1
|
Lee WS, Hwang JK, Ryu J, Choi YJ, Oh JW, Kim CR, Han MY, Oh IH, Lee KS. The relationship between childhood asthma and socioeconomic status: a Korean nationwide population-based study. Front Public Health 2023; 11:1133312. [PMID: 37181696 PMCID: PMC10167280 DOI: 10.3389/fpubh.2023.1133312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose This study aimed to investigate associations of socioeconomic status (SES) with asthma exacerbation and asthma-related hospital utilization factors among children with asthma in the Republic of Korea. Methods This study retrospectively analyzed population-level data from the Korean National Health Insurance Service, collected from 2013 through 2019. SES was classified into five categories according to the national health insurance premiums quantiles (0 [lowest] to 4 [highest]). The hazard ratios (HRs) for asthma exacerbation, emergency department (ED) visits, hospital admission, and intensive care unit (ICU) admission were analyzed with respect to SES. Results Among the five SES groups, SES group 0 (medical aid), had the highest tallies and proportions of children who experienced asthma exacerbations (n = 1,682, 4.8%), ED visits (n = 932, 2.6%), hospital admission (n = 2,734, 7.7%) and ICU admission (n = 14, 0.04%). Compared with SES group 4, SES group 0 had adjusted HRs of 3.73 (p = 0.0113) and 1.04 (p < 0.0001) for ventilator support/tracheal intubation and administration of systemic corticosteroids, respectively. Relative to group 4, the adjusted HRs for ED visits, hospital admission, and ICU admission in group 0 were 1.88 (p < 0.0001), 2.20 (p < 0.0001), and 7.12 (p < 0.0001), respectively. In the survival analysis, group 0 had a significantly higher risk of ED presentation, hospital admission, and ICU admission than the other groups (log-rank p < 0.001). Conclusion Compared with children of higher SES, those in the lowest SES group had increased risk of asthma exacerbation, hospital admission, and receiving treatment for severe asthma symptoms.
Collapse
Affiliation(s)
- Won Seok Lee
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University College of Medicine, Goyang, Republic of Korea
| | - Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jiin Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - In Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| |
Collapse
|
2
|
Bingham Y, Sanghani N, Cook J, Hall P, Jamalzadeh A, Moore-Crouch R, Bush A, Fleming L, Saglani S. Electronic adherence monitoring identifies severe preschool wheezers who are steroid responsive. Pediatr Pulmonol 2020; 55:2254-2260. [PMID: 32621653 DOI: 10.1002/ppul.24943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 11/09/2022]
Abstract
Little is known about adherence to inhaled corticosteroids (ICS) in preschool children with troublesome wheeze. Children with aeroallergen senitization, or those reporting multiple trigger wheeze (MTW), are more likely to respond to ICS. We hypothesized that adherence to ICS and symptom control are only positively related in atopic children, or those reporting MTW. Patients aged 1 to 5 years with recurrent wheeze prescribed ICS were recruited from a tertiary respiratory clinic. Clinical phenotype and aeroallergen senitization were determined, and adherence assessed using an electronic monitoring device (Smartinhaler). Symptom control (test for respiratory and asthma control in kids [TRACK]), quality of life (PACQLQ), airway inflammation (offline exhaled nitric oxide) were assessed at baseline and follow-up. Forty-eight children (mean age 3.7 years; SD, 1.2) were monitored for a median of 112 (interquartile range [IQR], 91-126) days. At baseline n = 29 reported episodic viral wheeze and n = 19 reported MTW. Twenty-four out of 48 (50%) wheezers had suboptimal ICS adherence (<80%). Median adherence was 64% (IQR, 38-84). There was a significant increase in TRACK and PACQLQ in the group as a whole, unrelated to adherence. In subgroup analysis only atopic wheezers with moderate or good adherence ≥ 60% had a significant increase in TRACK. There was no relationship between clinical phenotype, and adherence or TRACK. In this pilot study, overall adherence to ICS was suboptimal and was positively related to symptom control in atopic wheezers only. Assessments of adherence are important in preschool troublesome wheezers before therapy escalation to help identify those with an ICS responsive phenotype.
Collapse
Affiliation(s)
- Yvonne Bingham
- Department of National Heart and Lung Institute, Imperial College London, UK.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Nina Sanghani
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - James Cook
- Department of National Heart and Lung Institute, Imperial College London, UK.,Department of Paediatrics, Kings College Hospital, London, UK
| | - Pippa Hall
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Angela Jamalzadeh
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | | | - Andrew Bush
- Department of National Heart and Lung Institute, Imperial College London, UK.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Louise Fleming
- Department of National Heart and Lung Institute, Imperial College London, UK.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Sejal Saglani
- Department of National Heart and Lung Institute, Imperial College London, UK.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Fiks AG, DuRivage N, Mayne SL, Finch S, Ross ME, Giacomini K, Suh A, McCarn B, Brandt E, Karavite D, Staton EW, Shone LP, McGoldrick V, Noonan K, Miller D, Lehmann CU, Pace WD, Grundmeier RW. Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study. J Med Internet Res 2016; 18:e172. [PMID: 27357835 PMCID: PMC4945817 DOI: 10.2196/jmir.5610] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 12/25/2022] Open
Abstract
Background Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established. Objective We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success. Methods We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework. Results We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success. Conclusions Although use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children. ClinicalTrial Clinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3)
Collapse
Affiliation(s)
- Alexander G Fiks
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Kaiser SV, Huynh T, Bacharier LB, Rosenthal JL, Bakel LA, Parkin PC, Cabana MD. Preventing Exacerbations in Preschoolers With Recurrent Wheeze: A Meta-analysis. Pediatrics 2016; 137:peds.2015-4496. [PMID: 27230765 DOI: 10.1542/peds.2015-4496] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined. OBJECTIVE Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. DATA SOURCES Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL. STUDY SELECTION Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids). DATA EXTRACTION Completed by 2 independent reviewers. RESULTS Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95% confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95% CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95% CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95% CI, 0.51-0.81; NNT = 6). LIMITATIONS More studies are needed that directly compare these strategies. CONCLUSIONS There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.
Collapse
Affiliation(s)
| | - Tram Huynh
- School of Public Health, University of California, Berkeley, California
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | | | - Leigh Anne Bakel
- Department of Pediatrics, University of Colorado, Denver, Colorado; and
| | - Patricia C Parkin
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cabana
- Department of Pediatrics, Phillip Lee Institute for Health Policy Studies, and Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| |
Collapse
|
6
|
Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, Chen A, Deng L, Ji W, Zhong N, Shen K. Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study. J Asthma 2016; 53:699-706. [PMID: 27043467 DOI: 10.3109/02770903.2016.1144199] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma afflicts many children in China but information about asthma management among Chinese pediatric asthma patients is limited. This study aims to evaluate asthma control among Chinese pediatric patients and identify risk factors associated with uncontrolled asthma. METHODS A total of 4223 patients with persistent asthma aged 2-16 years from 42 tertiary hospitals across all regions of mainland China except Tibet were surveyed. Asthma Control Test (ACT), Childhood Asthma Control Test (C-ACT) and Global Initiative for Asthma (GINA) criteria were used to assess asthma control for children aged 12-16 years, 4-11 years and 2-3 years, respectively. Uncontrolled asthma was defined as ACT or C-ACT score ≤19 or GINA-defined uncontrolled asthma. Risk factors associated with uncontrolled asthma were identified using multivariate logistic regression models. RESULTS Asthma was uncontrolled in 19.9% of the subjects. High rates of uncontrolled asthma were found in subjects with treatment non-adherence (44.1%), concomitant allergic rhinitis (AR) (23.3%), disease duration ≥ 1.5 years (22.8%), and first-degree relatives with AR (21.5%). The risk of uncontrolled asthma was much higher in the treatment non-adherence group compared to the complete adherence group (OR = 5.79, p < 0.001). Concomitant AR, disease duration ≥ 1.5 years, and first-degree relatives with AR were also confirmed as risk factors associated with uncontrolled asthma. CONCLUSIONS About 20% of Chinese pediatric asthma patients had uncontrolled asthma. Treatment adherence and AR were the most significant risk factors. Tailored measures aimed at improving treatment adherence and diagnosis and treatment of AR should be adopted to improve the level of asthma control in Chinese children.
Collapse
Affiliation(s)
- Li Xiang
- a Department of Respiratory Disease , Beijing Children's Hospital, Capital Medical University , Beijing , China
| | - Jing Zhao
- b Department of Respiratory Disease , Children's Hospital Affiliated with Capital Institute of Pediatrics , Beijing , China
| | - Yuejie Zheng
- c Department of Respiratory Disease , Shenzhen Children's Hospital , Shenzhen , China
| | - Hanmin Liu
- d Department of Respiratory Disease , West China Second University Hospital , Chengdu , China
| | - Jianguo Hong
- e Department of Pediatrics , Shanghai General Hospital , Shanghai , China
| | - Yixiao Bao
- f Department of Pediatrics Respiratory Disease , Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Aihuan Chen
- g Department of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Li Deng
- h Department of Respiratory Disease , Guangzhou Women and Children's Medical Center , Guangzhou , China
| | - Wei Ji
- i Department of Respiratory Disease , Children's Hospital of Soochow University , Suzhou , China
| | - Nanshan Zhong
- j Guangzhou Institute of Respiratory Disease , Guangzhou , China
| | - Kunling Shen
- a Department of Respiratory Disease , Beijing Children's Hospital, Capital Medical University , Beijing , China
| |
Collapse
|
7
|
Ribeiro GL, Gomes MC, de Lima KC, Martins CC, Paiva SM, Granville-Garcia AF. Work absenteeism by parents because of oral conditions in preschool children. Int Dent J 2015; 65:331-7. [PMID: 26397722 DOI: 10.1111/idj.12184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the influence of oral conditions in preschool children and associated factors on work absenteeism experienced by parents or guardians. METHODS A preschool-based, cross-sectional study was conducted of 837 children, 3-5 years of age, in Campina Grande, Brazil. Parents or guardians answered the Brazilian version of the Early Childhood Oral Health Impact Scale. The item 'taken time off work' was the dependent variable. Questionnaires addressing sociodemographic variables, history of toothache and health perceptions (general and oral) were also administered. Clinical examinations for dental caries and traumatic dental injury (TDI) were performed by three dentists who had undergone training and calibration exercises. Cohen's kappa (κ) was 0.83-0.88 for interexaminer agreement and 0.85-0.90 for intra-examiner agreement. Descriptive, analytical statistics were conducted, followed by logistic regression for complex samples (α = 5%). RESULTS The prevalence of parents' or guardians' work absenteeism because of the oral conditions of their children was 9.2%. The following variables were significantly associated with work absenteeism: mother's low schooling [odds ratio (OR) = 2.31; 95% confidence interval (95% CI): 1.31-4.07]; history of toothache (OR = 6.33; 95% CI: 3.18-12.61); and avulsion or luxation types of TDI (OR = 8.54; 95% CI: 1.80-40.53). CONCLUSION Other oral conditions that do not generally cause pain, such as dental caries with a low degree of severity or inactive dental caries and uncomplicated TDI, were not associated with parents' or guardians' work absenteeism of preschool children. It is concluded that toothache, avulsion, luxation and a low degree of mother's schooling are associated with work absenteeism.
Collapse
Affiliation(s)
- Gustavo Leite Ribeiro
- Postgraduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, PB, Brazil
| | - Monalisa Cesarino Gomes
- Postgraduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, PB, Brazil
| | - Kenio Costa de Lima
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Carolina Castro Martins
- Department of Paediatric Dentistry and Orthodontic, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Department of Paediatric Dentistry and Orthodontic, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | |
Collapse
|
8
|
Zaihra T, Ernst P, Tamblyn R, Ahmed S. Tailoring interventions: identifying predictors of poor asthma control. Ann Allergy Asthma Immunol 2015; 114:485-491.e1. [PMID: 26021893 DOI: 10.1016/j.anai.2015.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determining the factors that will predict long-term asthma control is essential for improving health outcomes and decreasing the burden on the health care system. Patient-reported outcomes (PROs) on health behaviors can provide valuable information about future asthma control but have rarely been considered in previous analyses. OBJECTIVE To develop statistical models for evaluating the predictors of long-term asthma control using PROs such as scores of the Asthma Control Test and the Asthma Self-Efficacy Scale. METHODS Of 1,437 individuals contacted, 566 (39%) at baseline and 486 (34%) at follow-up completed the questionnaires, including 4 PROs (Asthma Control Test, Asthma Self-Efficacy Scale, Mini-Asthma Quality of Life Questionnaire, and Beliefs about Medication Questionnaire). Long-term asthma control was evaluated by assessing overuse of rescue medication and emergency department visits. A multivariate logistic generalized estimating equation model was fitted to evaluate the possible effect of the studied factors on asthma control. RESULTS The complete case generalized estimating equation analysis included 286 participants who had complete PROs at the 2 evaluation times. After adjusting for socioeconomic status and smoking status, the Mini-Asthma Quality of Life Questionnaire was a significant predictor of asthma exacerbation. For each 1-point increase on the Mini-Asthma Quality of Life Questionnaire, there was a 0.25 decrease in the odds of a patient's asthma getting out of control. CONCLUSION These findings suggest opportunities to decrease the burden on health care by tailoring interventions that combine PROs with other clinical and sociodemographic variables.
Collapse
Affiliation(s)
- Tasneem Zaihra
- Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR), Montreal, Quebec, Canada; Department of Mathematics, Brockport College, State University of New York, Brockport, New York
| | - Pierre Ernst
- Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sara Ahmed
- Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR), Montreal, Quebec, Canada.
| |
Collapse
|
9
|
Fiks AG, Mayne SL, Karavite DJ, Suh A, O’Hara R, Localio AR, Ross M, Grundmeier RW. Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics 2015; 135:e965-73. [PMID: 25755233 PMCID: PMC4379463 DOI: 10.1542/peds.2014-3167] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-linked patient portals are a promising approach to facilitate shared decision-making between families of children with chronic conditions and pediatricians. This study evaluated the feasibility, acceptability, and impact of MyAsthma, an EHR-linked patient portal supporting shared decision-making for pediatric asthma. METHODS We conducted a 6-month randomized controlled trial of MyAsthma at 3 primary care practices. Families were randomized to MyAsthma, which tracks families' asthma treatment concerns and goals, children's asthma symptoms, medication side effects and adherence, and provides decision support, or to standard care. Outcomes included the feasibility and acceptability of MyAsthma for families, child health care utilization and asthma control, and the number of days of missed school (child) and work (parent). Descriptive statistics and longitudinal regression models assessed differences in outcomes between study arms. RESULTS We enrolled 60 families, 30 in each study arm (mean age 8.3 years); 57% of parents in the intervention group used MyAsthma during at least 5 of the 6 study months. Parents of children with moderate to severe persistent asthma used the portal more than others; 92% were satisfied with MyAsthma. Parents reported that use improved their communication with the office, ability to manage asthma, and awareness of the importance of ongoing attention to treatment. Parents in the intervention group reported that children had a lower frequency of asthma flares and intervention parents missed fewer days of work due to asthma. CONCLUSIONS Use of an EHR-linked asthma portal was feasible and acceptable to families and improved clinically meaningful outcomes.
Collapse
Affiliation(s)
- Alexander G. Fiks
- The Pediatric Research Consortium,,Center for Biomedical Informatics,,PolicyLab, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Departments of Pediatrics, and
| | - Stephanie L. Mayne
- PolicyLab, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Andrew Suh
- PolicyLab, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - A. Russell Localio
- Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Ross
- Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert W. Grundmeier
- The Pediatric Research Consortium,,Center for Biomedical Informatics,,Departments of Pediatrics, and
| |
Collapse
|
10
|
Liu PC, Gau BS, Hung CC. Development and psychometric testing of a chinese version of the caregiver burden index for parents of children with allergies. J Pediatr Nurs 2015; 30:208-18. [PMID: 24813162 DOI: 10.1016/j.pedn.2014.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 04/09/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED BACKGROUNG: No specific instrument has thus far been developed for measuring the caregiver burden perceived by parents of children with allergies (CWA). OBJECTIVES To determine the psychometric properties of the Caregiver Burden Index (CBI). METHODS A mixed-methods design was adopted to evaluate the psychometric properties of the scale. RESULTS The content validity index was 0.89, and the internal consistency was high with a coefficient alpha of 0.98. Three factors were extracted after exploratory factor analysis. CONCLUSION The study findings suggest that the CBI has sufficient reliability and validity to evaluate the caregiver burden of parents of CWA.
Collapse
Affiliation(s)
- Pei-Ching Liu
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bih-Shya Gau
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chao-Chia Hung
- School of Nursing, Yuan-Pei Institute of Technology, Hsin-Chu, Taiwan
| |
Collapse
|
11
|
Wood MR, Bolyard D. Making education count: the nurse's role in asthma education using a medical home model of care. J Pediatr Nurs 2011; 26:552-8. [PMID: 22055375 DOI: 10.1016/j.pedn.2010.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 06/16/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
Abstract
Asthma care for patients who have limited health literacy is very costly. The resources to help patients who have lower health literacy levels are very few are not well identified. Significant gains in asthma control, self-efficacy in managing asthma, and improvement in overall costs of care for this patient population can be achieved when health literacy challenges are addressed. This research suggests that one-on-one education with an asthma educator that specifically addresses health literacy levels and care designed around the National Asthma Guidelines can produce significant reductions in the cost for asthma care through decreased emergency department visits and hospitalizations, and improved self-management of asthma exacerbations.
Collapse
|
12
|
Improving health and energy efficiency through community-based housing interventions. Int J Public Health 2011; 56:583-8. [PMID: 21858460 DOI: 10.1007/s00038-011-0287-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 07/22/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Houses designed for one climate and cultural group may not be appropriate for other places and people. Our aim is to find cost-effective ways to improve the characteristics of older homes, ill-fitted for New Zealand's climate, in order to improve the occupants' health. METHOD We have carried out two community randomised trials, in partnership with local communities, which have focused on retrofitted insulation and more effective heating and have two other studies under way, one which focuses on electricity vouchers and the other on housing hazard remediation. RESULTS The Housing, Insulation and Health Study showed that insulating 1,350 houses, built before insulation was required, improved the occupants' health and well being as well as household energy efficiency. In the Housing, Heating and Health Study we investigated the impact of installing more effective heating in insulated houses for 409 households, where there was a child with doctor-diagnosed asthma. Again, the study showed significant results in the intervention group; indoor temperatures increased and levels of NO(2) were halved. Children reported less poor health, lower levels of asthma symptoms and sleep disturbances by wheeze and dry cough. Children also had fewer days off school. CONCLUSION Improving the energy efficiency of older housing leads to health improvements and energy efficiency improvements. Multidisciplinary studies of housing interventions can create compelling evidence to support policies for sustainable housing developments which improve health.
Collapse
|
13
|
Cerdan NS, Alpert PT, Moonie S, Cyrkiel D, Rue S. Asthma severity in children and the quality of life of their parents. Appl Nurs Res 2011; 25:131-7. [PMID: 21439791 DOI: 10.1016/j.apnr.2011.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 01/03/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
This study examines the effect of asthma severity of children aged 7-17 years and sociodemographic characteristics on the caregiver's quality of life. For parents of asthmatic children, there was a negative correlation between overall asthma severity and quality-of-life score. Measuring parental quality of life enables the development of effective asthma programs.
Collapse
|
14
|
Watson WTA, Gillespie C, Thomas N, Filuk SE, McColm J, Piwniuk MP, Becker AB. Small-group, interactive education and the effect on asthma control by children and their families. CMAJ 2009; 181:257-63. [PMID: 19687105 PMCID: PMC2734203 DOI: 10.1503/cmaj.080947] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Effective approaches to education about asthma need to be identified. We evaluated the impact on asthma control by children and their caregivers of an intervention involving small-group, interactive education about asthma. METHODS We randomly assigned children who visited an emergency department for an exacerbation of asthma (n = 398) to either of 2 groups. Children assigned to the control group followed the usual care recommended by their primary care physician. Those assigned to the intervention group participated in a small-group, interactive program of education about asthma. We examined changes in the number of visits to the emergency department during the year after the intervention. RESULTS During the year after enrolment, children in the intervention group made significantly fewer visits to the emergency department (0.45 visits per child) compared with those in the control group (0.75 visits per child) (p = 0.004). The likelihood of a child in the intervention group requiring emergency care was reduced by 38% (relative risk [RR] 0.62, 95% confidence interval CI 0.48-0.81, p = 0.004). Fewer courses of oral corticosteroids (0.63 per child) were required by children in the intervention group than by those in the control group (0.85 per child) (p = 0.006). We observed significant improvements in the symptom domain of the questionnaire on pediatric asthma quality-of-life (p = 0.03) and the activity domain of the questionnaire on caregivers' quality of life (p = 0.05). Parents of children in the intervention group missed less work because of their child's asthma after participating in the educational program (p = 0.04). No impact on hospital admissions was observed. INTERPRETATION Education about asthma, especially in a small-group, interactive format, improved clinically important outcomes and overall care of children with asthma.
Collapse
Affiliation(s)
- Wade T A Watson
- Children's Asthma Education Centre, Dalhousie University, IWK Health Centre, Halifax, NS.
| | | | | | | | | | | | | |
Collapse
|
15
|
Safe Control of Pest and Pet Asthma Triggers. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Victorino CC, Gauthier AH. The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis. BMC Pediatr 2009; 9:53. [PMID: 19686599 PMCID: PMC2734529 DOI: 10.1186/1471-2431-9-53] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 08/17/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disparities in child health outcomes persist despite advances in medical technology and increased global wealth. The social determinants of health approach is useful in explaining the disparities in health. Our objective in this paper is four-fold: (1) to test whether the income relationship (and the related income gradient) is the same across different child health outcomes; (2) to test whether the association between income and child health outcomes persists after controlling for other traditional socioeconomic characteristics of children and their family (education and employment status); (3) to test the role of other potentially mediating variables, namely parental mental health, number of children, and family structure; and (4) to test the interaction between income and education. METHODS This population-based cross-sectional study used data from the 2003 US National Survey of Children's Health involving 102,353 children aged 0 to 17 years. Using multivariate logistic regression models, the association between household income, education, employment status, parental mental health, number of children, family structure and the following child health outcomes were examined: presence or absence of asthma, headaches/migraine, ear infections, respiratory allergy, food/digestive allergy, or skin allergy. RESULTS While the associations of some determinants were found to be consistent across different health outcomes, the association of other determinants such as household income depended on the specific outcome. Controlling for other factors, a gradient association persisted between household income and a child having asthma, migraine/severe headaches, or ear infections with children more likely to have the illness if their family is closer to the federal poverty level. Potentially mediating variables, namely parental mental health, number of children, and family structure had consistent associations across health outcomes. CONCLUSION There appears to be evidence of an income gradient for certain child health outcomes, even after controlling for other traditional measures of socioeconomic status. Our study also found evidence of an association between certain child health outcomes and potential mediating factors.
Collapse
Affiliation(s)
- Charlemaigne C Victorino
- Department of Pediatrics, Alberta Children's Hospital/University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | - Anne H Gauthier
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| |
Collapse
|
17
|
Lanier BQ, Nayak A. Prevalence and impact of nighttime symptoms in adults and children with asthma: a survey. Postgrad Med 2008; 120:58-66. [PMID: 19020366 DOI: 10.3810/pgm.2008.11.1939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The frequency of nighttime asthma symptoms is an important measure of asthma severity. This study was designed to determine the prevalence of daytime and nighttime symptoms in adults and children with asthma and to evaluate the impact of nighttime symptoms on sleep and daytime activities. METHODS An online survey was conducted among adults (> 18 years) and mothers of children aged 2 to 17 years with asthma. The survey included questions on daytime and nighttime asthma symptoms and asthma controller medication. Invitations to complete the survey were sent to 6349 members of a global opinion panel who were identified as having asthma. Data collection was from April to May 2005. RESULTS A total of 1600 invited panelists responded to the survey. Overall, 61% of participants reported nighttime asthma symptoms and 74% reported daytime asthma symptoms. Asthma-related sleep difficulties occurred approximately 4 times per week in adults and approximately 3 times per week in children. A significantly greater proportion of adults than children reported bothersome symptoms in the morning on awakening. Wheezing and difficulty breathing were reported in a greater proportion of adults, whereas coughing was reported in a greater proportion of children. A greater proportion of adults than children reported feelings of tiredness and impaired activity on days after experiencing nighttime symptoms. Absenteeism and lateness were more commonly reported by mothers of children with asthma than by other adults. CONCLUSIONS The prevalence of reported asthma symptoms, particularly nighttime symptoms, and the effects of nighttime symptoms on sleep and daytime activities indicates that survey participants had poorly controlled asthma.
Collapse
Affiliation(s)
- Bobby Quentin Lanier
- Pediatrics/Immunology, University of North Texas Health Science Center, Fort Worth, TX 76132, USA.
| | | |
Collapse
|
18
|
Howden-Chapman P, Pierse N, Nicholls S, Gillespie-Bennett J, Viggers H, Cunningham M, Phipps R, Boulic M, Fjällström P, Free S, Chapman R, Lloyd B, Wickens K, Shields D, Baker M, Cunningham C, Woodward A, Bullen C, Crane J. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ 2008; 337:a1411. [PMID: 18812366 PMCID: PMC2658826 DOI: 10.1136/bmj.a1411] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2008] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma. DESIGN Randomised controlled trial. SETTING Households in five communities in New Zealand. PARTICIPANTS 409 children aged 6-12 years with doctor diagnosed asthma. INTERVENTIONS Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial. MAIN OUTCOME MEASURES The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child's general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child's bedroom were recorded hourly. RESULTS Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child's bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children's bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001). CONCLUSION Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist. TRIAL REGISTRATION Clinical Trials NCT00489762.
Collapse
Affiliation(s)
- Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVES The objective of this study was to evaluate the association between socioeconomic factors and asthma control in children, as defined by the Canadian Pediatric Asthma Consensus Guidelines. PATIENTS AND METHODS Cross-sectional data from a completed study of 879 asthmatic children between the ages of 1 and 18 residing in the Greater Toronto Area were used. The database included data on demographics, health status, asthma control, and health-related quality of life. Stepwise forward modeling multiple regression was used to investigate the impact of socioeconomic status on asthma control, based on six control parameters from the 2003 Canadian Pediatric Asthma Consensus Guidelines. RESULTS Only 11% of patients met the requirements for acceptable control, while 20% had intermediate control, and 69% had unacceptable asthma control. Children from families in lower income adequacy levels had poorer control. CONCLUSIONS Disparities in asthma control between children from families of different socio-economic strata persist, even with adjustment for utilization of primary care services and use of controller medications.
Collapse
Affiliation(s)
- Shannon F Cope
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
20
|
Stein V, Dorner T, Lawrence K, Kunze M, Rieder A. [Economic aspects of allergies: status and prospects for Austria]. Wien Med Wochenschr 2007; 157:248-54. [PMID: 17915437 DOI: 10.1007/s10354-007-0421-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
According to epidemiological studies there has been an increase of allergic diseases and corresponding costs. Health economics analyses intend to offer decision guidance towards a more efficient and effective resource distribution, in the conflicting relationship of medicine and economics. In analogy with the "Global Initiative for Asthma (GINA)-study", one arrives at costs of Euro 227.7-455.4 million for the Austrian health system in 2004 for asthma. Direct costs of allergies in general are in part available from health insurance carriers. Between 1998 and 2005 the number of nasal preparations and antiobstructive therapies prescribed rose by 15% and 50% respectively, whilst the costs of these drugs dramatically increased by 96% and 70% respectively. Expenditure on anti-histamines rose by 31% between 2002 and 2004, whereas costs of topical and systemic anti-allergic drugs remained constant. Costs of allergies also include additional costs carried by the individuals affected, which must be added to those covered by the national health insurance carriers. Furthermore, patients with allergies more frequently turn to alternative and complimentary medicine to treat their condition (above all homeopathic remedies, massages and ointments) than people not suffering from allergies. Indirect costs due to allergies are, for instance, those caused by sick leave and loss of productivity. A continual systematic evaluation of available data on allergies in Austria could contribute to more effective implementation of medicines.
Collapse
Affiliation(s)
- Viktoria Stein
- Institut für Sozialmedizin, Centre for Public Health, Medizinische Universität Wien, Wien, Osterreich.
| | | | | | | | | |
Collapse
|
21
|
Schmier JK, Manjunath R, Halpern MT, Jones ML, Thompson K, Diette GB. The impact of inadequately controlled asthma in urban children on quality of life and productivity. Ann Allergy Asthma Immunol 2007; 98:245-51. [PMID: 17378255 DOI: 10.1016/s1081-1206(10)60713-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The burden of inadequately controlled pediatric asthma on education and other daily activities is not well described. OBJECTIVE To evaluate asthma-related activity limitations and productivity losses among children and caregivers. METHODS Surveys were mailed to caregivers of children with asthma. Caregivers provided demographics, health-related quality of life (HRQL), workplace productivity, and asthma-related costs. Adolescents (aged 12-18 years) provided HRQL, asthma control, and school-based productivity, and young children (aged 4-11 years) completed an asthma control questionnaire with help from a caregiver. RESULTS Among the 239 respondents, the mean age was 10.1 years; 49% were girls. More than half were inadequately controlled as measured using the Asthma Control Test. Both HRQL and productivity were significantly lower in patients with inadequately controlled asthma compared with those with controlled asthma. In the previous year, caregivers reported missing 1.4 days of work due to their child's asthma, with the child missing an average of 4.1 school days. Fewer adolescents with controlled asthma reported missing 1 or more school days in the previous week compared with adolescents with inadequately controlled asthma (3.5% vs 34.0%; P < .001). There were similar differences in caregiver workdays missed and health care resource use: both were significantly higher in children with inadequately controlled asthma. CONCLUSIONS Inadequately controlled asthma has a significant impact on asthma-specific HRQL, school productivity and attendance, and work productivity of children and their caregivers.
Collapse
|
22
|
McGhan SL, MacDonald C, James DE, Naidu P, Wong E, Sharpe H, Hessel PA, Befus AD. Factors associated with poor asthma control in children aged five to 13 years. Can Respir J 2006; 13:23-9. [PMID: 16470250 PMCID: PMC2539007 DOI: 10.1155/2006/149863] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Most children with asthma should be able to achieve acceptable control. However, are there differences between those with acceptable and poor control, and if so, how can health care approaches be modified accordingly? OBJECTIVE To examine the characteristics of elementary school children aged five to 13 years with acceptable and poor levels of asthma control. METHODS The present cross-sectional study of children with asthma used five indicators of control, as outlined by the Canadian Asthma Consensus Report, to categorize acceptable and poor asthma control. RESULTS Of 153 children, 115 (75%) were rated as having poorly controlled asthma. Of those with poor control, 65 (64%) children were currently using inhaled corticosteroids, and 65% of those reported using inhaled corticosteroids daily versus as needed. Fifty-one per cent of the children with poorly controlled asthma had exposure to tobacco smoke, whereas 79% of the children with asthma under acceptable control were from households with no smokers (P=0.002). The poor control group also had significantly worse parental perceptions of the psychosocial impact of asthma on their child. No significant difference was found in the percentage of those who had written action plans in the poor control group (28%) compared with the acceptable control group (26%), and similar percentages in each group stated that they used the plans. CONCLUSIONS Despite the high use of inhaled corticosteroids, the majority of children had poorly controlled asthma. The poor control group had more exposure to tobacco smoke and a worse psychosocial impact due to asthma. Few children had past asthma education and action plans, suggesting that there is a need to improve access to and tools for education.
Collapse
Affiliation(s)
- S L McGhan
- Alberta Asthma Centre, Edmonton, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
The epidemiology of asthma is complex but essential in enhancing the understanding of a disease that affects millions of patients. Asthma is associated with significant morbidity and mortality. Asthma prevalence rates in the United States reached a plateau after 1998 with an estimated overall prevalence of 3.8% in 2003. Racial disparities exist and there are staggering differences in morbidity and mortality. The analysis of data collected from epidemiologic studies continues to be a critical part of enhancing the understanding of the pathophysiology of asthma, which will lead to improved patient outcomes.
Collapse
Affiliation(s)
- Njira L Lugogo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, P.O. Box 2641, Durham, NC 27710, USA.
| | | |
Collapse
|
24
|
Green RJ. Cost-effectiveness of asthma therapy. S Afr Fam Pract (2004) 2006. [DOI: 10.1080/20786204.2006.10873339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
25
|
Abstract
The provider's ability to judge the severity of a patient's illness is a vital part of the care of chronic disorders. In the treatment of asthma, it should extend beyond the objectively quantifiable measures of obstruction or inflammation. "Interference with activities of daily living" is a highly subjective assessment that may not allow quantitative comparisons, but it matters to the patient. Interventions aimed at lessening the burden of asthma on the daily life of the patient and his or her family may hold the key to improvement in a broader range of outcome measures.
Collapse
Affiliation(s)
- Robert Sherman
- Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO, USA
| | | |
Collapse
|
26
|
|
27
|
Le suivi de l’asthmatique adulte et adolescent : recommandations ANAES-AFSSAPS, septembre 2004. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85553-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
28
|
Laforest L, Ernst P, Pietri G, Yin D, Pacheco Y, Bellon G, Kocevar VS, Ganse EV. Asthma-Related Costs Relative to Severity and Control in General Practice. ACTA ACUST UNITED AC 2005. [DOI: 10.1089/pai.2005.18.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|