Patterns of asthma control perception in adolescents: associations with psychosocial functioning

Difficult-to-treat asthma patients from ethnic minority groups in central England are at an enhanced risk of house dust mite sensitisation

BACKGROUND

House dust mite (HDM) is the most common sensitising allergen in asthma. Ethnic minority groups (EMGs) in the UK are more likely to live in deprived conditionings with a greater exposure to HDM and other aero-allergens.

AIM

To compare the ethnicity-based patterns of sensitisation to aero-allergens and the impact of ethnicity on clinical outcomes in patients with difficult-to-treat asthma (DTA).

METHODS

Data of patients with DTA were extracted from the registry of the Birmingham Regional Severe Asthma Service (BRSAS), which have a catchment population of 7.3million from Central England. Patients from White and EMG backgrounds were compared in terms of the prevalence of atopy, total serum immunoglobulin E (IgE), specific serum IgE (ssIgE) and asthma related clinical outcomes. Logistic regression analysis was conducted to explore ethnicity-based risk factors for HDM sensitisation.

RESULTS

A total of 1272 patients [White 1016 (79.9%), EMG 256 (20.1%) EMG] with a median age of 51 years (range 16-97) were included in the analysis. Patients from EMG were more likely (64%) to reside in the worst scale of index of multiple deprivation (IMD) than the White patients (25.5%), p < 0.0001. Positive HDM sensitisation was more prevalent in the EMG than in the White group [142/216 (66%) versus 375/842 (45%), p < 0.0001]. The median HDM ssIgE level was higher in the EMG than in the White group [3.0 KUA/L (IQR 0.06, 11.5) versus 0.1 (0.01, 3.0), p < 0.000001]. The odds ratio for positive sensitisation to HDM conveyed by the EMG status was 2.61 (95%CI, 1.8-3.8), p < 0.0001. Compared to the White group, the EMG had higher median total serum IgE [326 KU/L (115, 971) versus 114 (29.8, 434.8), p < 0.000001], higher blood eosinophil count (0.36 × 109 (0.18, 0.62) versus 0.23 (0.1,0.47), p < 0.000001), were marginally more atopic (79.2% vs. 75.6%, p = 0.098) and were less likely to being on maintenance oral corticosteroids (22% vs. 39.7%, p < 0.0001).

CONCLUSION

In this DTA cohort, positive HDM sensitisation was greater amongst the EMG than the White patients. The EMG status was a significant risk factor for HDM sensitisation.

Children's and adolescents' descriptors of asthma symptoms: An integrative review

Background

Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms-how it is perceived and reported-remain challenging in pediatric clinical and research settings.

Objective

To synthesize the existing pediatric literature on children's and adolescents' word descriptors of asthma symptoms.

Methods

In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents' word descriptors of asthma symptoms.

Results

The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents' descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. 'helpless', 'afraid of dying') and sensory words (e.g. 'pressure in chest', 'tightness, lungs feel shut') to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking.

Conclusions

Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents' experience of asthma symptoms.

Development of a motivation-based tool to facilitate individualized self-management interventions for adolescents with asthma

OBJECTIVE

To develop a questionnaire for segmenting adolescents with asthma into archetypes based on their motivations for individualized self-management interventions.

METHODS

A prospective observational study using segmentation methodology. First, adolescents created photo diaries followed by in-person semi-structured interviews to develop a pool of candidate items for identifying and describing archetypes. Second, quantitative methods were used to test the pool of items to determine which ones best identified each archetype.

RESULTS

Six archetypes based on motivations were identified and described: goal oriented visionaries; mentors and helpers; influencers; discouraged adolescents; dependent adolescents; and shame avoiders. A questionnaire with 63 candidate items was administered to 201 adolescents. Confirmatory factor analysis resulted in a 17-item questionnaire that identified the archetypes.

CONCLUSION

This study is the first step towards applying a segmentation methodology to facilitate the application of interventions during a clinic visit to increase adherence. It has shown that a relatively short questionnaire can be used to identify archetypes based on motivations.

PRACTICE IMPLICATIONS

The 17-item questionnaire could provide a framework and direction for healthcare professionals to customize existing adherence interventions, such as motivational interviewing, to different segments of adolescents. It would be especially helpful in primary care settings where time is limited.

Intersectional identity approach to chronic pain disparities using latent class analysis

ABSTRACT

Research on intersectionality and chronic pain disparities is very limited. Intersectionality explores the interconnections between multiple aspects of identity and provides a more accurate image of disparities. This study applied a relatively novel statistical approach (ie, Latent Class Analysis) to examine chronic pain disparities with an intersectional identity approach. Cross-sectional data were analyzed using pretreatment data from the Learning About My Pain trial, a randomized comparative effectiveness study of group-based psychosocial interventions (Patient-Centered Outcomes Research Institute Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. Latent Class Analysis results suggested a 5-class model. To easily identify each class, the following labels were created: older adults, younger adults, severe disparity, older Black or African American, and Working Women. The latent disparity classes varied by pretreatment chronic pain functioning. Overall, the severe disparity group had the lowest levels of functioning, and the Working Women group had the highest levels of functioning. Although younger and with higher literacy levels, the younger adults group had similar levels of pain interference and depressive symptoms to the severe disparity group (P's < 0.05). The younger adults group also had higher pain catastrophizing than the older adults group (P < 0.005). Results highlighted the importance of the interactions between the multiple factors of socioeconomic status, age, and race in the experience of chronic pain. The intersectional identity theory approach through Latent Class Analysis provided an integrated image of chronic pain disparities in a highly understudied and underserved population.

Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis

BACKGROUND

High levels of moderate-to-vigorous intensity physical activity (MVPA) are strongly associated with sustained weight loss, however the majority of adults are unsuccessful in maintaining high levels of MVPA long-term. Our goal was to identify profiles based on exercise motives, and examine the association between motivational profile and longitudinal changes in MVPA during a weight loss intervention.

METHODS

Adults with overweight or obesity (n = 169, mean ± SE; age 39 ± 0.7 years, BMI 34.4 ± 0.3 kg/m2, 83% female) underwent an 18-month behavioral weight loss program, including 6 months of supervised exercise, followed by 6 months of unsupervised exercise. Participants self-reported behavioral regulations for exercise at baseline (BREQ-2). Latent profile analysis identified subgroups from external, introjected, identified, and intrinsic regulations measured at baseline. Mean differences in device-measured total MVPA were compared across motivational profiles at baseline, after 6 months of supervised exercise and after a subsequent 6 months of unsupervised exercise.

RESULTS

Three motivational profiles emerged: high autonomous (high identified and intrinsic, low external regulations; n = 52), high combined (high scores on all exercise regulations; n = 25), and moderate combined (moderate scores on all exercise regulations; n = 92). Motivational profile was not associated with baseline level of MVPA or the increase in MVPA over the 6-month supervised exercise intervention (high autonomous: 21 ± 6 min/d; high combined: 20 ± 9 min/d; moderate combined: 33 ± 5 min/d; overall P > 0.05). However, during the transition from supervised to unsupervised exercise, MVPA decreased, on average, within all three profiles, but the high autonomous profile demonstrated the least attenuation in MVPA (- 3 ± 6 min/d) compared to the moderate combined profile (- 20 ± 5 min/d; P = 0.043).

CONCLUSIONS

Results were in alignment with the Self-Determination Theory. Adults motivated by autonomous reasons (value benefits of exercise, intrinsic enjoyment) may be more likely to sustain increases in MVPA once support is removed, whereas participants with moderate-to-high scores on all types of exercise regulations may need additional long-term support in order to sustain initial increases in MVPA.

CLINICAL TRIAL REGISTRATION

NCT01985568. Registered 24 October 2013.

A step closer to nationwide electronic health record-based chronic disease surveillance: characterizing asthma prevalence and emergency department utilization from 100 million patient records through a novel multisite collaboration

OBJECTIVE

The study sought to assess the feasibility of nationwide chronic disease surveillance using data aggregated through a multisite collaboration of customers of the same electronic health record (EHR) platform across the United States.

MATERIALS AND METHODS

An independent confederation of customers of the same EHR platform proposed and guided the development of a program that leverages native EHR features to allow customers to securely contribute de-identified data regarding the prevalence of asthma and rate of asthma-associated emergency department visits to a vendor-managed repository. Data were stratified by state, age, sex, race, and ethnicity. Results were qualitatively compared with national survey-based estimates.

RESULTS

The program accumulated information from 100 million health records from over 130 healthcare systems in the United States over its first 14 months. All states were represented, with a median coverage of 22.88% of an estimated state's population (interquartile range, 12.05%-42.24%). The mean monthly prevalence of asthma was 5.27 ± 0.11%. The rate of asthma-associated emergency department visits was 1.39 ± 0.08%. Both measures mirrored national survey-based estimates.

DISCUSSION

By organizing the program around native features of a shared EHR platform, we were able to rapidly accumulate population level measures from a sizeable cohort of health records, with representation from every state. The resulting data allowed estimates of asthma prevalence that were comparable to data from traditional epidemiologic surveys at both geographic and demographic levels.

CONCLUSIONS

Our initiative demonstrates the potential of intravendor customer collaboration and highlights an organizational approach that complements other data aggregation efforts seeking to achieve nationwide EHR-based chronic disease surveillance.

A mixed-methods analysis of younger adults' perceptions of asthma, self-management, and preventive care: "This isn't helping me none"

BACKGROUND

Young adults (ages 18-44) have increased emergency department use for asthma and poor adherence to medications. The objective of this mixed-methods study was to understand experiences with and approaches to managing asthma, of which little is known in this age group.

METHODS

Surveys (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire) and 1:1 semi-structured interviews were used to explore experiences with asthma, symptoms, self-management behaviours, and relationship to asthma control and quality of life. Qualitative data were analysed using content analysis techniques. Descriptive statistics and bivariate correlations were used to examine distributive characteristics and associations between variables.

RESULTS

Forty urban adults participated (mean age 32.7 ± 6.2, 1σ). Coughing was reported nearly 46% more often than wheezing, with 42.5% (17/40) coughing until the point of vomiting most days. Most participants delayed using medication for symptoms due to misperceptions about inhalers. Higher symptom frequency and worse asthma control were associated with greater use of non-pharmacologic symptom management strategies (r = 0.645, P < .001; r = 0.360, P = .022, respectively). Five themes were identified regarding young adults experiences with asthma: (1) having asthma means being limited and missing out on life; (2) health care for asthma is burdensome, and other things are more important; (3) there is not enough personal benefit in medical interactions to make preventive care worthwhile; (4) there are insufficient support and education about asthma for adults; and (5) people normalize chronic symptoms over time and find ways of coping that fit with their lifestyle.

CONCLUSIONS AND CLINICAL RELEVANCE

Young adults may tolerate symptoms without using quick-relief medication or seeking preventive care. Increasing engagement with preventive services will require decreasing perceived burdens and increasing the personal benefits of care. Evaluating for non-pharmacologic approaches to managing symptoms and asthma-related coughing may identify uncontrolled asthma. Enhanced training for clinicians in patient-centric asthma care may be needed.

Asthma attacks in children are always preceded by poor asthma control: myth or maxim?

Some, but not all, asthma exacerbations in children are preceded by poor asthma control https://bit.ly/3muIy6h.

Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey

BACKGROUND

The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown.

OBJECTIVE

To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found.

METHODS

Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression.

RESULTS

A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008).

CONCLUSIONS

Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.

Comparing Three Measures of Self-Efficacy of Asthma Self-Management in Adolescents

OBJECTIVE

This study examines the relationships between 3 measures of asthma-related self-efficacy and compares them by their relationships to quality of life, medication adherence, asthma control, asthma knowledge, and attitudes in adolescents.

METHODS

Participants included 371 urban adolescents (age 12-20 years) with asthma. Three self-efficacy measures included the Asthma Outcome Expectation-self-efficacy subscale (AOE-SE), Asthma Management Index-self-efficacy subscale (AMI-SE), and the Asthma Self-Efficacy scale (ASE).

RESULTS

The sample included 50% male, predominantly African American (78.4%) participants. All 3 measures of self-efficacy were positively correlated with each other (r = 0.46-0.54, P < .001). After controlling for gender, age, race, and health insurance type, all 3 self-efficacy measures predicted the symptom domain of quality of life, adherence, asthma control, and knowledge. Activity limitation was predicted by AMI-SE (B = 0.19, P = .008) and ASE (B = 0.38, P < .001) but not by AOE-SE, while emotional function associated only with ASE (B = 0.37, P < 0.001). Attitudes were positively associated with AOE-SE and ASE (B = 1.83 and 2.87, respectively, P < 0.001 for both), but not with AMI-SE.

CONCLUSIONS

Medication adherence and symptom control in adolescents were predicted by self-efficacy measured by the 3 measures, while these measures differed in their performance in predicting psychosocial outcomes. ASE appears the measure of choice in measuring adolescents' self-efficacy given its association with all outcome measures of the study. Further research is needed to investigate the generalized use of the self-efficacy measures in populations with varying demographic or asthma characteristics.

The influence of self-assessment of asthma control on the Asthma Control Test outcome

OBJECTIVE

The Asthma Control Test (ACT) consists of five items, one of which is self-assessment of asthma control. The goal of this study was to compare the responses to the first four ACT items with the response to the fifth item and determine whether this response affects the final ACT score.

METHODS

Adult asthmatics (n = 417) were recruited from a specialty asthma center in Poland. Clinical data were collected by questionnaire. Spirometry and skin prick tests were performed for clinical evaluation. Asthma control was assessed through the ACT. The cutoff point for uncontrolled asthma was <20 points.

RESULTS

Asthma was uncontrolled in 42.5% of patients. Based upon scores of the first four ACT items, three clusters of patients were identified. Cluster 1 comprised very well-controlled asthmatics [mean (sd) ACT total score 24.7 (0.7)]. Cluster 2 included both controlled and uncontrolled asthmatics [ACT total score 20.1 (2.5)]. Cluster 3 comprised poorly controlled asthmatics [ACT total score 12.1 (2.9)]. Misjudgment of asthma control in the fifth ACT item had no impact on the ACT total score in clusters 1 and 3. In cluster 2, the response to this item caused misclassification in 10.2% of patients.

CONCLUSIONS

In patients with either very well or very poorly controlled asthma, the response to the fifth ACT item did not alter the assignment into the appropriate asthma control group. Only in a small group of patients with a total ACT score of approximately 20 points did the asthma group classification result in either controlled or uncontrolled.

Asthma control and quality of life in adolescents: The role of illness perceptions, medication beliefs, and adherence

Objective: Asthma control and quality of life (QoL) are important disease outcomes for asthma patients. Illness perceptions (cognitive and emotional representations of the illness) and medication beliefs have been found to be important determinants of medication adherence, and subsequently disease control and QoL in adults with asthma. In adolescents, this issue needs further elucidation. Therefore, the aim of this study was to explore the relationship between illness perceptions, medication beliefs, medication adherence, disease control, and QoL in adolescents with asthma.Methods: In this cross-sectional study, we used baseline data of adolescents with asthma (age 12-18 years) who participated in the ADolescent Adherence Patient Tool (ADAPT) study. Questionnaires were administrated online, and included sociodemographic variables and validated questionnaires measuring self-reported illness perceptions, medication beliefs, medication adherence, disease control, and QoL.Results: Data of 243 adolescents with asthma were available; age 15.1 ± 2.0 years and 53% females. More than half of these adolescents (62%; n = 151) reported to be non-adherent (Medication Adherence Report Scale ≤23) and 77% (n = 188) had uncontrolled asthma. There was a strong positive correlation between disease control and QoL (r = 0.74). All illness perceptions items were correlated with disease control and QoL, with the strongest correlation between 'identity' (symptom perception) and QoL (r=-0.66). Medication adherence was correlated to medication beliefs (r = 0.38), disease control (r = 0.23), and QoL (r = 0.14), whereas medication beliefs were only associated with adherence.Conclusions: Stimulating positive illness perceptions and medication beliefs might improve adherence, which in turn might lead to improved disease control and better QoL.

Activity-Aware Wearable System for Power-Efficient Prediction of Physiological Responses

Wearable health monitoring has emerged as a promising solution to the growing need for remote health assessment and growing demand for personalized preventative care and wellness management. Vital signs can be monitored and alerts can be made when anomalies are detected, potentially improving patient outcomes. One major challenge for the use of wearable health devices is their energy efficiency and battery-lifetime, which motivates the recent efforts towards the development of self-powered wearable devices. This article proposes a method for context aware dynamic sensor selection for power optimized physiological prediction using multi-modal wearable data streams. We first cluster the data by physical activity using the accelerometer data, and then fit a group lasso model to each activity cluster. We find the optimal reduced set of groups of sensor features, in turn reducing power usage by duty cycling these and optimizing prediction accuracy. We show that using activity state-based contextual information increases accuracy while decreasing power usage. We also show that the reduced feature set can be used in other regression models increasing accuracy and decreasing energy burden. We demonstrate the potential reduction in power usage using a custom-designed multi-modal wearable system prototype.

Mixed-methods content and sentiment analysis of adolescents' voice diaries describing daily experiences with asthma and self-management decision-making

BACKGROUND

Accurate symptom assessment remains challenging in teen populations. Little is known of usual symptom/response patterns, and self-reported paper diaries have traditionally low compliance rates. Therefore, we used concurrent digital voice diaries to capture daily asthma experiences.

OBJECTIVE

(a) To qualitatively explore usual symptom patterns and self-management responses and (b) to quantitatively explore relationships between symptom severity and sentiment scores (a marker of emotional response to events).

METHODS

Fourteen minority and nonminority teenagers (age 13-17) with controlled (50%) and uncontrolled asthma used digital recorders to report about their asthma once daily over 14 days. Dairy entries were coded for symptom frequency, severity, type, and self-management responses, while sentiment analysis was used to evaluate the emotional valence of diary entries and to explore whether increased symptom levels correlated with greater negative sentiment.

RESULTS

Symptom frequency and severity recorded in voice diaries were much higher than teens indicated at baseline and were discordant with clinical assessments of asthma control. Of 175 entries, teens had symptoms 69.1% of days (121/175) and severe symptoms on one-third of these. Atypical symptoms (coughing, throat clearing) were reported twice as often as traditional symptoms (wheezing, chest tightness) and often not recognized as asthma, but rather attributed to being "sick" (25.6% of symptom days). Teens frequently minimized symptoms, used rescue and controller medication inconsistently, and resorted to alternative strategies to manage symptoms. Sentiment was not significantly correlated with assessed control (β = 0.14, P = 0.28), but for teens reporting severe symptoms, sentiment scores decreased by 0.31 relative to teens without symptoms (P = 0.006).

CONCLUSIONS AND CLINICAL RELEVANCE

Teens may minimize symptoms and have greater symptom frequency and severity than is recognized by themselves or providers. Screening for specific symptoms including coughing, throat clearing, and respiratory illness may be needed to identify those experiencing burden from asthma.

Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics

Background

The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making.

Methods

Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6–8 weeks later. The ACT-based asthma control assessment was compared to physician assessment.

Results

For baseline and follow-up visits, internal consistency, as measured using Cronbach’s alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ≤19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ≤21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status.

Conclusions

Concerns for the ACT’s ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making.

Trial registration

ClinicalTrials.gov: NCT02671643, NCT02662413.

Electronic supplementary material

The online version of this article (10.1186/s12931-018-0858-0) contains supplementary material, which is available to authorized users.

Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training

OBJECTIVE

To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents.

METHODS

Fourty-two inner-city adolescents (ages 16-20) participated in a 12hour asthma self-management training program. Self-management knowledge, attitude toward asthma, and asthma-related self-efficacy were measured using short-answer tests before and after training. T-Tests were used to evaluate impact and effect sizes were calculated.

RESULTS

Mean pretest knowledge was 21.37/46 points; mean posttest was 36.33/46 points. Change from pre- to posttest was highly significant (t=10.34; p<0.0001), with a large effect size (d=1.68). Females improved more than males (18.66±8.58 vs. 12.29±8.13, p=0.039). Greatest effects were seen in awareness of long-term consequences of uncontrolled asthma (d=2.04), ability to recognize symptoms of life-threatening asthma (d=1.61), correctly monitor symptoms (d=1.49), and tell if asthma was uncontrolled (d=1.39). Asthma self-efficacy also improved significantly (p=0.017), particularly confidence in ability to correctly manage asthma, however improvements in attitude did not achieve statistical significance.

CONCLUSION

Developmentally appropriate training is effective in increasing critical self-management knowledge and self-efficacy in inner city adolescents, particularly females.

PRACTICE IMPLICATIONS

Providers should screen carefully for symptoms and educate using developmentally appropriate training materials on ways to correctly monitor and manage symptom.

Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents

BACKGROUND

The factors associated with poor asthma control, exacerbations, and health care utilization in black adolescents are complex and not well understood. Although psychological comorbidities such as anxiety are common in patients with asthma, these have not been studied in this population.

OBJECTIVE

This study characterized anxiety and associated asthma features in a cohort of black inner-city adolescents with persistent asthma and determined the association between anxiety symptoms, persistent uncontrolled asthma, and prospective health care utilization over 1 year.

METHODS

Eighty-six black adolescents were enrolled, phenotyped, and screened for anxiety symptoms with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A). Participants were telephoned every 2 months and a second study visit was completed at 1 year. Primary outcomes included persistent uncontrolled asthma, asthma exacerbations requiring systemic corticosteroids, and unscheduled health care utilization during the 1-year study period.

RESULTS

A total of 31% (n = 27) of adolescents had probable anxiety (ie, HADS-A score >7) and 27% (n = 23) had possible anxiety (ie, HADS-A score 5-7) at the baseline visit. Anxiety symptoms were associated with poorer asthma control, more impaired quality of life, and more insomnia symptoms. Adolescents with probable anxiety disorders also had increased odds of persistent uncontrolled asthma and emergency department utilization, with no differences in physician visits or systemic corticosteroid receipt.

CONCLUSIONS

Inner-city black adolescents with persistent asthma have a high prevalence of anxiety symptoms associated with poorer asthma control, impaired quality of life, insomnia, and increased prospective emergency department utilization for asthma. Routine screening for anxiety disorders may be useful in the clinical management of adolescents with asthma.

Accommodating interruptions: A grounded theory of young people with asthma

AIMS AND OBJECTIVES

The aim of this study was to develop an explanatory theory on the lives of young people with asthma, issues affecting them and the impact of asthma on their day-to-day lives.

BACKGROUND

Accommodating Interruptions is a theory that explains young people's concerns about living with asthma. Although national and international asthma management guidelines exist, it is accepted that the symptom control of asthma among the young people population is poor.

DESIGN

This study was undertaken using Classic Grounded Theory.

METHODS

Data were collected through in-depth interviews and clinic consultations with young people aged 11-16 years who had asthma for over 1 year. Data were also collected from participant diaries. Constant comparative analysis, theoretical coding and memo writing were used to develop the substantive theory.

RESULTS

The theory explains how young people resolve their main concern of being restricted by Accommodating Interruptions in their lives. They do this by assimilating behaviours in balance finding, moderating influence, fitting in and assuming control minimising the effects of asthma on their everyday lives.

CONCLUSION

The theory of Accommodating Interruptions explains young people's asthma management behaviours in a new way. It allows us to understand how and why young people behave the way they do because they want to participate and be included in everyday activities, events and relationships. The theory adds to the body of knowledge on how young people with asthma live their day-to-day lives and it challenges some existing viewpoints in the literature regarding their behaviours.

RELEVANCE TO CLINICAL PRACTICE

The findings have implications for developing services to support young people in a more meaningful way as they accommodate the interruptions associated with asthma in their lives.

Asthma Home Management in the Inner-City: What can the Children Teach us?

OBJECTIVE

Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited.

METHOD

Convenience sampling methods were used to recruit families of low-income children who are frequently in the emergency department for uncontrolled asthma. Thirteen youths participated in focus groups designed to elicit reflections on asthma home management. Data were analyzed using grounded theory coding techniques.

RESULTS

Participants (Mean age = 9.2 years) were African American (100%), enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency department visits over the prior 3 months, and resided in homes with at least 1 smoker (61.5%). Two themes reflecting multifaceted challenges to the development proper of self-management emerged in the analysis.

DISCUSSION

Findings reinforce the need to provide a multipronged approach to improve asthma control in this high-risk population including ongoing child and family education and self-management support, environmental control and housing resources, linkages to smoking cessation programs, and psychosocial support.

Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: a prospective study

Background

Success in asthma management hinges on patients’ competency to detect and respond to ever-changing symptom severity. Thus, it is crucial to have reliable, simple, and sustainable methods of symptom monitoring that can be readily incorporated into daily life. Although visual analogue scale (VAS) has been considered as a simple symptom assessment method, its utility as a daily symptom monitoring tool in adolescents is unknown. This study was to determine the concurrent validity of VAS in capturing diurnal changes in symptoms and to examine the relationships between VAS and asthma control and pulmonary function.

Methods

Forty-two adolescents (12–17 years old) with asthma completed daily assessment of symptoms twice per day, morning and bedtime, for a week using VAS and 6-item symptom diary concurrently. Asthma control was measured at enrollment and 6 month later, and spirometry was conducted at enrollment. Pearson correlations, multilevel modeling and regression were conducted to assess the relationships between VAS and symptom diary, asthma control and FEV1.

Results

Morning and evening VAS was positively associated with symptom diary items of each corresponding time frame of the day (r = 0.41–0.58, p < 0.0001). Morning VAS was significantly predicted by morning diary data reflecting nocturnal wakening (β = 2.13, p = 0.033) and morning symptoms (β = 4.09, p = 0.002), accounting for 57% of the total variance of morning VAS. Similarly, changes in four evening diary items, particularly shortness of breath (β = 2.60, p = 0.028), significantly predicted changes in evening VAS, accounting for 55% of the total variance. Average VAS scores correlated with asthma control (r = 0.65, p < 0.001) and FEV1 (r = −0.38, p = 0.029), and were predictive of asthma control 6 months later (β = 0.085, p = 0.006).

Conclusions

VAS is a valid tool capturing diurnal changes in symptoms reflected in a multi-item symptom diary. Moreover, VAS is a valid measure predicting concurrent and future asthma control. The findings suggest VAS can be a simple alternative to daily dairies for daily symptom monitoring, which can provide invaluable information about current and future asthma control without substantially increasing self-monitoring burdens for adolescent patients.

Clinical Trial Registration NCT01696357. Registered 18 September 2012

Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma

BACKGROUND

Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors.

OBJECTIVES

To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms.

METHODS

A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis.

RESULTS

Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms.

CONCLUSIONS

Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.

Parents and adolescents preferences for asthma control: a best-worst scaling choice experiment using an orthogonal main effects design

Background

The preferences of parents and children with asthma influence their ability to manage a child’s asthma and achieve good control. Potential differences between parents and adolescents with respect to specific parameters of asthma control are not considered in clinical asthma guidelines. The objective was to measure and compare the preferences of parents and adolescents with asthma with regard to asthma control parameters using best worst scaling (BWS).

Methods

Fifty-two parents of children with asthma and 44 adolescents with asthma participated in a BWS study to quantify preferences regarding night-time symptoms, wheezing/chest tightening, changes in asthma medications, emergency visits and physical activity limitations. Conditional logit regression was used to determine each group’s utility for each level of each asthma control parameter.

Results

Parents displayed the strongest positive preference for the absence of night-time symptoms (β = 2.09, p < 0.00001) and the strongest negative preference for 10 emergency room visits per year (β = −2.15, p < 0.00001). Adolescents displayed the strongest positive preference for the absence of physical activity limitations (β = 2.17, p < 0.00001) and the strongest negative preference for ten physical activity limitations per month (β = −1.97). Both groups were least concerned with changes to medications.

Conclusion

Parents and adolescents placed different weights on the importance of asthma control parameters and each group displayed unique preferences. Understanding the relative importance placed on each parameter by parents and adolescents is essential for designing effective patient-focused disease management plans.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-015-0141-9) contains supplementary material, which is available to authorized users.

Evaluating the Validity of an Automated Device for Asthma Monitoring for Adolescents: Correlational Design

BACKGROUND

Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients' consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo.

OBJECTIVE

The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases.

METHODS

A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device's capacity to discriminate between asthma versus nonasthma cases.

RESULTS

ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=-.26, P=.05), forced vital capacity (FVC) (r=-.31, P=.02), and overall asthma control (r=-.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control (β=-.48, P=.003), quality of life (β=-.55, P=.001), and health care utilization (β=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95% CI 0.58-0.84), which was significantly different from chance (χ(2) 1=9.7, P=.002), indicating the device's discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3% and a specificity of 72.7%.

CONCLUSIONS

This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients' awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma.

Automated Cough Assessment on a Mobile Platform

The development of an Automated System for Asthma Monitoring (ADAM) is described. This consists of a consumer electronics mobile platform running a custom application. The application acquires an audio signal from an external user-worn microphone connected to the device analog-to-digital converter (microphone input). This signal is processed to determine the presence or absence of cough sounds. Symptom tallies and raw audio waveforms are recorded and made easily accessible for later review by a healthcare provider. The symptom detection algorithm is based upon standard speech recognition and machine learning paradigms and consists of an audio feature extraction step followed by a Hidden Markov Model based Viterbi decoder that has been trained on a large database of audio examples from a variety of subjects. Multiple Hidden Markov Model topologies and orders are studied. Performance of the recognizer is presented in terms of the sensitivity and the rate of false alarm as determined in a cross-validation test.

Predictors of perceived asthma control among patients managed in primary care clinics

OBJECTIVE

To estimate the extent to which symptom status, physical activity, beliefs about medications, self-efficacy, emotional status, and healthcare utilization predict perceived asthma control over a period of 16 months among a primary care population.

METHODS

The current study is a secondary analysis of data from a longitudinal study that examined health outcomes of asthma among participants recruited from primary care clinics. Path analysis, based on the Wilson and Cleary and International Classification of Functioning, Disability and Health frameworks, was used to estimate the predictors of perceived asthma control.

RESULTS

The path analysis identified initial perceived asthma control asthma (β = 0.43, p < 0.0001), symptoms (β = 0.35, p < 0.0001), physical activity (β = 0.27, p < 0.0001), and self-efficacy (β = 0.29, p < 0.0001) as significant predictors of perceived asthma control (total effects, i.e., direct and indirect), while emotional status (β = 0.08, p = 0.03) was a significant indirect predictor through physical activity. The model explained 24 % of the variance of perceived asthma control. Overall, the model fits the data well (χ (2) = 6.65, df = 6, p value = 0.35, root-mean-square error of approximation = 0.02, Comparative Fit Index = 0.999, and weighted root-mean-square residual = 0.27).

CONCLUSION

Initial perceived asthma control, current symptoms status, physical activity, and self-efficacy can be used to identify individuals likely to have good perceived asthma control in the future. Emotional status also has an impact on perceived asthma control mediated through physical activity and should be considered when planning patient management. Identifying these predictors is important to help the care team tailor interventions that will allow individuals to optimally manage their asthma, to prevent exacerbations, to prevent other respiratory-related chronic disease, and to maximize quality of life.

Evaluation of a pilot national online asthma e-learning program for secondary school students

BACKGROUND

Ireland has the fourth highest incidence of asthma in the world, with Irish children losing on average 10 days of school per annum due to their asthma. It is highly probable that a large percentage of students in each class in Irish schools have asthma and are required to manage symptoms during the out-of-home period. Young people with chronic illnesses such as asthma find themselves labelled and marginalized due to a lack of awareness of others about their condition.

AIMS AND OBJECTIVES

Young people who feel supported by their peers have been shown to have higher levels of self-efficacy and fewer exacerbations of their asthma symptoms.

METHODS

An on-line asthma e-learning program was developed to provide support to teenagers who have asthma, and help them inform their classmates and friends about asthma. A quasi-experimental approach was used to pilot the educational intervention.

RESULTS

The results of the pilot demonstrate that the program is effective. Teenagers who have asthma found the e-learning program to be informative and relevant to them. The increase in awareness of asthma among teenagers who did not have asthma is shown to influence their confidence in assisting their peers who are experiencing asthma symptoms.

Quantifying preferences for asthma control in parents and adolescents using best-worst scaling

BACKGROUND

Understanding the views of parents and children is critical to designing effective asthma management programs. It was hypothesized that parents and adolescents would exhibit heterogenous preferences with regard to asthma control.

METHODS

Fifty parents of children with asthma and 51 adolescents with asthma participated in a best-worst scaling study to quantify preferences regarding night-time symptoms, wheezing/chest tightening, changes in asthma medications, emergency visits and physical activity limitations.

RESULTS

A latent class analysis revealed heterogeneity inherent in the preferences of parents and adolescents. Two classes of parents emerged from the analysis that displayed significantly different preferences. The first displayed strong preferences for averting night-time symptoms, wheezing/chest tightening, physical activity limitations and emergency room visits with odds ratios (OR) of 42 (95% CI 24, 72), 40 (95% CI 23, 68), 26 (95% CI 15, 44) and 21 (95% CI 12, 35), respectively, compared to an OR of 1 for 10 physical activity limitations per month. A second smaller parent class displayed more balanced preferences. Most adolescents displayed similar preferences for averting night-time symptoms, wheezing/chest tightening, physical activity limitations and emergency room visits, with ORs of 28 (95% CI 16, 48), 25 (95% CI 14, 44), 27 (95% CI 15, 46) and 20 (95% CI 11, 34) respectively.

CONCLUSIONS

This study revealed the importance placed on averting night-time symptoms, wheezing and chest tightening, emergency room visits and physical activity limitations by parents and adolescents alike, with greater emphasis on symptom aversion by parents. Preference heterogeneity exists and should be considered in customized asthma management programs.

The impact of student-directed videos on community asthma knowledge

The Student Asthma Research Team (START) program was designed to enable students to explore socio-ecological factors contributing to asthma through the use of Photovoice, a technique that gathers both photographs and personal experiences from participants. The photographs taken by and commentary from student participants were integrated into public service announcements (PSAs) intended to increase community asthma awareness and catalyze behavior change. This article evaluates the effectiveness of these student-directed PSAs at improving asthma awareness among peers and community members. Pre-PSA, immediate post-PSA, and 4 month post-PSA follow-up assessments were conducted to evaluate changes in community members' asthma knowledge and behavior. The student-directed PSAs were found to significantly increase asthma knowledge among community members, irrespective of age, gender, or race. Increased knowledge persisted through the 4-month post-PSA follow-up. Of the thirty-six participants who were successfully contacted for the follow-up survey, nearly 40 % reported meaningful behavior-change in response to the PSAs. Photovoice and media production techniques were effective in engaging adolescent students--an under-served and often disenfranchised population--in asthma health education through the development and dissemination of PSAs. The extension of participatory techniques such as Photovoice to include the creation of student-directed PSAs holds promise for engaging adolescents in public health initiatives within their communities.

Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study

PURPOSE

Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone-based asthma self-management aid for adolescents (mASMAA) that was designed to facilitate symptom monitoring, treatment adherence, and adolescent-parent partnership. The system used state-of-the-art natural language-understanding technology that allowed teens to use unconstrained English in their texts, and to self-initiate interactions with the system.

MATERIALS AND METHODS

mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English. Fifteen adolescent-parent dyads participated in a 2-week trial that involved adolescents' daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents' asthma condition automatically generated by mASMAA. Subsequently, four focus groups were conducted to systematically obtain user feedback on the system. Frequency data on the daily usage of mASMAA over the 2-week period were tabulated, and content analysis was conducted for focus group interview data.

RESULTS

Response rates for daily text messages were 81%-97% in adolescents. The average number of self-initiated messages to mASMAA was 19 per adolescent. Symptoms were the most common topic of teen-initiated messages. Participants concurred that use of mASMAA improved awareness of symptoms and triggers, promoted treatment adherence and sense of control, and facilitated adolescent-parent partnerships.

CONCLUSION

This study demonstrates the utility and user acceptability of mASMAA as a potential asthma self-management tool in a selective group of adolescents. Further research is needed to replicate the findings in a large group of adolescents from sociodemographically diverse backgrounds to validate the findings.

Experiences of living with asthma - a focus group study with adolescents and parents of children with asthma

OBJECTIVE

The goal for asthma treatment is that every individual, so far as possible, shall live without symptoms and exacerbations. Patients and health care professionals sometimes have different perceptions of what is important for achieving good quality of life. This work aims to describe the experiences among adolescents as well as those of parents with young children living with asthma.

METHODS

Four focus group interviews were performed, two with parents of young children and two with adolescents. The data were qualitatively analyzed, using Systematic Text Condensation.

RESULT

Three themes relevant to the participants' experiences of living with asthma were presented; strategies, frustrations and expectations. The adolescents wanted to be like their peers and developed their own strategies for self-management of asthma, which included not always taking medication as prescribed. The parents emphasized frustration regarding not being believed, lack of understanding feelings of loneliness, or anxiety. One identified expectation was that the participants wanted to be met with competence and understanding in asthma care from health care professionals. Another expectation expressed among parents was that teachers in nursery and primary schools should have more knowledge and understanding on how to care for children with asthma.

CONCLUSION

Living with asthma leads to developing personal strategies in self-management of asthma. Moreover both parents and adolescents had expectations of being met by competent and understanding health care professionals. Developing a partnership between patients and health care professionals could be a successful way to improve the care of patients with asthma.

Using Orem's self-care model for asthmatic adolescents

PURPOSE

The aim of the study was to determine the effect of Orem's self-care model on the self-care of adolescents with asthma.

DESIGN AND METHODS

In this experimental design, adolescents with asthma (N = 80) received home visits and individualized care based on theory-guided nursing diagnoses. Patients in the experimental group were visited in their homes eight times, and those in the control group were visited two times.

RESULTS

The five self-care skills of medicine usage, peak expiratory flow meter usage, applying an asthma action plan, keeping a daily follow-up schedule, and protecting against triggering factors differed significantly between the first and last visits in the experimental group, whereas the self-care skills of adolescents in the control group did not change.

PRACTICE IMPLICATIONS

Applying Orem's self-care model increased the self-care skills of adolescents with asthma.

Adolescent Asthma Self-Management: A Concept Analysis and Operational Definition

BACKGROUND: Adolescents with asthma have a higher risk of morbidity and mortality than other age groups. Asthma self-management has been shown to improve outcomes; however, the concept of asthma self-management is not explicitly defined. METHODS: We use the Norris method of concept clarification to delineate what constitutes the concept of asthma self-management in adolescents. Five databases were searched to identify components of the concept of adolescent asthma self-management, and lists of relevant subconcepts were compiled and categorized. RESULTS: Analysis revealed 4 specific domains of self-management behaviors: (1) symptom prevention; (2) symptom monitoring; (3) acute symptom management; and (4) communication with important others. These domains of self-management were mediated by intrapersonal/cognitive and interpersonal/contextual factors. CONCLUSIONS: Based on the analysis, we offer a research-based operational definition for adolescent asthma self-management and a preliminary model that can serve as a conceptual base for further research.

Latent variable mixture modeling: a flexible statistical approach for identifying and classifying heterogeneity

BACKGROUND

Latent variable mixture modeling is becoming increasingly popular in nursing research, in part due to the sophistication of the method in identifying relationships, patterns, and clusters in the data.

OBJECTIVE

The aim of this study was to provide an overview of mixture modeling techniques, specifically as applied to nursing research, and to present examples from two studies to illustrate how these techniques may be used cross-sectionally and longitudinally.

METHODS

The first data example demonstrates the use of latent profile analysis as applied to the St. George respiratory symptoms questionnaire in 2,232 smokers from the Lovelace Smokers Cohort. The second data example demonstrates growth mixture modeling as applied to condom use trajectories among 728 at-risk adolescents on probation.

RESULTS

Three classes of symptoms emerged among the smokers cohort: those who were high on all symptoms, those who were low on all symptoms, and those who were high on cough and phlegm only. These classes were then distinguishable by participant gender and wood smoke exposure. In the second data example, four classes of condom use emerged. Only 59% of the sample indicated the previously reported decline in condom use over time; condom use remained stable or significantly increased for the remaining 41%.

DISCUSSION

Both sets of results provide additional substantive information about patterns in the data that were not apparent from previously applied traditional methodological techniques. Considerations for the use of latent variable mixture modeling in nursing research are discussed.

Relationship among asthma knowledge, behavior management and social adaptation in school-age children with asthma in Taiwan

This study examined the relationships between asthma knowledge, behavior management, and social adaptation among school-age children with asthma. A total of 210 school-age asthmatic children and their parents were recruited from a medical hospital in Taiwan. The children completed asthma knowledge and behavior management questionnaires, and their parents completed the Child and Adolescent Adjustment Profile. There was a statistically significant positive correlation between behavior management and social adaptation among asthmatic children. Asthma knowledge and behavior management were positively associated but did not correlate with children's social adaptation. The behavior management of the children acted as a predictor of their social adaptation. These findings suggest that efforts to raise children's asthma knowledge will benefit these individuals in terms of behavior management. The introduction of asthma behavior management plans could facilitate the social adaptation of asthmatic children and, in particular, increase their independence and reduce their withdrawal as well as enhance their self-confidence and self-esteem.

Living with asthma: an analysis of patients' perspectives

OBJECTIVES

To investigate asthmatic patients' perceptions of their disease.

METHODS

The study was done with the participation of 23 patients among the asthmatics whose progress is monitored regularly in a university hospital. Phenomenological methodology was used, and the first step was to determine the socio-demographic characteristics of the participants. Then, in order to determine their feelings and opinions on the subject of their asthma, each participant was asked to write a letter to answer the following question: "If asthma were a friend of yours, what would you like to say to it in a letter?" Data were analyzed using the continuous comparative method of Colaizzi (1978; "Psychological research as a phenomenologist views it", in Valle, R. And King, M. (Eds), Existential Phenomenological Alternatives for Psychology, Oxford University Press, New York, NY.). For this purpose, each researcher read the letters separately and identified the important thoughts, and similar statements were classified under the same theme groups.

RESULTS

The mean age of the patients was 41.43 ± 6.23 years, and 69.6% of them were female, 73.9% were married, 34.8% were primary school graduates, and 34.7% were civil servants (with no social security problems). The statements of the asthmatics in the study were grouped according to the following themes: "The Most Important Factor in Accepting Asthma Is Time," "It's So Hard to Be Asthmatic," "Being Asthmatic Means Understanding the Value of Life," "I Don't Like Asthma, so I Can't Make Friends with It," "Learning to Live with Asthma," "One Day I May Recover from Asthma," "Feeling Anger," and "Suffering from Continuous Worry and Fear."

CONCLUSION

Asthmatic patients need psychosocial support since they believe that there is no certain treatment for asthma, and attacks are inevitable.

Symptoms, lung function, and perception of asthma control: an exploration into the heterogeneity of the asthma control construct

BACKGROUND

Asthma control is still surprisingly poor, which may be related to factors causing discrepancies between objective lung function measures and subjective symptom reports or discrepancies between objective indicators of asthma control and control perception. Identifying patients prone to such discrepancies may help to understand asthma control problems.

METHODS

Ninety-four persons with asthma participated in this study. We used cluster analysis to identify different subgroups of asthma control, based on a measure of lung function and self-report of daytime and nighttime symptoms, activity limitations, reliever medication use, and perception of asthma control. Subsequently, we explored between-cluster differences in clinical and psychological characteristics.

RESULTS

We identified two homogeneous clusters: a cluster of persons with poorly controlled asthma and a cluster of persons with well-controlled asthma. A third cluster included persons with an intermediate level of asthma control, an absence of nighttime symptoms, and a reduced impact of asthma symptoms on daily activities despite high levels of symptoms and reliever medication use. Members of the poorly controlled asthma cluster showed higher symptom levels, more catastrophic thinking, and activity avoidance beliefs compared with members of other clusters.

CONCLUSION

The clusters we identified crosscut current definitions of asthma severity and asthma control and indicate the importance of affective evaluation of symptoms in explaining poor asthma control.

"I want to meet other kids like me": support needs of children with asthma and allergies

CONTEXT

Asthma is the most common chronic illness of childhood and the leading cause of hospitalization in young children. Asthma negatively impacts physical health, psychosocial wellbeing, and quality of life for affected children but the psychosocial support needs of children with asthma and severe have not been studied from their point of view.

OBJECTIVE

The objective of this study was to assess the support and education needs and preferred interventions of allergic children with asthma and/or severe allergies.

METHODS

Qualitative constant comparative content analysis was used to identify major themes from semi-structured individual interviews with 20 children with asthma and allergies and 35 parents.

FINDINGS

Children expressed frustration with the limitations imposed by asthma and allergies on their regular activities and normal lives. Parents believed that peer support--someone to whom their child could relate as a role model--could improve both their children's and their own coping.

CONCLUSIONS

Parents and children preferred a combination of in-person meetings and Internet support to enhance the capacity of children, reduce children's anxiety, increase their self-care skills, and self-confidence. In addition they believed a support intervention was a stepping stone to developing a community of support for children with asthma, allergies, and anaphylaxis.

Management of exercise-induced bronchospasm in adolescents with asthma

Physical activity in persons with asthma is important at any age but even more so in adolescents. Collaboration between the nurse practitioner and adolescent is essential to develop an asthma management plan that will provide for optimal physical activity and prevent asthma exacerbations while exercising.

Adolescents' perception of asthma symptoms and health care utilization

INTRODUCTION

Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services.

METHODS

This exploratory study included 126 adolescents with asthma who were between 13 and 20 years of age. Subjects were classified as having inaccurate symptom perception (IG); well-controlled accurate symptom perception (WCA); and poorly controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization, including emergency department (ED) visits, hospitalization, and office visits and school absenteeism in the past 3 months.

RESULTS

More adolescents in the IG group had at least one hospitalization compared with adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6%, respectively). A similar trend was seen for ED visits. Compared with the WCA group, adolescents in the IG group were nearly nine times more likely to have been hospitalized, 3.4 times more likely to have visited an ED, and four times more likely to have missed school days.

DISCUSSION

Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school compared with those who have accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to ensure appropriate care.

Exhaled NO and exhaled breath condensate pH in the evaluation of asthma control

BACKGROUND

Asthma is a chronic inflammatory airways disorder. However, no biomarker of airways inflammation has been included in the assessment of asthma control.

OBJECTIVE

To evaluate exhaled NO (FeNO) and exhaled breath condensate (EBC) pH in patients with asthma according to the level of control, and their performance in the identification of not well-controlled patients.

METHODS

FeNO and EBC pH after Argon deaeration were measured in 274 consecutive patients. Asthma control was evaluated by two asthma specialists blinded to FeNO and pH measurements according to GINA guidelines, as well as by asthma control test (ACT) and asthma control questionnaire (ACQ).

RESULTS

FeNO was higher and EBC pH was lower in patients with not well-controlled compared to controlled asthma. In ROC analysis, FeNO presented an AUC of 0.790 for the identification of not well-controlled asthma performing better in non-smokers; EBC pH presented an AUC of 0.791 for the identification of not well-controlled asthma, performing better in smokers. The performance of both biomarkers was inferior to that of ACT and ACQ. FeNO values >30 ppb presented positive predictive values (PPV) > 0.85 with the exception of smokers treated with inhaled corticosteroids. EBC pH values ≤7.20 presented PPV >0.80 in all groups. The presence of FeNO >30 ppb and/or EBC pH ≤7.20 was indicative of not well-uncontrolled asthma in 88.3% of the patients.

CONCLUSION

FeNO and EBC pH levels may identify patients with not well-controlled asthma. However, their performance was inferior to clinical judgment and may be limited to selected subgroups of asthmatic patients.

Diagnosis and management of asthma in adolescents

OBJECTIVES

In this review we explore some of the issues surrounding the diagnosis and misdiagnosis of asthma in adolescents and suggest a management approach which might facilitate the provision of optimal treatment in order to minimise morbidity from asthma in this vulnerable and often difficult-to-manage age group.

RESULTS

We highlight important diagnostic traps which occur in the adolescent age group, including the misdiagnosis of asthma in young people presenting with exercise-related symptoms or cough, and stress the importance of considering alternative diagnoses, including vocal cord dysfunction. We explore how adolescence impacts on asthma management and emphasise the importance of an understanding of normal adolescent development and an awareness of high-risk indicators in developing a strategy to optimally manage a young person with asthma. We also illustrate how psychosocial functioning may impact on both perceived asthma severity and quality of life as well as interfere with optimal asthma control both directly and by increasing non-adherence. A suggested management strategy for adolescents is provided which emphasises a supportive approach to help facilitate optimal control of asthma by involving the young person in management decisions about their asthma. Specific mention is made about smoking cessation assistance and the interrelationship between physical activity, obesity and asthma. Finally we discuss the importance of an appropriate transition process to prepare the young person for transfer from child-centred care to adult-centred care.

CONCLUSION

Many different factors is of outmost importance when diagnosing adolescents with shortness of breath; furthermore, management of asthma need a supportive approach in both paediatric and adult setting.

Asthma and ethnic minorities: socioeconomic status and beyond

PURPOSE OF REVIEW

We aim to discuss current insights into our understanding of the mechanisms by which socioeconomic status influences the prevalence and severity of asthma in ethnic minorities. In addition, we review potential risk factors for ethnic disparities in asthma that are not mediated by socioeconomic status.

RECENT FINDINGS

Exposures and factors correlated with ethnicity through socioeconomic status (e.g. indoor and outdoor air quality, smoke exposure, and access to healthcare) are likely to explain a significant proportion of the observed ethnic differences in asthma morbidity. However, other factors correlated with ethnicity (e.g. genetic variation) can impact ethnic disparities in asthma independently of and/or interacting with socioeconomic status-related factors.

SUMMARY

Socioeconomic status is a rough marker of a variety of environmental/behavioral exposures and a very important determinant of differences in asthma prevalence and severity among ethnic minorities in the United States. However, socioeconomic status is unlikely to be the sole explanation for ethnic disparities in asthma, which may also be due to differences in genetic variation and gene-by-environment interactions among ethnic groups.