inclusion, adherence was positively associated with having had a loss of control event requiring a step-up in asthma controller (aAR:2.34 [1.10;4.98], p = 0.03), oral corticosteroids (aAR:2.45 [1.13;5.34], p = 0.026) or redeeming a short-acting b2-agonist prescription (aAR:2.91 [1.26;6.74], p = 0.015). Further, atopic comorbidity was associated with increased adherence (aAR:1.18 [1.01;1.37], p = 0.039), whereas having a first degree relative with asthma was associated with worse adherence (aAR:0.44 [0.23;0.84], p = 0.015). This study found poor adherence to ICS among three quarters of preschool children with asthma. Increasing adherence was associated with atopic comorbidity and loss of control events, whereas lower adherence was associated with atopic predisposition. These findings should be considered to improve adherence in preschool children with asthma.
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Affiliation(s)
- Louise Mandrup Bach
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Danish Center of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescents Medicine, Institute of Clinical Medicine, University Hospital of Aarhus, University of Aarhus, 8000 Aarhus, Denmark
| | - Sune Rubak
- Danish Center of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescents Medicine, Institute of Clinical Medicine, University Hospital of Aarhus, University of Aarhus, 8000 Aarhus, Denmark
| | - Adam Holm-Weber
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Julie Prahl
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Mette Hermansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Allergy Clinic, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Bo Chawes
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Correspondence: ; Tel.: +45-3868-1152
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Tony SM, Abdelrahman MA, Abd Elsalam M, Sameer Shafik M, Abdelrahim MEA. Effect of using acoustic flo-tone training device and its smartphone application on enhancing inhalation technique from metered-dose inhaler with spacer in asthmatic children. Exp Lung Res 2022; 48:224-238. [PMID: 35997099 DOI: 10.1080/01902148.2022.2113573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim of study: This research study aims to compare between two different counseling approaches; traditional verbal counseling vs. advanced counseling (in which we used the acoustic Flo-tone training device and its smartphone application combined with traditional verbal counseling) to determine the most beneficial counseling approach for asthmatic children who use metered-dose inhaler (MDI) with spacers concerning inhalation duration and inhalation technique mistakes. Methods: A total of 100 asthmatic children (8-18) years old were randomized into two groups (a control group, and an advanced group). Each group included 50 subjects. Every subject received 3 counseling meetings, one each month. Asthmatic children in the control group were trained on inhalation technique from MDI + spacer verbally (traditional counseling), while asthmatic children in advanced group were trained on inhalation technique from MDI + spacer verbally and by advanced counseling (whistling Flo-tone + smartphone application). At each visit mistakes in inhalation technique steps were; detected, corrected, and recorded and the inhalation duration was measured for every child in each group. Results: In both study groups, the total mean number of inhalation technique mistakes decreased significantly (p < 0.05) from visit 2, also the total mean inhalation durations in seconds showed a significant increase (p < 0.05) from visit 2. A significant (p < 0.05) reduction in the total mean number of mistakes and a significant (p < 0.05) increase in total mean inhalation durations were observed from visit 2 in advanced group compared to control group. Conclusion: Combination between traditional verbal and advanced counseling methods resulted in significant (P < 0.05) improvements in the number of inhalation technique mistakes and inhalation durations from MDI with spacer in children compared to using traditional verbal counseling alone.
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Affiliation(s)
- Sara M Tony
- Beni-Suef Specialized Hospital, Beni-Suef, Egypt
| | - Mona A Abdelrahman
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | | | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Andrenacci B, Ferrante G, Roberto G, Piacentini G, La Grutta S, Marseglia GL, Licari A. Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician. Expert Rev Clin Immunol 2022; 18:807-821. [PMID: 35730635 DOI: 10.1080/1744666x.2022.2093187] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children's lung function and the whole family's well-being. AREAS COVERED Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma. EXPERT OPINION In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.
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Affiliation(s)
- Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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9
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Silva-Lavigne N, Valderrama A, Pelaez S, Bransi M, Balli F, Gervais Y, Gaudy T, Tse SM. Acceptability of Serious Games in Pediatric Asthma Education and Self-management: Pilot Study. JMIR Pediatr Parent 2022; 5:e33389. [PMID: 35389354 PMCID: PMC9030910 DOI: 10.2196/33389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Asthma is the most common chronic pediatric disease. Despite existing tools to manage asthma, 40%-55% of children with asthma experience uncontrolled asthma. Serious games (SGs) represent a novel approach in promoting asthma education and self-management for children. OBJECTIVE In this qualitative pilot study with an embedded quantitative design, we aim to use focus groups and questionnaires to describe the perceived role of SGs in different aspects of asthma self-management by children and their parents. These aspects include asthma perception and knowledge, the impact of asthma and barriers to asthma self-management, and the support system for asthma self-management. METHODS A total of 5 children with asthma and their parents were invited to participate in an organized gaming session. Children and their parents completed a pregaming questionnaire on their medical history and asthma knowledge. Then, they were invited to test 4 original SG prototypes, after which the children answered a postgaming questionnaire on their asthma knowledge and perception of the SGs. Children and their parents subsequently participated in parallel focus groups, which were video-recorded or audio-recorded, transcribed verbatim, and analyzed by reaching consensus among members of the research team. RESULTS The mean age of the children was 10.3 (SD 1.5) years, with 20% (1/5) of the children being male. Qualitative data from the transcripts were coded into three separate domains: asthma self-management perception and knowledge, impact of asthma and barriers to asthma self-management, and support system for asthma self-management. We specifically explored the perceived roles of SGs within each domain. A key takeaway message was identified for each of these three domains: heterogeneity of asthma knowledge and the ability of SGs to encourage knowledge transfer through games, consequences and limitations of asthma and the ability of SGs to allow for identification and management of real-life situations through games, and insufficient support system and the ability of SGs to encourage playing with others for support and shared knowledge. CONCLUSIONS Our pilot study explored the role of SGs in the self-management of asthma, as perceived by children and their parents. Our findings support the acceptability of SGs in asthma education and self-management in pediatrics and the necessity for future development in this field.
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Affiliation(s)
| | - Alena Valderrama
- Health Promotion Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Breathing Games Association, Geneva, Switzerland
| | - Sandra Pelaez
- Research Centre, Sainte-Justine University Hospital Center, Montreal, QC, Canada.,School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Myriam Bransi
- Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Pediatrics, Centre mère-enfant Soleil of Quebec City University Hospital Center, Quebec, QC, Canada
| | - Fabio Balli
- Breathing Games Association, Geneva, Switzerland.,Concordia University, Montreal, QC, Canada
| | | | - Thomas Gaudy
- Breathing Games Association, Geneva, Switzerland
| | - Sze Man Tse
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
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10
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Adherence to inhaled corticosteroids prescribed once vs twice daily in children with asthma. Ann Allergy Asthma Immunol 2022; 128:423-431.e3. [PMID: 35077865 DOI: 10.1016/j.anai.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suboptimal adherence to inhaled corticosteroids (ICS) is associated with poor asthma control. Adult studies suggest that simplification of ICS regimen leads to better adherence. OBJECTIVE We aimed to determine whether once-daily, compared with twice-daily, ICS dosing was associated with better adherence among children with asthma. METHODS We conducted a retrospective observational study of children with asthma prescribed with either once-daily or twice-daily ICS monotherapy between 2011 and 2019. Our primary adherence outcome was the proportion of prescribed days covered (PPDC)-that is, the number of days for which the drug was dispensed by the pharmacy divided by the number of days for which it was prescribed. The impact of once-daily vs twice-daily ICS regimen on adherence was evaluated using linear multivariable regression analysis adjusting for covariates. Secondary outcomes included the proportion of patients with greater than or equal to 75% adherence analyzed using logistic regression models. RESULTS A total of 232 children (61% boys; mean age of 5.8 [3.6] years) were included; 120 children were prescribed once-daily, and 112 twice-daily, ICS. The median PPDC was 66.8% for the once-daily and 57.9% for the twice-daily group (P = .03). Children prescribed once-daily ICS had a 7.2% (95% confidence interval, 1.3-13.1) greater mean PPDC compared with the twice-daily group and greater odds of having PPDC greater than or equal to 75% (71.4% vs 45.5%; odds ratio, 1.80; 95% confidence interval, 1.01-3.26). CONCLUSION Our findings suggest that once-daily dosing of ICS is associated with better medication adherence than twice-daily dosing. Whether the gain in adherence leads to better asthma control and health outcomes remains to be evaluated.
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11
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Pearce CJ, Chan AHY, Jackson T, Fleming L, Foot H, Bush A, Horne R. Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review. Pediatr Pulmonol 2022; 57:822-847. [PMID: 35064651 PMCID: PMC9303909 DOI: 10.1002/ppul.25838] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Nonadherence to inhaled corticosteroids (ICSs) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarizes the efficacy and the characteristics of effective interventions. METHODS Six databases were systematically searched on October 3, 2020 for randomized control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the National Institute for Health and Care Excellence guidelines for medicines adherence (the Perceptions and Practicalities Approach, PAPA) and behavior change techniques (BCTs), to determine the effective aspects of the intervention. RESULTS Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the 25 studies were categorized as being highly reliable. Nine of the 13 interventions were effective at increasing adherence and 6 of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards, reminders, feedback and monitoring of adherence, pharmacological support, instruction on how to take their ICS/adhere, and information about triggers for symptoms and nonadherence. CONCLUSION Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design.
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Affiliation(s)
- Christina J Pearce
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Usher Institute, Asthma UK Centre for Applied Research, London, UK
| | - Amy H Y Chan
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Usher Institute, Asthma UK Centre for Applied Research, London, UK.,Faculty of Medical and Health Sciences, School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Tracy Jackson
- Usher Institute, Asthma UK Centre for Applied Research, London, UK
| | - Louise Fleming
- Usher Institute, Asthma UK Centre for Applied Research, London, UK.,Pediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Holly Foot
- Faculty of Medical and Health Sciences, School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Andy Bush
- Usher Institute, Asthma UK Centre for Applied Research, London, UK.,Pediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Rob Horne
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Usher Institute, Asthma UK Centre for Applied Research, London, UK
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12
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Takkinsatian P, Chantaratin S, Sirisakpanit S, Srisuwatchari W, Pacharn P, Jirapongsananuruk O, Visitsunthorn N. Psychosocial factors and lack of asthma knowledge undermine child and adolescent adherence to inhaled corticosteroid. J Asthma 2021; 59:2234-2245. [PMID: 34752204 DOI: 10.1080/02770903.2021.1999468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with non-adherence in pediatric asthma patients. A total of 134 patients aged 8-18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (<75%). "Intentional" and "hectic lifestyle and forgetfulness" were the main reasons for missing ICS doses in mid-late adolescents and children, respectively. Asthma knowledge generally improved with age. Overall, 89% and 67.7% of patients could define symptoms and triggers of asthma, respectively; however, less than 25% understood how asthma affected their body and the chronic nature of asthma. Patients with ICS adherence <75% had unfavorable expectations from asthma treatment (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.10), and a higher proportion of inhaled short-acting beta-agonist use before exercise (OR: 4.12, 95% CI: 1.27-13.36). Depression and anxiety were frequently found (27.5%) and 23.3%, respectively; p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.
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Affiliation(s)
- P Takkinsatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Chantaratin
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Sirisakpanit
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Pacharn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - O Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Visitsunthorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Said ASA, Hussain N, Abdelaty LN, Al Haddad AHI, Mellal AA. Inhaled Corticosteroid phobia among parents of Egyptian asthmatic children. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Alahmadi FH, Keevil B, Elsey L, George K, Niven R, Fowler SJ. Serum Inhaled Corticosteroid Detection for Monitoring Adherence in Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4279-4287.e6. [PMID: 34153519 DOI: 10.1016/j.jaip.2021.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/15/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Daily inhaled corticosteroids (ICSs) are fundamental to asthma management, but adherence is low. OBJECTIVES To investigate (1) whether LC-MS/MS could be used to detect ICSs in serum and (2) whether serum levels related to markers of disease severity. METHODS We collected blood samples over an 8-hour period from patients with severe asthma prescribed at least 1000 μg daily of beclomethasone dipropionate equivalent. Following baseline sampling, patients were observed taking their usual morning dose. Subsequent blood samples were obtained 1, 2, 4, and 8 hours postinhalation and analyzed by LC-MS/MS. Correlations between serum ICS levels and severity markers were investigated. RESULTS A total of 60 patients were recruited (41 females; 39 prescribed maintenance prednisolone; mean age, 49 ± 12 years; FEV1, 63 ± 20 %predicted). Eight hours postinhalation, all patients using budesonide (n = 10) and beclomethasone dipropionate (15), and all but 1 using fluticasone propionate (28), had detectable serum drug levels. Fluticasone furorate was detected in 2 patients (of 4), ciclesonide in none (of 7). Low adherence by repeat prescription records (<80%) was identified in 43%. Blood ICS levels correlated negatively with exacerbation rate, and (for fluticasone propionate only) positively with FEV1 %predicted. CONCLUSIONS Commonly used ICSs can be reliably detected in the blood at least 8 hours after dosing, and could therefore be used as a measure of adherence in severe asthma. Higher exacerbation rates and poorer lung function (for fluticasone propionate) were associated with lower blood levels.
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Affiliation(s)
- Fahad H Alahmadi
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Brian Keevil
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Lynn Elsey
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Kate George
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Robert Niven
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen J Fowler
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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15
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Zhao D, Chen D, Li L, Zou Y, Shang Y, Zhang C, Zhang L, Pan J, Chen Q, Ai T, Ni Q. CARE: an observational study of adherence to home nebulizer therapy among children with asthma. Ther Adv Respir Dis 2021; 15:1753466620986391. [PMID: 33541235 PMCID: PMC7874342 DOI: 10.1177/1753466620986391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China. Methods: The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers). Results: The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control. Conclusions: Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma. Trial registration ClinicalTrials.gov identifier: NCT03156998 The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Deyu Zhao
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, China
| | - Dehui Chen
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ling Li
- Wuxi Children's Hospital, Wuxi, China
| | - YingXue Zou
- Tianjin Children's Hospital, Tianjing, China
| | - Yunxiao Shang
- ShengJing Hospital of China Medical University, Shenyang, China
| | | | - Li Zhang
- Nanjing First Hospital, Nanjing, China
| | | | - Qiang Chen
- Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Tao Ai
- Chengdu Women & Children's Central Hospital, Chengdu, China
| | - Qian Ni
- Second Hospital of Lanzhou University, Lanzhou, China
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16
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Ravandi B, George M, Thompson L, Vangala SV, Chang T, Okelo S. Inhaled corticosteroid beliefs, complementary and alternative medicine in children presenting to the emergency department for asthma. J Asthma 2020; 58:1359-1366. [PMID: 32646322 DOI: 10.1080/02770903.2020.1786113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Negative beliefs about inhaled corticosteroids (ICS) and endorsement of complementary and alternative medicine (CAM) have been associated with medication non-adherence and uncontrolled asthma. The association of CAM and negative health beliefs is not described in children in acute care settings. Our study objective is to determine the relationship between negative ICS beliefs, CAM use and poorly controlled asthma among a predominantly Latino population in an acute care setting. METHODS The study was conducted in the pediatric emergency department of a children's hospital. During an ED asthma encounter, validated questionnaires surveyed parents about negative ICS beliefs, CAM use, and asthma health and control. We compared asthma health reports between parents who did or did not endorse negative ICS beliefs or CAM use, by chi-squared test (or a Fisher's exact test where appropriate). RESULTS Parents of 174 children identified mostly as Latino with Medicaid insurance and high asthma morbidity. CAM endorsement and negative ICS beliefs were both associated with increased use of lifetime glucocorticoid (p = 0.03 and p=0.01 respectively). While CAM endorsement was associated with less hospitalizations (p = 0.04) and parental report of asthma "getting better" (p = 0.01), CAM users reported trouble with paying for rent or food (p = 0.02). Negative ICS beliefs and CAM endorsement were not associated with medication adherence. CONCLUSIONS Negative ICS beliefs are associated with higher number of oral glucocorticoid courses. The association between CAM endorsement and asthma control is varied, but mostly in favor of improved control. Financial difficulties may make CAM use more likely.
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Affiliation(s)
- Bahareh Ravandi
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Maureen George
- Columbia University School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - Lindsey Thompson
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Todd Chang
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Sande Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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17
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Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
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Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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18
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Abstract
Education on its own doesn't make people take their treatment as intended. However, when it follows shared decision making, in which patient and doctor together agree on the best course of therapeutic action, education helps patients take their treatment. http://bit.ly/2G2XswD.
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Affiliation(s)
- Ellen M. Driever
- Dept of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Paul L.P. Brand
- Dept of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
- LEARN network, University of Groningen and University Medical Centre, Groningen, The Netherlands
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19
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Can C, Akkelle E, Gökmirza Özdemir P, Yazıcıoğlu M, Süt N. Assessment of regular drug use and inhaler technique skills in asthmatic children. Allergol Immunopathol (Madr) 2020; 48:124-129. [PMID: 31627970 DOI: 10.1016/j.aller.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/22/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to assess the regular use of long-term asthma-control medication and to determine inhaler techniques in asthmatic children. METHODS The study was conducted on asthmatic children aged 6-18 years. Information on rescue and controller medications was given and the proper inhalation technique was demonstrated. One month later, patients and parents were asked to answer a questionnaire on drug use and to demonstrate their inhaler techniques. RESULTS One hundred children and/or their parents were interviewed for the study. All of the patients identified long-term asthma-control medications while quick-relief asthma medications were identified by 93% of the patients. Of the patients, 34% described the dose of their quick-relief medication correctly. All steps in the inhalation technique were correctly carried out by 60.6% of patients using a metered-dose inhaler (MDI), 80% of patients using a Turbuhaler, and 58% of patients using a capsule-based dry-powder inhaler (DPI). Of the participants, 73% reported regular use of long-term asthma-control medications. While the mean age of the patients regularly using long-term asthma medications was 9.05±2.5 years, that of patients not compliant with the regular treatment was 10.29±3.26 years (p=0.04). The most common reason for irregular drug use was forgetting to take the drug. CONCLUSION Adherence to long-term asthma-control medications tends to be better in younger patients. Since the most common cause of irregular drug use is forgetting to take the drug, repeated training is necessary to ensure asthma control and the successful treatment of asthmatic children.
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Affiliation(s)
- Ceren Can
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey.
| | - Emre Akkelle
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Pınar Gökmirza Özdemir
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mehtap Yazıcıoğlu
- Department of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Necdet Süt
- Department of Biostatistics, Trakya University Faculty of Medicine, Edirne, Turkey
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20
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Divecha CA, Tullu MS, Jadhav DU. Parental knowledge and attitudes regarding asthma in their children: Impact of an educational intervention in an Indian population. Pediatr Pulmonol 2020; 55:607-615. [PMID: 31962003 DOI: 10.1002/ppul.24647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/05/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Research shows positive effects of asthma education in improving parental knowledge, self-management skills, and reducing healthcare costs. Such studies are lacking in resource-limited countries. We studied the effectiveness of educational intervention in improving the knowledge and attitudes of parents/caregivers of asthmatic children. METHODS The study was conducted in the pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into the interventional group (A) receiving education module and control group (B). Parents' asthma knowledge and attitudes were assessed at baseline and 5 months postenrollment using 25-item questionnaire. Detailed demographic data, clinical data, and exacerbations during study were noted. RESULTS A total of 75 parents/guardians fulfilling inclusion criteria were analyzed (cases/group A: 37 and controls/group B: 38). 8.3 percent of parents/caregivers were illiterate. Around 36.9% of patients had a family history of allergy/asthma. Mean knowledge scores at follow-up were 12.24 and 9.89 for groups A and B, respectively (P < .05). Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma, and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude-based questions postintervention as compared with the nonintervention group (B). There was no statistically significant difference in asthma severity and control between the two groups at follow-up. CONCLUSIONS Small group education on asthma in parents/caregivers improves their knowledge and attitudes. Healthcare plans should invest in pediatric asthma education and identify key personnel/opportunities to impart the same in routine care.
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Affiliation(s)
- Chhaya A Divecha
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Devika U Jadhav
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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21
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De Keyser HH, Ramsey R, Federico MJ. They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity. Pediatr Pulmonol 2020; 55:818-825. [PMID: 31944593 PMCID: PMC10187561 DOI: 10.1002/ppul.24643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult-to-treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient-related factors may all affect medication adherence. Multicomponent patient-centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.
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Affiliation(s)
- Heather Hoch De Keyser
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monica J Federico
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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22
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Jácome C, Pereira AM, Almeida R, Ferreira-Magalhaes M, Couto M, Araujo L, Pereira M, Correia MA, Loureiro CC, Catarata MJ, Maia Santos L, Pereira J, Ramos B, Lopes C, Mendes A, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Afonso I, Carvalho J, Arrobas A, Coutinho Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Leiria Pinto P, Neuparth N, Palhinha A, Gaspar Marques J, Pinto N, Martins P, Todo Bom F, Alvarenga Santos M, Gomes Costa A, Silva Neto A, Santalha M, Lozoya C, Santos N, Silva D, Vasconcelos MJ, Taborda-Barata L, Carvalhal C, Teixeira MF, Alves RR, Moreira AS, Sofia Pinto C, Morais Silva P, Alves C, Câmara R, Coelho D, Bordalo D, Fernandes RM, Ferreira R, Menezes F, Gomes R, Calix MJ, Marques A, Cardoso J, Emiliano M, Gerardo R, Nunes C, Câmara R, Ferreira JA, Carvalho A, Freitas P, Correia R, Fonseca JA. Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. BMJ Open 2019; 9:e031732. [PMID: 31699737 PMCID: PMC6858182 DOI: 10.1136/bmjopen-2019-031732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. DESIGN Baseline data from two prospective multicentre observational studies. SETTING 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. PARTICIPANTS 395 patients (≥13 years old) with persistent asthma. MEASURES Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. RESULTS High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). CONCLUSION Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Manuel Ferreira-Magalhaes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mariana Couto
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Luís Araujo
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Mariana Pereira
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | | | - Cláudia Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Maria Joana Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Lília Maia Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Pereira
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Bárbara Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | | | - Georgeta Oliveira
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Paula Aguiar
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ivete Afonso
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - José Coutinho Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Joana Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Azevedo
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Marta Alves
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nuno Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Ana Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - João Gaspar Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nicole Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Pedro Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Filipa Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | | | - Marta Santalha
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimaraes, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar do Algarve EPE, Faro, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Hospital São João, Porto, Portugal
| | | | - Luís Taborda-Barata
- University of Beira Interior, CICS - Health Sciences Research Centre; NuESA - Environment & Health Study Group, Faculty of Health Sciences, Covilha, Portugal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Célia Carvalhal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rodrigo Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Cláudia Sofia Pinto
- Serviço de Pneumologia, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | | | - Carlos Alves
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Didina Coelho
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Centro Hospitalar do Médio Ave EPE, Santo Tirso, Portugal
| | - Ricardo M Fernandes
- Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon Medical Faculty, Lisboa, Portugal
| | | | - Fernando Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Ana Marques
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - João Cardoso
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Rita Gerardo
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - José Alberto Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Aurora Carvalho
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Freitas
- Bloco operatório, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Correia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
| | - Joao A Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
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Arcoleo KJ, McGovern C, Kaur K, Halterman JS, Mammen J, Crean H, Rastogi D, Feldman JM. Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Use. Ann Am Thorac Soc 2019; 16:715-723. [PMID: 30860858 PMCID: PMC6543480 DOI: 10.1513/annalsats.201807-462oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Researchers tend to study Latinos as a single group, but recent asthma research confirmed differences among Latino subgroups. Variations in controller medication adherence may be a factor in the observed health disparities between Mexican and Puerto Rican children. Adherence is not a stable phenomenon; however, there is a paucity of data on patterns of adherence, sociodemographic predictors of patterns, and variations in asthma-related acute healthcare use by adherence pattern among Latino subgroups. Objectives: To identify patterns of inhaled corticosteroid medication adherence over 12 months among Mexican and Puerto Rican children with persistent asthma, to examine sociodemographic predictors of adherence patterns by ethnicity, and to investigate asthma-related acute healthcare use based on these patterns. Methods: We analyzed controller medication Doser data from Mexican and Puerto Rican children (n = 123; ages 5-12 yr) with persistent asthma who participated with their caregivers in a longitudinal nonintervention study (Phoenix, AZ, and Bronx, NY). Interview and medical record data were collected at enrollment and at 3, 6, 9, and 12 months after enrollment. Results: Forty-seven to fifty-three percent of children had poor adherence (<50%) over each of the follow-up periods (cross-sectional). Children with lowest adherence were Puerto Rican, from nonpoor families, or female. Longitudinal latent class analysis yielded four adherence classes: poor, moderate, decreasing adherence, and increasing adherence. Puerto Rican children had significantly higher odds of "decreasing" (odds ratio [OR], 2.86; 95% confidence interval [CI], 0.40 to 20.50) and "poor" (OR, 5.62; 95% CI, 1.44 to 21.90) adherence than Mexican children. Females had significantly greater odds of "decreasing" (OR, 4.80; 95% CI, 0.73 to 31.74) and "poor" (OR, 5.20; 95% CI, 1.77 to 15.30) adherence group membership than males. The "decreasing" adherence group was comprised of only poor children. Children in the "poor" adherence class had the highest mean number of acute visits and emergency department visits/hospitalizations across all assessment periods. Conclusions: This study demonstrated that unique ethnicity within Latino populations may be associated with different risk levels for suboptimal controller medication adherence, which may be a factor in the observed asthma health disparities between Mexican and Puerto Rican children. Increased understanding of and attention to children's controller medication adherence patterns will provide evidence needed to identify children at highest risk for acute healthcare use and offer more-intensive intervention using less-intensive approaches for those at low risk. Clinical trial registered with www.clinicaltrials.gov (NCT01099800).
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Affiliation(s)
| | - Colleen McGovern
- 2 School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Karenjot Kaur
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jill S Halterman
- 4 Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Jennifer Mammen
- 5 School of Nursing, University of Rhode Island, Providence, Rhode Island; and
| | | | - Deepa Rastogi
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jonathan M Feldman
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
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Abstract
PURPOSE OF REVIEW Asthma attacks are frequent in children with asthma and can lead to significant adverse outcomes including time off school, hospital admission and death. Identifying children at risk of an asthma attack affords the opportunity to prevent attacks and improve outcomes. RECENT FINDINGS Clinical features, patient behaviours and characteristics, physiological factors, environmental data and biomarkers are all associated with asthma attacks and can be used in asthma exacerbation prediction models. Recent studies have better characterized children at risk of an attack: history of a severe exacerbation in the previous 12 months, poor adherence and current poor control are important features which should alert healthcare professionals to the need for remedial action. There is increasing interest in the use of biomarkers. A number of novel biomarkers, including patterns of volatile organic compounds in exhaled breath, show promise. Biomarkers are likely to be of greatest utility if measured frequently and combined with other measures. To date, most prediction models are based on epidemiological data and population-based risk. The use of digital technology affords the opportunity to collect large amounts of real-time data, including clinical and physiological measurements and combine these with environmental data to develop personal risk scores. These developments need to be matched by changes in clinical guidelines away from a focus on current asthma control and stepwise escalation in drug therapy towards inclusion of personal risk scores and tailored management strategies including nonpharmacological approaches. SUMMARY There have been significant steps towards personalized prediction models of asthma attacks. The utility of such models needs to be tested in the ability not only to predict attacks but also to reduce them.
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25
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Roche N, Campbell JD, Krishnan JA, Brusselle G, Chisholm A, Bjermer L, Thomas M, van Ganse E, van den Berge M, Christoff G, Quint J, Papadopoulos NG, Price D. Quality standards in respiratory real-life effectiveness research: the REal Life EVidence AssessmeNt Tool (RELEVANT): report from the Respiratory Effectiveness Group-European Academy of Allergy and Clinical Immunology Task Force. Clin Transl Allergy 2019; 9:20. [PMID: 30962875 PMCID: PMC6436229 DOI: 10.1186/s13601-019-0255-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/31/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development. METHODS The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real-life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real-life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. RESULTS Although highlighting a general lack of high-quality real-life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. CONCLUSIONS Using such quality appraisal tools is mandatory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and/or decision-making in clinical practice.
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Affiliation(s)
- Nicolas Roche
- Pneumologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Jonathan D. Campbell
- Center for Pharmaceutical Outcomes Reasearch, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO USA
| | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, 221, 85 Lund, Sweden
| | - Mike Thomas
- University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Eric van Ganse
- Claude-Bernard Lyon1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | | | - George Christoff
- Medical University - Sofia, Faculty of Public Health, 8 “Bialo more” str, 1527, Sofia, Bulgaria
| | - Jennifer Quint
- Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | | | - David Price
- Observational and Pragmatic Research Institute, 60 Paya Lebar Road, Paya Lebar Square, #05-33/34, Singapore, 409051 Singapore
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Davis SA, Carpenter D, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE, Sleath B. Effect of an Asthma Question Prompt List and Video Intervention on Adolescents' Medication Adherence 12 Months Later. Ann Pharmacother 2019; 53:683-689. [PMID: 30758220 DOI: 10.1177/1060028019831259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Many adolescents do not obtain the maximum benefit from their asthma medications. Improving patient-provider communication may improve adolescents' asthma knowledge, adherence, and clinical outcomes. OBJECTIVE To determine how a question prompt list and educational video intervention affect youth- and caregiver-reported medication adherence and self-reported medication problems. METHODS Adolescents with persistent asthma (n = 359; 56.4% with moderate to severe asthma) and their caregivers were enrolled in a randomized controlled trial at 4 pediatric clinics. Intervention group families received a question prompt list and watched a short video before seeing the provider; control families received usual care. Youth- and caregiver-reported medication adherence was measured with a Visual Analog Scale, ranging from 0 to 100. Generalized estimating equations were used to determine how the intervention and covariates were associated with medication adherence and reported problems at 12 months. RESULTS The intervention was not a significant predictor of medication adherence at 12 months. Higher caregiver education was associated with higher youth-reported adherence (β = 1.1; 95% CI = 0.1, 2.1; P = 0.036) and caregiver-reported adherence (β = 1.2; 95% CI = 0.3, 2.0; P = 0.006). The intervention was associated with fewer caregiver-reported problems at 12 months (β = -0.32; 95% CI = -0.48, -0.16; P < 0.001). CONCLUSIONS AND RELEVANCE A question prompt list and educational video decreased the number of caregiver-reported medication problems, but did not significantly affect medication adherence. Further research is needed to develop more effective interventions to improve medication adherence and outcomes.
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Affiliation(s)
- Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Boutopoulou B, Koumpagioti D, Matziou V, Priftis KN, Douros K. Interventions on Adherence to Treatment in Children With Severe Asthma: A Systematic Review. Front Pediatr 2018; 6:232. [PMID: 30186824 PMCID: PMC6110874 DOI: 10.3389/fped.2018.00232] [Citation(s) in RCA: 24] [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: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction: Poor adherence to inhaled medication is a commonly encountered problem among children with asthma. However, there is a relatively paucity of data regarding the adherence of children with severe asthma, as well as the merit of any interventions to improve this adherence. Objectives: The aim of this systematic review was to identify the available literature on the rate of adherence and the influence of interventions in improving adherence to controller inhaled medication, in children with severe asthma. Methods: A systematic literature search was performed in MEDLINE/PubMed, Cochrane Library, and Scopus databases. Studies were included in the present review if their target population were children and/or adolescents with severe asthma and presented data on medication adherence before and after a given intervention. Results: A total of seven studies, conducted in USA, Canada, and UK, and published between 2012 and 2018, met the inclusion criteria. Adherence to controller medication was assessed via either objective or subjective measures (questionnaires), or a combination of them. Interventions included communication during pediatric visits and audio-taped medical visits, individualized care programs, electronic monitoring devices, interactive website and peak-flow prediction with feedback. Adherence rates for the baseline (before intervention) or for the control groups ranged from 28 to 67%. In general, there was a significant improvement of adherence after intervention with rates increasing to 49-81%. Conclusion: Adherence rate in children with severe asthma is not satisfactory but it can be improved after proper interventions. Nevertheless, the heterogeneity among adherence assessment tools, and the variety of interventions, in combination with the lack of studies focusing on severe asthma, highlight the need for further research in this field.
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Affiliation(s)
- Barbara Boutopoulou
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Despoina Koumpagioti
- 2nd Pediatric Department of National and Kapodistrian University of Athens, “P & A Kiriakou” Children Hospital, Athens, Greece
| | - Vasiliki Matziou
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas N. Priftis
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Konstantinos Douros
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
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Adherence to Polyethylene Glycol Treatment in Children with Functional Constipation Is Associated with Parental Illness Perceptions, Satisfaction with Treatment, and Perceived Treatment Convenience. J Pediatr 2018; 199:132-139.e1. [PMID: 29754864 DOI: 10.1016/j.jpeds.2018.03.066] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/28/2018] [Accepted: 03/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess treatment adherence in children with functional constipation and to evaluate the association with parental beliefs about medication, illness perceptions, treatment satisfaction, and satisfaction with information about medication. STUDY DESIGN A cross-sectional survey was administered among parents of children with functional constipation treated with polyethylene glycol. Adherence was measured via the Medication Adherence Report Scale (MARS-5, score 5-25), with greater scores indicating better adherence (scores ≥23 were defined as adherent). Beliefs about medication, illness perceptions, satisfaction with treatment, and satisfaction with information about treatment were measured with the Beliefs about Medication Questionnaire, the Brief Illness Perception Questionnaire, the Treatment Satisfaction Questionnaire for Medication (TSQM), and the Satisfaction with Information about Medication Questionnaire. Associations between the questionnaire scores and adherence (MARS-5 score as a continuous variable) were analyzed with regression analyses. RESULTS In total, 43 of 115 included children (37%) were adherent (MARS-5 ≥23). Spearman rank correlation test revealed a statistically significant correlation between TSQM-convenience, TSQM-satisfaction, Brief Illness Perception Questionnaire question 8 (emotions), and the MARS-5 score (rs 0.342, P = .000; rs 0.258, P = .006; rs -0.192, P = .044), which suggests that parental perceived treatment convenience, satisfaction with treatment, and illness perceptions may affect adherence in children with functional constipation. In the hierarchical multivariate regression model, 22% of the variability of the MARS-5 score could be explained by the selected predictors. The TSQM-convenience score contributed the most to the model (β: 0.384, P = .000). CONCLUSIONS Parents reported low adherence rates in their children with functional constipation. Treatment inconvenience, dissatisfaction with treatment, and the emotional impact of functional constipation may negatively influence treatment adherence.
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29
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Licari A, Brambilla I, Marseglia A, De Filippo M, Paganelli V, Marseglia GL. Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. Front Pediatr 2018; 6:170. [PMID: 29971223 PMCID: PMC6018103 DOI: 10.3389/fped.2018.00170] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 01/14/2023] Open
Abstract
Evaluating the degree of disease control is pivotal when assessing a patient with asthma. Asthma control is defined as the degree to which manifestations of the disease are reduced or removed by therapy. Two domains of asthma control are identified in the guidelines: symptom control and future risk of poor asthma outcomes, including asthma attacks, accelerated decline in lung function, or treatment-related side effects. Over the past decade, the definition and the tools of asthma control have been substantially implemented so that the majority of children with asthma have their disease well controlled with standard therapies. However, a small subset of asthmatic children still requires maximal therapy to achieve or maintain symptom control and experience considerable morbidity. Childhood uncontrolled asthma is a heterogeneous group and represents a clinical and therapeutic challenge requiring a multidisciplinary systematic assessment. The identification of the factors that may contribute to the gain or loss of control in asthma is essential in differentiating children with difficult-to-treat asthma from those with severe asthma that is resistant to traditional therapies. The aim of this review is to focus on current concept of asthma control, describing monitoring tools currently used to assess asthma control in clinical practice and research, and evaluating comorbidities and modifiable and non-modifiable factors associated with uncontrolled asthma in children, with particular reference to severe asthma.
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Affiliation(s)
| | | | | | | | | | - Gian L. Marseglia
- Department of Pediatric, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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30
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Sleath B, Gratie D, Carpenter D, Davis SA, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Reported Problems and Adherence in Using Asthma Medications Among Adolescents and Their Caregivers. Ann Pharmacother 2018; 52:855-861. [PMID: 29592540 DOI: 10.1177/1060028018766603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many factors affect youth adherence to asthma medications. Better understanding of the relationship between problems reported by youth in using asthma medications, self-efficacy, outcome expectations, and adherence is needed. OBJECTIVE The study examined the relationship between youth and caregiver problems in using asthma medications, asthma management self-efficacy, outcome expectations, and youth- and caregiver-reported adherence to asthma controller medications. METHODS Adolescents with persistent asthma and their caregivers were recruited at 4 pediatric practices. Youth were interviewed after their medical visit while caregivers completed a questionnaire. Multivariable linear regression was used to analyze the data. RESULTS Of 359 participating youth, 319 were on controller medications. Youth reported 60% average adherence, whereas caregivers reported 69%. Youth who reported difficulty using their inhaler correctly and youth who reported difficulty remembering to take their medications were significantly less likely to be adherent. Caregivers who reported that it was hard to remember when to give the asthma medications were significantly less likely to report their child being adherent. Both youth and caregivers with higher outcome expectations were significantly more likely to self-report being adherent. CONCLUSIONS Pharmacists and other health care providers should consider asking youth and caregivers about problems in using asthma medications, self-efficacy in managing asthma, and outcome expectations for following treatment regimens, so that they can help youth overcome difficulties they might have in managing their asthma.
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Affiliation(s)
- Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Gratie
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Lee
- 2 Polyglot Systems, Inc, Morrisville, NC, USA
| | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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31
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Ramratnam SK, Bacharier LB, Guilbert TW. Severe Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:889-898. [PMID: 28689839 DOI: 10.1016/j.jaip.2017.04.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
Severe asthma in children is associated with significant morbidity and is a highly heterogeneous disorder with multiple clinical phenotypes. Cluster analyses have been performed in several groups to explain some of the heterogeneity of pediatric severe asthma, which is reviewed in this article. The evaluation of a child with severe asthma includes a detailed diagnostic assessment and excluding other possible diagnoses and addressing poor control due to comorbidities, lack of adherence to asthma controller medications, poor technique, and other psychological and environmental factors. Children with severe asthma require significant resources including regular follow-up appointments with asthma education, written asthma action plan, and care by a multidisciplinary team. Management of pediatric severe asthma now includes emerging phenotypic-directed therapies; however, continued research is still needed to further study the long-term outcomes of pediatric severe asthma and its treatment.
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Affiliation(s)
- Sima K Ramratnam
- University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Leonard B Bacharier
- Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Theresa W Guilbert
- Division of Pulmonology Medicine, Cincinnati Children's Hospital & Medical Center, Cincinnati, Ohio
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32
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Sulaiman I, Greene G, MacHale E, Seheult J, Mokoka M, D'Arcy S, Taylor T, Murphy DM, Hunt E, Lane SJ, Diette GB, FitzGerald JM, Boland F, Sartini Bhreathnach A, Cushen B, Reilly RB, Doyle F, Costello RW. A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma. Eur Respir J 2018; 51:51/1/1701126. [PMID: 29301919 DOI: 10.1183/13993003.01126-2017] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/29/2017] [Indexed: 11/05/2022]
Abstract
In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence.Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis.The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%-17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%).Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.
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Affiliation(s)
- Imran Sulaiman
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Garrett Greene
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Elaine MacHale
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Jansen Seheult
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Matshediso Mokoka
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Shona D'Arcy
- Trinity Centre for Bioengineering, Trinity College, The University of Dublin, Dublin, Ireland
| | - Terence Taylor
- Trinity Centre for Bioengineering, Trinity College, The University of Dublin, Dublin, Ireland
| | - Desmond M Murphy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,HRB Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - Eoin Hunt
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,HRB Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | | | - Gregory B Diette
- Dept of Medicine, Johns Hopkins University Hospital, Baltimore, USA
| | - J Mark FitzGerald
- UBC Institute for Heart and Lung Health, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Boland
- Population Health Sciences (Psychology), RCSI, Dublin, Ireland
| | | | - Breda Cushen
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Bioengineering, Trinity College, The University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College, The University of Dublin, Dublin, Ireland.,School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Frank Doyle
- Population Health Sciences (Psychology), RCSI, Dublin, Ireland
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland .,Dept of Respiratory Medicine, RCSI, Dublin, Ireland
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33
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Abstract
Severe asthma is a complex and heterogeneous disease. The European Respiratory Society and American Thoracic Society guidelines define severe asthma for patients 6 years or older as "asthma which requires treatment with high-dose inhaled corticosteroids…plus a second controller or systemic corticosteroids to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy." This article reviews available traditional therapies, data behind their uses in severe asthma, and varying recommendations. As various asthma endotypes and phenotypes are better understood and characterized, targeted therapies should help improve disease outcomes, efficacy, and cost-effectiveness.
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Affiliation(s)
- Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, 1635 Aurora Court, Aurora, CO 80045, USA
| | - Flavia C L Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, 1635 Aurora Court, Aurora, CO 80045, USA.
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34
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Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E, Saglani S, Bush A, Frey U, Fleming LJ. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. Eur Respir J 2017; 50:50/6/1700910. [PMID: 29269577 DOI: 10.1183/13993003.00910-2017] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 09/19/2017] [Indexed: 11/05/2022]
Abstract
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
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Affiliation(s)
- Anja Jochmann
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.,University of Basel, University Children's Hospital (UKBB), Basel, Switzerland
| | - Luca Artusio
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Angela Jamalzadeh
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Prasad Nagakumar
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | | | - Sejal Saglani
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Bush
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Urs Frey
- University of Basel, University Children's Hospital (UKBB), Basel, Switzerland
| | - Louise J Fleming
- Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK .,National Heart and Lung Institute, Imperial College London, London, UK
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35
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Incorporating technology to advance asthma controller adherence. Curr Opin Allergy Clin Immunol 2017; 17:153-159. [PMID: 28118240 DOI: 10.1097/aci.0000000000000343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Technological innovations, including text messaging, smart phone applications, and electronic monitoring devices, aimed at improving asthma controller adherence are being rapidly introduced both into clinical care and directly marketed to patients. This review analyzes recent clinical trials implementing these interventions, with a focus on their benefits and shortcomings. RECENT FINDINGS Poor medication adherence continues to exert significant morbidity on patients with asthma. Objective, real-time measures to monitor adherence can overcome the limitations of prior methods, including self-report and prescription refills. Technological advances, especially those incorporating reminder systems, have demonstrated improved controller adherence. The increased adherence in these trials has not translated into consistent clinical improvement, including reducing hospitalizations, emergency department visits, and asthma exacerbations, possibly secondary to study design and poor inhalation technique. SUMMARY Novel monitoring and reminder technology can augment patient medication adherence and provide clues to management before escalating therapy. Further studies are needed to investigate the overarching clinical impact of this technology, especially as it grows into routine clinical practice.
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Brand PLP, van Dulmen S. Can we trust what parents tell us? A systematic review. Paediatr Respir Rev 2017; 24:65-71. [PMID: 28283301 DOI: 10.1016/j.prrv.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/11/2022]
Abstract
Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.
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Affiliation(s)
- Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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37
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Cook J, Beresford F, Fainardi V, Hall P, Housley G, Jamalzadeh A, Nightingale M, Winch D, Bush A, Fleming L, Saglani S. Managing the pediatric patient with refractory asthma: a multidisciplinary approach. J Asthma Allergy 2017; 10:123-130. [PMID: 28461761 PMCID: PMC5404805 DOI: 10.2147/jaa.s129159] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Children with asthma that is refractory to high levels of prescribed treatment are described as having problematic severe asthma. Those in whom persistent symptoms result from a failure of basic asthma management are described as having "difficult asthma", while those who remain symptomatic despite these factors having been addressed are described as having "severe therapy-resistant asthma" (STRA). The majority of children have difficult asthma; asthma that is poorly controlled because of a failure to get the basics of asthma management right. Modifiable factors including nonadherence to medication, persistent adverse environmental exposures, and psychosocial factors often contribute to poor control in these patients. As our skill in identifying and addressing modifiable factors has improved, we have found that a progressively smaller proportion of our clinic patients is categorized as having true STRA, resulting in an infrequent resort to escalation of treatment. Many of the modifiable factors associated with the diagnosis of difficult asthma can be identified in a general pediatric clinic. Characterization of more complex factors, however, requires the time, skill, and expertise of multiple health care professionals within the asthma multidisciplinary team. In this review, we will describe the structured approach adopted by The Royal Brompton Hospital in the management of the child with problematic severe asthma. We highlight the roles of members of the multidisciplinary team at various stages of assessment and focus on prominent themes in the identification and treatment of modifiable factors.
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Affiliation(s)
- James Cook
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Fran Beresford
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Valentina Fainardi
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
| | - Pippa Hall
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Georgie Housley
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | | | | | - David Winch
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Andrew Bush
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Louise Fleming
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Sejal Saglani
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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38
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ASMA SEVERA PROBLEMÁTICA EN PEDIATRÍA. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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39
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Can exhaled nitric oxide fraction predict adherence to inhaled corticosteroids in atopic and nonatopic children with asthma? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:521-522. [PMID: 27888027 DOI: 10.1016/j.jaip.2016.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 11/21/2022]
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40
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Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, SOH JY, Le Souef P. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J 2016; 9:26. [PMID: 27551328 PMCID: PMC4982274 DOI: 10.1186/s40413-016-0117-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023] Open
Abstract
Despite the availability of several formulations of inhaled corticosteroids (ICS) and delivery devices for treatment of childhood asthma and despite the development of evidence-based guidelines, childhood asthma control remains suboptimal. Improving uptake of asthma management plans, both by families and practitioners, is needed. Adherence to daily ICS therapy is a key determinant of asthma control and this mandates that asthma education follow a repetitive pattern and involve literal explanation and physical demonstration of the optimal use of inhaler devices. The potential adverse effects of ICS need to be weighed against the benefit of these drugs to control persistent asthma especially that its safety profile is markedly better than oral glucocorticoids. This article reviews the key mechanisms of inhaled corticosteroid action; recommendations on dosage and therapeutic regimens; potential optimization of effectiveness by addressing inhaler technique and adherence to therapy; and updated knowledge on the real magnitude of adverse events.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | | | - Bee Wah Lee
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meenu Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dalia El-Ghoneimy
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | - Jian Yi SOH
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Le Souef
- Winthrop Professor of Paediatrics & Child Health, School of Paediatrics & Child Health, University of Western Australia, Crawley, Australia
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41
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Abstract
INTRODUCTION Children with difficult asthma have significant morbidity and fail to achieve asthma control despite being prescribed high dose maintenance treatment. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Underlying modifiable factors including non-adherence to medication, persistent environmental exposures that trigger asthma symptoms and psychosocial factors contribute to poor control in these patients. AREAS COVERED The focus of this review is to provide a practical approach to the diagnosis and management of difficult asthma including an overview of long term assessments to identify potential progression to true, severe asthma. A multi-disciplinary team is critical to enable modifiable factors to be identified and addressed. Significant resources are required to manage paediatric difficult asthma optimally and only specialist centres should be tasked with the assessment of these patients. Although this may have an impact on healthcare resources, long term benefits for lung health are significant. Expert commentary: The management of paediatric difficult asthma is not simple and involves numerous professionals with varied expertise. However, if it is not undertaken with the appropriate skills, there is a significant risk of children receiving inappropriate invasive investigations and therapies that will have no impact on morbidity.
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Affiliation(s)
- Sejal Saglani
- a Inflammation, Repair and Development , National Heart & Lung Institute, Imperial College London , London , UK.,b Respiratory Paediatrics , Royal Brompton Hospital , London , UK
| | - Louise Fleming
- a Inflammation, Repair and Development , National Heart & Lung Institute, Imperial College London , London , UK.,b Respiratory Paediatrics , Royal Brompton Hospital , London , UK
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42
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Garcia-Marcos PW, Brand PLP, Kaptein AA, Klok T. Is the MARS questionnaire a reliable measure of medication adherence in childhood asthma? J Asthma 2016; 53:1085-9. [PMID: 27177241 DOI: 10.1080/02770903.2016.1180699] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the reliability of the Medication Adherence Report Scale (MARS-5) for assessing adherence in clinical practice and research. METHODS Prospective cohort study following electronically measured inhaled corticosteroids (ICS) adherence for 1 year in 2-13-year-old children with persistent asthma. The relationship between electronically measured adherence and MARS-5 scores (ranging from 5 to 25) was assessed by Spearman's rank correlation coefficient. A ROC (receiver operating characteristic) curve was performed testing MARS-5 against electronically measured adherence. Sensitivity, specificity, positive and negative likelihood ratios of the closest MARS-5 cut-off values to the top left-hand corner of the ROC curve were calculated. RESULTS High MARS scores were obtained (median 24, interquartile range 22-24). Despite a statistically significant correlation between MARS-5 and electronically assessed adherence (Spearman's rho = 0.47; p < 0.0001), there was considerable variation of adherence rates at every MARS-5 score. The area under the ROC curve was 0.7188. A MARS-5 score ≥23 had the best predictive ability for electronically assessed adherence, but positive and negative likelihood ratios were too small to be useful (1.65 and 0.27, respectively). CONCLUSIONS Self-report using MARS-5 is too inaccurate to be a useful measure of adherence in children with asthma, both in clinical practice and in research.
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Affiliation(s)
- Patricia W Garcia-Marcos
- a Deparment of General Pediatrics, Arrixaca University Children's Hospital , University of Murcia , Murcia , Spain.,b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands
| | - Paul L P Brand
- b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands.,c UMCG Postgraduate School of Medicine , University Medical Center, University of Groningen , The Netherlands
| | - Adrian A Kaptein
- d Unit of Psychology , Leiden University Medical Center , Leiden , The Netherlands
| | - Ted Klok
- b Princess Amalia Children's Center , Isala Hospital , Zwolle , The Netherlands.,e Department of Paediatric Pulmonology and Allergology , Wilhelmina Children's Hospital, University Medical Centre Utrecht , The Netherlands
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43
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Kikidis D, Konstantinos V, Tzovaras D, Usmani OS. The Digital Asthma Patient: The History and Future of Inhaler Based Health Monitoring Devices. J Aerosol Med Pulm Drug Deliv 2016; 29:219-32. [PMID: 26919553 DOI: 10.1089/jamp.2015.1267] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The wave of digital health is continuously growing and promises to transform healthcare and optimize the patients' experience. Asthma is in the center of these digital developments, as it is a chronic disease that requires the continuous attention of both health care professionals and patients themselves. The accurate and timely assessment of the state of asthma is the fundamental basis of digital health approaches and is also the most significant factor toward the preventive and efficient management of the disease. Furthermore, the necessity of inhaled medication offers a basic platform upon which modern technologies can be integrated, namely the inhaler device itself. Inhaler-based monitoring devices were introduced in the beginning of the 1980s and have been evolving but mainly for the assessment of medication adherence. As technology progresses and novel sensing components are becoming available, the enhancement of inhalers with a wider range of monitoring capabilities holds the promise to further support and optimize asthma self-management. The current article aims to take a step for the mapping of this territory and start the discussion among healthcare professionals and engineers for the identification and the development of technologies that can offer personalized asthma self-management with clinical significance. In this direction, a technical review of inhaler based monitoring devices is presented, together with an overview of their use in clinical research. The aggregated results are then summarized and discussed for the identification of key drivers that can lead the future of inhalers.
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Affiliation(s)
- Dimitrios Kikidis
- 1 Centre of Research & Technology-Hellas, Information Technologies Institute , Thessaloniki, Greece
| | - Votis Konstantinos
- 1 Centre of Research & Technology-Hellas, Information Technologies Institute , Thessaloniki, Greece
| | - Dimitrios Tzovaras
- 1 Centre of Research & Technology-Hellas, Information Technologies Institute , Thessaloniki, Greece
| | - Omar S Usmani
- 2 Imperial College London and Royal Brompton Hospital, National Heart and Lung Institute , London, United Kingdom
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