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van der Kamp MR, Klaver EC, Thio BJ, Driessen JMM, de Jongh FHC, Tabak M, van der Palen J, Hermens HJ. WEARCON: wearable home monitoring in children with asthma reveals a strong association with hospital based assessment of asthma control. BMC Med Inform Decis Mak 2020; 20:192. [PMID: 32795352 PMCID: PMC7427745 DOI: 10.1186/s12911-020-01210-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background Asthma is one of the most common chronic diseases in childhood. Regular follow-up of physiological parameters in the home setting, in relation to asthma symptoms, can provide complementary quantitative insights into the dynamics of the asthma status. Despite considerable interest in asthma home-monitoring in children, there is a paucity of scientific evidence, especially on multi-parameter monitoring approaches. Therefore, the aim of this study is to investigate whether asthma control can be accurately assessed in the home situation by combining parameters from respiratory physiology sensors. Methods Sixty asthmatic and thirty non-asthmatic children were enrolled in the observational WEARCON-study. Asthma control was assessed according to GINA guidelines by the paediatrician. All children were also evaluated during a 2-week home-monitoring period with wearable devices; a physical activity tracker, a handheld spirometer, smart inhalers, and an ambulatory electrocardiography device to monitor heart and respiratory rate. Multiple logistic regression analysis was used to determine which diagnostic measures were associated with asthma control. Results 24 of the 27 uncontrolled asthmatic children and 29 of the 32 controlled asthmatic children could be accurately identified with this model. The final model showed that a larger variation in pre-exercise lung function (OR = 1.34 95%-CI 1.07–1.68), an earlier wake-up-time (OR = 1.05 95%-CI 1.01–1.10), more reliever use (OR = 1.11 95%-CI 1.03–1.19) and a longer respiratory rate recovery time (OR = 1.12 95%-CI 1.05–1.20) were significant contributors to the probability of having uncontrolled asthma. Conclusions Home-monitoring of physiological parameters correlates with paediatrician assessed asthma control. The constructed multivariate model identifies 88.9% of all uncontrolled asthmatic children, indicating a high potential for monitoring of asthma control. This may allow healthcare professionals to assess asthma control at home. Trial registration Netherlands Trail Register, NL6087. Registered 14 February 2017.
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Affiliation(s)
- M R van der Kamp
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands. .,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands. .,Roessingh Research and Development, Enschede, the Netherlands.
| | - E C Klaver
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - B J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - J M M Driessen
- OCON sport, Hengelo, Netherlands.,Department of Sports Medicine, Ziekenhuis Tjongerschans, Heerenveen, Netherlands
| | - F H C de Jongh
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Engineering Fluid Dynamics, University of Twente, Enschede, Netherlands
| | - M Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research and Development, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands
| | - H J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research and Development, Enschede, the Netherlands
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Roychowdhury P, Badwal J, Alkhatib F, Singh DK, Lindenauer PK, Knee A, Lagu T. Spirometry Utilization Among Patients with Asthma. J Asthma Allergy 2020; 13:193-203. [PMID: 32636652 PMCID: PMC7335289 DOI: 10.2147/jaa.s254431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine predictors of spirometry use at a tertiary academic health system and association between receipt of spirometry and outcomes. PATIENTS AND METHODS We conducted a retrospective cohort study of adult patients with an ICD-9 CM diagnostic code for asthma and a 2014 outpatient visit in either a community health center or private practice associated with a tertiary academic medical center. The main outcome was receipt of spirometry during a 2007-2015 "exposure period." We secondarily examined future hospitalizations and emergency department (ED) visits during a follow-up period (2016-2019). RESULTS In a sample of 394 patients, the majority were white (48%; n=188) and female (72%; n=284). Mean (SD) age was 52 years. Approximately half (185, 47%) of the patients received spirometry and 25% (n=97) saw a specialist during the exposure period. Nearly, 88% (n=85) of patients who saw a specialist received spirometry. More than half of the cohort (220/394, 56%) had an ED visit or admission during the follow-up period. Of these, 168 (76.4%) had not seen a specialist and 111 (50.5%) had not received spirometry within the exposure period. We saw no association between spirometry in the exposure window and future ED visit or hospitalization. CONCLUSION In a cohort of patients at a tertiary medical center, spirometry was underused. We observed a strong association between seeing a specialist and use of spirometry, suggesting a need to better incorporate spirometry into routine primary care for patients with asthma. Among 220 patients who had an asthma-related hospitalization or ED visit in 2016-2019, the majority had no record of receiving spirometry and no documentation indicating a prior specialist visit.
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Affiliation(s)
| | - Jasdeep Badwal
- Allergy and Immunology Associates of New England, Greenfield, MA, USA
| | | | | | - Peter K Lindenauer
- Department of Medicine, UMMS-Baystate, Springfield, MA, USA
- Institute of Healthcare Delivery & Population Science, UMMS-Baystate, Springfield, MA, USA
| | - Alexander Knee
- Department of Medicine, UMMS-Baystate, Springfield, MA, USA
- Epidemiology and Biostatistics Research Core, Office of Research, Baystate Medical Center, Springfield, MA, USA
| | - Tara Lagu
- Department of Medicine, UMMS-Baystate, Springfield, MA, USA
- Institute of Healthcare Delivery & Population Science, UMMS-Baystate, Springfield, MA, USA
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Affiliation(s)
- Rebecca Dobra
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Amanda Equi
- Department of Paediatrics, Watford General Hospital, Watford, UK
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Harver A, Dyer A, Ersek J, Kotses H, Humprhies CT. Reliability and predictors of resistive load detection in children with persistent asthma: a multivariate approach. J Asthma 2015; 52:146-54. [PMID: 25144552 PMCID: PMC4662862 DOI: 10.3109/02770903.2014.955188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Resistive load detection tasks enable analysis of individual differences in psychophysical outcomes. The purpose of this study was to determine both the reliability and predictors of resistive load detection in children with persistent asthma who completed multiple testing sessions. METHODS Both University of North Carolina (UNC) Charlotte and Ohio University institutional review boards approved the research protocol. The detection of inspiratory resistive loads was evaluated in 75 children with asthma between 8 and 15 years of age. Each child participated in four experimental sessions that occurred approximately once every 2 weeks. Multivariate analyses were used to delineate predictors of task performance. RESULTS Reliability of resistive load detection was determined for each child, and predictors of load detection outcomes were investigated in two groups of children: those who performed reliably in all four sessions (n = 31) and those who performed reliably in three or fewer sessions (n = 44). Three factors (development, symptoms, and compliance) accounted for 66.3% of the variance among variables that predicted 38.7% of the variance in load detection outcomes (Multiple R = 0.62, p = 0.004) and correctly classified performance as reliable or less reliable in 80.6% of the children, χ(2)(12) = 28.88, p = 0.004. CONCLUSIONS Cognitive and physical development, appraisal of symptom experiences, and adherence-related behaviors (1) account for a significant proportion of the interrelationships among variables that affect perception of airflow obstruction in children with asthma and (2) differentiate between children who perform more or less reliably in a resistive load detection task.
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Affiliation(s)
- Andrew Harver
- University of North Carolina Charlotte, Charlotte, NC
| | - Allison Dyer
- University of North Carolina Charlotte, Charlotte, NC
| | | | | | - C. Thomas Humprhies
- University of North Carolina Charlotte, Charlotte, NC
- Asthma and Allergy Specialists, PA, Charlotte, NC
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Kelly W, Massoumi A, Lazarus A. Asthma in pregnancy: Physiology, diagnosis, and management. Postgrad Med 2015; 127:349-58. [PMID: 25702799 DOI: 10.1080/00325481.2015.1016386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Asthma is a common, potentially serious, medical condition that affects an estimated 8% of pregnant patients, with 4% of all pregnant patients experiencing an exacerbation in the past year. Practitioners must be able to diagnose, educate, and treat such patients as they undergo significant physiological and immunologic change. But staying current can be challenging given over 3000 citations for "asthma and pregnancy" in a recent PubMed search, with 750 described as review articles. Patients have even more difficulty navigating information, with 29 million Google search results for this same query and 1.2 million alone for the question whether asthma medications are safe during pregnancy. This review provides brief answers to important management questions followed by supporting background literature.
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Harver A, Kotses H, Ersek J, Humphries CT, Ashe WS, Black HR. Effects of feedback on the perception of inspiratory resistance in children with persistent asthma: a signal detection approach. Psychosom Med 2013; 75:729-36. [PMID: 24077770 PMCID: PMC4668923 DOI: 10.1097/psy.0b013e3182a8bcde] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Accurate perception of asthma episodes increases the likelihood that they will be managed effectively. The purpose of the study was to examine the effect of feedback in a signal detection task on perception of increased airflow obstruction in children with persistent asthma. METHODS The effect of feedback training on the perception of resistive loads was evaluated in 155 children with persistent asthma between 8 and 15 years of age. Each child participated in four experimental sessions that occurred approximately once every 2 weeks, an initial session followed by three training sessions. During the initial session, the threshold resistance to breathing was determined for each child. Subsequently, each child was randomly assigned to one of two resistive load training conditions in a signal detection paradigm: training with immediate performance feedback or training with no performance feedback. RESULTS The threshold resistance to breathing, determined in the initial session, was equivalent between groups. Children in the feedback condition discriminated more accurately between both the presence and the absence of increases in the resistance to breathing (206 [48] versus 180 [39] correct responses, p < .001), and differences over time between groups increased reliably as a function of training (165 [40] versus 145 [32] correct responses, p < .001). Response times and confidence ratings were equivalent between groups, and no differences in breathing patterns were observed between conditions. CONCLUSIONS Feedback training results in improved perception of respiratory sensations in children with asthma, a finding with implications for strategies of asthma self-management.
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Affiliation(s)
- Andrew Harver
- AE-C, Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC 28223.
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Ayala GX, Gillette C, Williams D, Davis S, Yeatts KB, Carpenter DM, Sleath B. A prospective examination of asthma symptom monitoring: provider, caregiver and pediatric patient influences on peak flow meter use. J Asthma 2013; 51:84-90. [PMID: 24020680 DOI: 10.3109/02770903.2013.838255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined whether provider, caregiver and child communication predicted peak flow meter (PFM) use one month later. METHODS Five practices, 35 providers and 296 children with persistent asthma and their caregivers comprised the study sample. Audio-recorded provider-caregiver-child communication during the baseline medical visit captured discussion of the PFM; and child and caregiver baseline interviews after the medical visit collected factors associated with PFM use. Child- and caregiver-reported PFM availability and use, and observed child use of PFM were collected one-month later in the family's home. RESULTS During the medical visit, provider communication about PFM use was infrequent (10% maximum) and child- or caregiver-initiated communication was nearly absent (0%-2%). Despite this, children demonstrated good use of the PFM one month later. Children were significantly more likely to perform at least six PFM steps correctly one month later when there was more communication about PFM during the medical visit. Few other factors predicted availability and use. CONCLUSIONS Few providers discussed use of a PFM; observed performance was predicted by having talked about it with the child's provider. Provider communication should be targeted in future interventions to improve asthma management skills.
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Affiliation(s)
- Guadalupe X Ayala
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, Institute for Behavioral and Community Health, San Diego State University , San Diego, CA , USA
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Burkhart PV, Rayens MK, Oakley MG. Effect of peak flow monitoring on child asthma quality of life. J Pediatr Nurs 2012; 27:18-25. [PMID: 22222102 PMCID: PMC3254019 DOI: 10.1016/j.pedn.2010.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 11/02/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the effect of peak flow monitoring on asthma quality of life (QOL) for school-age children with asthma (N = 77) who participated in a 16-week asthma self-management program. QOL was measured using the Children's Health Survey for Asthma. Findings indicated significant improvement in asthma QOL from baseline to Week 16 and higher QOL scores for those with better asthma health outcomes.
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Abstract
Although patient education is central to the ethical practice of nursing, it can be practiced in an ethically contested or unethical way. It is sometimes used to: forward a societal goal the individual might not have chosen; assume that patients should learn to accommodate unjust treatment; exclude the views of all except the dominant health care provider group; limit the knowledge a patient can receive; make invalid or unreliable judgments about what a patient can learn; or require a patient to change his or her identity to meet a medical ideal. Both health promotion education and manipulating patient beliefs in situations of uncertainty are ethically contested. Nussbaum's capabilities approach is used here as a moral framework through which to view the goals and practice of patient education. This provides better guidance than the current conception of patient education as an instrument to carry out the directives of medical practice.
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Affiliation(s)
- Barbara K Redman
- University of Pennsylvania Center for BIoethics, 3401 Market Street, Suite 320, Philadelphia, PA 19104, USA,
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