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Fitzpatrick AM, Kavalieratos D, Vickery BP, Lee T, Mason C, Grunwell JR. Altered Symptom Perception in Children With Asthma Is Associated With Poor Childhood Opportunity and Adverse Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:983-990. [PMID: 38142865 PMCID: PMC10999352 DOI: 10.1016/j.jaip.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Effective asthma self-management requires that children recognize their asthma symptoms when they occur. However, some children have altered symptom perception, which impairs their ability to respond to their asthma symptoms in a timely manner. OBJECTIVE To characterize the prevalence and features of altered symptom perception in children aged 5 to 18 years. We hypothesized that children with altered symptom perception would have more features of uncontrolled asthma, more health inequity, and poorer longitudinal asthma outcomes over 12 months. METHODS Children (N = 371) completed an outpatient research visit for clinical characterization. Altered symptom perception was defined by discordance between child responses on the 6-item Asthma Control Questionnaire and medical provider-elicited symptoms. Electronic medical records were reviewed for 12 months for the occurrence of an asthma exacerbation treated with systemic corticosteroids and an asthma exacerbation prompting an emergency department visit. RESULTS Approximately 15% of children had altered symptom perception and their asthma features were similar to those of children with uncontrolled asthma. Children with altered symptom perception were uniquely distinguished by non-White race and more severe prior exacerbations. These children also resided in ZIP codes with the poorest childhood opportunity (ie, poorest education, health and environmental features, and socioeconomic features). Outcomes of children with altered symptom perception were equally disparate with approximately 2-fold higher odds of a future exacerbation and approximately 3-fold higher odds of an emergency department visit for asthma. CONCLUSIONS Altered symptom perception is present in a small but significant number of children with asthma and is related to poorer childhood opportunity and other health inequities that require additional intervention.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Dio Kavalieratos
- Department of Pediatrics, Emory University, Atlanta, Ga; Department of Family and Preventative Medicine, Emory University, Atlanta, Ga
| | - Brian P Vickery
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Tricia Lee
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
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Wisnivesky JP, Agrawal N, Ankam J, Gonzalez A, Busse P, Lin J, Federman A, Feldman J, Weiss JJ, Markowitz SB. World Trade Center workers with asthma and post-traumatic stress disorder perceive airflow limitation more accurately. Ann Allergy Asthma Immunol 2024; 132:62-68. [PMID: 37580015 DOI: 10.1016/j.anai.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a major risk factor for increased asthma morbidity among World Trade Center (WTC) workers. OBJECTIVE To investigate whether differences in perception of airflow limitation mediate the association of PTSD with worse asthma control in WTC workers. METHODS We collected data from WTC workers on asthma control (Asthma Control Questionnaire and Asthma Quality of Life Questionnaire) and daily peak expiratory flow (PEF) measures over 6 weeks. Perception of airway limitation was assessed by comparing guessed vs actual PEF values. Post-traumatic stress disorder was diagnosed using the Structured Clinical Interview. We used unadjusted and adjusted models to compare PEF and perception measures in WTC workers with PTSD with those of workers without PTSD. RESULTS Overall, 25% of 224 participants had PTSD. Post-traumatic stress disorder was associated with worse Asthma Control Questionnaire (2.2±0.8 vs 1.1±0.9, P < .001) and Asthma Quality of Life Questionnaire (3.9±1.1 vs 5.4±1.1, P < .001) scores. Adjusted analyses showed no significant differences in PEF between WTC workers with (351.9±143.3 L/min) and those without PTSD (364.6±131.6 L/min, P = .55). World Trade Center workers with PTSD vs those without PTSD had increased proportion of accurate perception (67.0±37.2% vs 53.5±38.1%, P = .01) and decreased underperception (23.3.0±32.1% vs 38.9±37.5%, P = .004) of airflow limitation during periods of limitation. Similar results were obtained in adjusted analyses. CONCLUSION This study indicates that differences in perception of airflow limitation may mediate the relationship of PTSD and increased asthma symptoms, given WTC workers with PTSD have worse self-reported asthma control, an increased proportion of accurate perception, and decreased underperception, despite no differences in daily PEF measures.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Nikita Agrawal
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York
| | - Paula Busse
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Bronx, New York; Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York; Division of Academic General Pediatrics, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jeffrey J Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven B Markowitz
- Barry Commoners Center for Health and Environment, Queens College, City University of New York, New York
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Fruchter N, Arcoleo K, Rastogi D, Serebrisky D, Warman K, Feldman JM. Attention-Deficit Hyperactivity Disorder Symptoms, Underperception of Respiratory Compromise, and Illness Representations in Black and Latino Children With Asthma. J Pediatr Psychol 2023; 48:896-906. [PMID: 37743051 PMCID: PMC10653357 DOI: 10.1093/jpepsy/jsad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE This study examined the associations between attention-deficit/hyperactivity disorder (ADHD) symptoms, underperception of respiratory compromise, and illness representations in Black and Latino children with asthma. We hypothesized that increased child-reported ADHD symptoms, as well as parent reports for their child, would be associated with underperception of respiratory compromise, and maladaptive asthma beliefs. METHODS Two hundred ninety-six parent-child dyads were recruited from pediatric asthma and primary care clinics in the Bronx. Participants completed demographic questionnaires, the Conners-3 ADHD Index to measure ADHD symptoms, and the Asthma Illness Representation Scale to assess asthma beliefs. Perception of respiratory compromise was assessed by programmable electronic peak flow monitors that measured the child's subjective estimates of peak expiratory flow (PEF) and actual PEF, with underperception as the primary measure. RESULTS Child-reported ADHD symptoms were associated with greater underperception (β = .117, p = .049) of respiratory compromise. Parent-reported ADHD symptoms were associated with greater underperception (β = .129, p = .028) of respiratory compromise. Child-reported ADHD symptoms (β = -.188, p < .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 13.135. Parent-reported ADHD symptoms (β = -.203, p ≤ .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 15.644. CONCLUSIONS ADHD symptoms were associated with a greater underperception of respiratory compromise and more maladaptive asthma beliefs. Deficits of attentional processes and/or hyperactivity levels might be contributing factors. We emphasize the need for psychoeducation and interventions that improve perception and health beliefs in children with comorbid ADHD and asthma.
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Affiliation(s)
| | | | - Deepa Rastogi
- Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine/The Children's Hospital at Montefiore, USA
| | | | - Karen Warman
- Division of General Academic Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/The Children’s Hospital at Montefiore, USA
| | - Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, USA
- Division of General Academic Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/The Children’s Hospital at Montefiore, USA
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Owusu-Ansah S, Crowe RP, Ramgopal S. Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma. PREHOSP EMERG CARE 2023; 27:1107-1114. [PMID: 37748188 DOI: 10.1080/10903127.2023.2260471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Asthma represents one of the most common medical conditions among children encountered by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare settings, limited data exist characterizing disparities in prehospital care. We sought to characterize differences in prehospital treatment and transport of children with suspected asthma exacerbations by race and ethnicity, within the context of community socioeconomic status. METHODS We conducted a multi-agency retrospective study of EMS encounters in 2019 for children (2-17 years) with asthma and wheezing using a national prehospital database. Our primary outcomes included EMS transport and prehospital bronchodilator or systemic corticosteroid administration. Scene socioeconomic status was evaluated using the social vulnerability index. We used generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age, presence of abnormal vital signs, community size, bronchodilator use prior to EMS arrival, and transport disposition. RESULTS We analyzed 5,266 EMS encounters (median age 8 years). Approximately half (53%) were Black non-Hispanic and 34% were White non-Hispanic. Overall, 77% were transported by EMS. In an adjusted model, Black non-Hispanic children were 25% less likely to be transported compared to White non-Hispanic children (aOR: 0.75, 95%CI: 0.58-0.96). EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White, non-Hispanic patients. Relative to White non-Hispanic children, EMS bronchodilator administration was greater for Black non-Hispanic children, (aOR: 1.55, 95%CI: 1.25-1.93), after controlling for scene socioeconomic status and potential confounding variables. Systemic corticosteroids were administered in 3% of all encounters. Odds of prehospital systemic corticosteroid administration did not differ significantly by race and ethnicity. CONCLUSION Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma and were more likely to receive a bronchodilator in adjusted analyses accounting for community socioeconomic status. However, these children were less likely to be transported by EMS. These findings may reflect disease severity not manifested by abnormal vital signs, management, and other social factors that warrant further investigation.
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Affiliation(s)
- Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Feldman JM, Arcoleo K, Greenfield N, Styke S, Becker J, Jariwala S, Federman AD, Wisnivesky JP. Under-perception of airflow limitation, self-efficacy, and beliefs in older adults with asthma. J Psychosom Res 2023; 170:111353. [PMID: 37178474 PMCID: PMC10247476 DOI: 10.1016/j.jpsychores.2023.111353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Under-perception of airflow limitation is more common in older adults with asthma and may lead to under-reporting of asthma symptoms. Asthma management self-efficacy is linked with better asthma control and quality of life (QoL). We sought to examine asthma and medication beliefs as a mediator in the relationship between both under-perception and self-efficacy with asthma outcomes. METHODS This cross-sectional study recruited participants with asthma ≥60 years from hospital-affiliated practices in East Harlem and the Bronx, New York. Perception of airflow limitation was measured for 6 weeks by having participants enter peak expiratory flow (PEF) estimates into an electronic peak flow meter followed by PEF blows. We used validated instruments to assess asthma and medication beliefs, asthma management self-efficacy, asthma control, and QoL. Asthma self-management behaviors (SMB) were quantified by electronic and self-report measures of inhaled corticosteroid (ICS) adherence and observation of inhaler technique. RESULTS The sample comprised 331 participants (51% Hispanic, 27% Black, 84% female). Beliefs mediated the relationship between greater under-perception and better self-reported asthma control (β = -0.08, p = .02) and better asthma QoL (β =0.12, p = .02). Higher self-efficacy was also associated with better reported asthma control (β = -0.10, p = .006) and better asthma QoL (β =0.13, p = .01) in this indirect effect through beliefs. Accurate perception of airflow limitation was associated with higher adherence to SMB (β = 0.29, p = .003). CONCLUSIONS Less threatening asthma beliefs may be maladaptive in under-perception of airflow limitation by contributing to under-reporting of asthma symptoms, but adaptive in the context of higher self-efficacy and better asthma control.
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Affiliation(s)
- Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States of America; Albert Einstein College of Medicine, Children's Hospital at Montefiore, Department of Pediatrics and Department of Psychiatry and Behavioral Sciences, Division of Academic General Pediatrics, Bronx, NY, United States of America.
| | - Kimberly Arcoleo
- The University of Rhode Island, College of Nursing, Kingston, RI, United States of America
| | - Naomi Greenfield
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States of America
| | - Sarah Styke
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States of America
| | - Jacqueline Becker
- Icahn School of Medicine at Mount Sinai, Division of General Internal Medicine, New York, NY, United States of America
| | - Sunit Jariwala
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine, Division of Allergy/Immunology, Bronx, NY, United States of America
| | - Alex D Federman
- Icahn School of Medicine at Mount Sinai, Division of General Internal Medicine, New York, NY, United States of America
| | - Juan P Wisnivesky
- Icahn School of Medicine at Mount Sinai, Division of General Internal Medicine, New York, NY, United States of America; Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY, United States of America
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6
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Yeo AJ, Jelalian E, Kopel SJ, Koinis-Mitchell D. Asthma-related lung function and physical activity patterns among children living in urban neighborhoods. J Asthma 2023; 60:1386-1393. [PMID: 36395359 PMCID: PMC10191883 DOI: 10.1080/02770903.2022.2149410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Black and Latino American children residing in urban environments are at increased risk for comorbid asthma and obesity. Physical activity (PA) is a modifiable behavior known to contribute to the asthma-obesity phenotype. While research has indicated links between optimal asthma status and high PA among children, little is documented about whether this group may display other asthma and PA patterns that warrant clinical attention and tailored interventions. METHODS Children with persistent asthma (N = 97) ages 7-9 and their caregivers from urban neighborhoods completed daily measures of asthma status and moderate-to-vigorous physical activity (MVPA) and questionnaires about health and sociodemographic characteristics. Clinical asthma guidelines (e.g. FEV1 ≥ 80%) and sample means were used to categorize children into high or low lung function and MVPA patterns. Individual, family, and contextual differences across lung function and MVPA patterns were investigated. RESULTS Twenty-nine percent of participants displayed optimal lung function and high MVPA. The remainder of the sample exhibited various less optimal patterns (e.g. poorer lung function and high MVPA). Caregivers of children displaying poorer lung function and high MVPA levels were more likely to report asthma related fears than caregivers of children with low MVPA levels regardless of lung function status. CONCLUSIONS Asthma and PA interventions can be tailored to better address each child's unique clinical and behavioral patterns. An enhanced understanding of risk factors for suboptimal patterns of asthma status and PA may aid in multicomponent intervention efforts.
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Affiliation(s)
- Anna J Yeo
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Elissa Jelalian
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Sheryl J Kopel
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
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D'Angelo C, Jelalian E, Dunsiger S, Noga R, Kopel SJ, Boergers J, Mitchell K, Powers K, Koinis-Mitchell D. Physical Activity Among Urban Children with Asthma: Does Sleep Matter? J Clin Psychol Med Settings 2022; 29:666-677. [PMID: 34523033 DOI: 10.1007/s10880-021-09815-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
The present study examined associations between sleep and physical activity among a diverse sample of 97 urban children (ages 7-9) with persistent asthma. Differences in associations were evaluated by race/ethnicity and weight status. The extent to which sleep moderated the association between lung function and physical activity was also evaluated. Generalized linear models were utilized to examine associations. Findings indicated that, among the aggregate sample, more frequent nighttime awakenings were associated with less time spent engaging in moderate-to-vigorous physical activity (MVPA). Important differences in these associations were identified by both race/ethnicity and weight status. Better lung function was associated with, (a) higher levels of MVPA for children with better sleep efficiency and fewer nighttime awakenings, and (b) lower levels of MVPA for children with poorer sleep efficiency and more frequent nighttime awakenings. In short, sleep mattered with respect to children's physical activity levels in this sample.
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Affiliation(s)
- Christina D'Angelo
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA.
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elissa Jelalian
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca Noga
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
| | - Sheryl J Kopel
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Julie Boergers
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Katherine Mitchell
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
| | - Kate Powers
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Bradley Hasbro Children's Research Center, Rhode Island/Hasbro Children's Hospital, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Spray J, Hunleth J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Fechtel H, Shepperd JA, Bowen DJ, Waters EA. How do embodied experiences of asthma influence caregiver conceptual models? Soc Sci Med 2022; 294:114706. [PMID: 35033796 PMCID: PMC10389678 DOI: 10.1016/j.socscimed.2022.114706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE Many studies propose that patients', caregivers', and children's asthma management practices may diverge from biomedical recommendations because their understandings of asthma (i.e., conceptual models) are different from biomedical perspectives. However, little research in this area has examined conceptual models of asthma using embodiment theory, which suggests that caregivers' and children's experiences of the physical body shape their perspectives and consequent management strategies. OBJECTIVE We investigated how two embodied processes of symptom perception-detection and interpretation-may influence caregiver or patient conceptions of asthma. METHODS We interviewed 41 caregivers of children with asthma in Gainesville, Florida, and St. Louis, Missouri, and conducted ethnographic visits or virtual interviews with 19 children with asthma aged 6-16. RESULTS Four aspects of asthma's embodied experience shaped conceptual models via processes of detection and interpretation: 1) symptoms are experienced in the context of other bodily processes; 2) acute symptoms and exacerbations are more salient than their absence; 3) the embodied experience of asthma is one of integrated physiological and emotional processes; and 4) caregivers and children acquire embodied practices of perceiving symptoms that produce embodied knowledge. CONCLUSION Participant narratives suggest that embodied experiences of asthma shape caregivers' and children's understandings of asthma in ways that differ from the biomedical model. We argue that a focus on embodied experiences may provide important ground for mutual understanding and communication between providers and caregivers and/or patients.
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Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, United States
| | | | - Hannah Fechtel
- Department of Psychology, University of Florida, United States
| | | | - Deborah J Bowen
- School of Public Health, University of Washington, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States.
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Koinis-Mitchell D, Marshall GD, Kopel SJ, Belanger NMS, Ayala-Figueroa J, Echevarria S, Millman R, Zheng T, Weathers J, Gredvig CA, Carskadon MA. Experimental methods to study sleep disruption and immune balance in urban children with asthma. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac003. [PMID: 35355783 PMCID: PMC8947185 DOI: 10.1093/sleepadvances/zpac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/08/2021] [Indexed: 11/13/2022]
Abstract
Study Objectives We describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illustrate effects of experimentally disrupted sleep on the immune balance profile (Th1/Th2 cytokines), key sleep variables from polysomnography data, and lung function in our sample. Methods Children follow an individualized structured sleep schedule consistent with their habitual sleep need (≥9.5 hours' time in bed) for six days before a laboratory-based experimental sleep protocol. Children then spend two successive nights in the sleep lab monitored by polysomnography: a baseline night consisting of uninterrupted sleep, and a disruption night, during which they are awoken for 2 minutes between 20-minute intervals of uninterrupted sleep. Evening and morning blood draws bracket baseline and disruption nights for immune biomarker assessment. Results A shift towards immune imbalance following the sleep disruption protocol was observed in these illustrative cases. Conclusions Data from these case examples provide evidence that the experimental protocol caused disruptions in sleep as observed on polysomnography and had the hypothesized downstream effects on immune balance associated with clinical asthma control. Documenting the effects of sleep disruption on immune function in children with persistent asthma is a crucial step towards understanding associations between sleep, immune balance, and asthma outcomes and provides important information for developing novel interventions for youth with asthma and suboptimal sleep. Clinical Trials Not applicable.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gailen D Marshall
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sheryl J Kopel
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole M S Belanger
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jesús Ayala-Figueroa
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Sofia Echevarria
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Richard Millman
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tao Zheng
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica Weathers
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
| | - Caroline A Gredvig
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
| | - Mary A Carskadon
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
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Mozun R, Ardura-Garcia C, Pedersen ESL, Goutaki M, Usemann J, Singer F, Latzin P, Moeller A, Kuehni CE. Agreement of parent- and child-reported wheeze and its association with measurable asthma traits. Pediatr Pulmonol 2021; 56:3813-3821. [PMID: 34597475 PMCID: PMC9293286 DOI: 10.1002/ppul.25690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma. METHODS LuftiBus in the school is a cross-sectional survey of respiratory health among Swiss schoolchildren aged 6-17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent-child answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1 s over forced vital capacity (FEV1 /FVC), using quantile regression. RESULTS We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k = 0.37) and exertional wheeze (k = 0.36). Median FeNO varied when wheeze was reported by children (19 ppb, interquartile range [IQR]: 9-44), parents (22 ppb, IQR: 12-46), both (31 ppb, IQR: 16-55), or neither (11 ppb, IQR: 7-19). Median absolute FEV1 /FVC was the same when wheeze was reported by children (84%, IQR: 78-89) and by parents (84%, IQR: 78-89), lower when reported by both (82%, IQR: 78-87), and higher when reported by neither (87%, IQR: 82-91). For exertional wheeze findings were similar. Results did not differ by age or sex. CONCLUSION Our findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits.
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Affiliation(s)
- Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | | | - Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jakob Usemann
- Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research center, University of Zurich, Zurich, Switzerland.,University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,PEDNET, Paediatric Clinical Trial Unit, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research center, University of Zurich, Zurich, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Feldman JM, Becker J, Arora A, DeLeon J, Torres-Hernandez T, Greenfield N, Wiviott A, Jariwala S, Shim C, Federman AD, Wisnivesky JP. Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma. Psychosom Med 2021; 83:787-794. [PMID: 33938504 PMCID: PMC8419010 DOI: 10.1097/psy.0000000000000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older adults are at increased risk for depression and poor asthma outcomes. We examined whether depressive symptoms are associated with overperception of airflow obstruction and a pattern of worse asthma control, but not pulmonary function. METHODS We recruited a cohort of adults with asthma 60 years and older in East Harlem and the Bronx, New York. Baseline measures included the Geriatric Depression Scale, Asthma Control Questionnaire, and Mini Asthma Quality of Life Questionnaire. Spirometry was conducted at baseline to assess pulmonary function. Perception of airflow obstruction was assessed for 6 weeks following baseline by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter followed by PEF blows. Participants were blinded to actual PEF values. The percentage of time that participants were in the overperception zone was calculated as an average. RESULTS Among the 334 participants (51% Hispanic, 25% Black), depressive symptoms were associated with overperception of airflow obstruction (β = 0.14, p = .029), worse self-reported asthma control (β = 0.17, p = .003), and lower asthma-related quality of life (β = -0.33, p < .001), but not with lung function (β = -0.01, p = .82). Overperception was also associated with worse self-reported asthma control (β = 0.14, p = .021), but not lung function (β = -0.05, p = .41). CONCLUSIONS Depressive symptoms were associated with greater perceived impairment from asthma, but not pulmonary function. Overperception of asthma symptoms may play a key role in the relationship between depression and asthma outcomes in older adults.
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Affiliation(s)
- Jonathan M Feldman
- From the Ferkauf Graduate School of Psychology (Feldman, Greenfield, Wiviott), Yeshiva University; Division of Academic General Pediatrics, Department of Pediatrics (Feldman, DeLeon, Torres-Hernandez), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx; Division of General Internal Medicine (Becker, Arora, Federman, Wisnivesky), Icahn School of Medicine at Mount Sinai, New York; Division of Allergy/Immunology, Department of Medicine (Jariwala), Albert Einstein College of Medicine/Montefiore Medical Center; Division of Pulmonary Medicine, Department of Medicine (Shim), Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; and Division of Pulmonary, Critical Care and Sleep Medicine (Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Powers KE, Jelalian E, Dunsiger S, Farrow M, Miranda LG, Mitchell P, Kopel S, Koinis-Mitchell D. Physical activity, lung function, and sleep outcomes in urban children with asthma. Pediatr Pulmonol 2021; 56:1938-1945. [PMID: 33844885 PMCID: PMC8240966 DOI: 10.1002/ppul.25397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine (1) whether daily declines in physical activity (PA) level and/or in lung function (FEV1) predict an asthma exacerbation in a sample of urban children with asthma, and (2) the association between number of sleep awakenings and decline in daytime PA in this group. METHODS In this sample of urban children aged 7-9 years with persistent asthma (N = 147), objective methods assessing lung function via a handheld spirometer and moderate-to-vigorous physical activity (MVPA) via accelerometry were measured over a 4-week period during the fall and early winter of each year as part of a larger 5-year study. RESULTS In the entire sample, a significant association between PA and lung function was noted such that a greater decline in daily MVPA was associated with lower odds of exacerbation. Ethnic group differences showed that this association was also significant only among Latino children (odds ratio [OR] = 0.98; 95% confidence interval [CI]:0.97-0.99). A greater number of sleep awakenings were associated with greater declines in daily MVPA among Latinos only (p = .05). CONCLUSIONS Results suggest that declining MVPA may contribute to lower risk for an exacerbation. Reasons for declining MVPA need to be further explored in this group. Children with asthma may avoid or be fearful of engaging in PA or may face early symptoms which influence patterns of PA, and this may minimize risk for an exacerbation. Results also suggest reasons for night-time disruptions may need to be targeted in further research or interventions as they can contribute to PA avoidance in this high-risk group.
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Affiliation(s)
- Kate Elizabeth Powers
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
- Bradley/Hasbro Children’s Research Center, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Elissa Jelalian
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
- Bradley/Hasbro Children’s Research Center, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, School of Public Health
| | - Michael Farrow
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
| | - Luis Gonzalez Miranda
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
| | - Patricia Mitchell
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
- Bradley/Hasbro Children’s Research Center, Providence, RI
| | - Sheryl Kopel
- Bradley/Hasbro Children’s Research Center, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
- Bradley/Hasbro Children’s Research Center, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
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13
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Koinis-Mitchell D, Kopel SJ, Dunsiger S, McQuaid EL, Miranda LG, Mitchell P, Vehse N, Jelalian E. Asthma and Physical Activity in Urban Children. J Pediatr Psychol 2021; 46:970-979. [PMID: 33749790 DOI: 10.1093/jpepsy/jsab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Asthma and obesity disproportionately affect urban minority children. Avoidance of physical activity contributes to obesity, and urban children with asthma are at risk for lower levels of physical activity. We examined associations between lung function and moderate to vigorous physical activity (MVPA) and moderators of this association in a diverse sample of children with asthma. METHODS Urban children (N = 142) ages 7-9 with persistent asthma and their caregivers completed a study of asthma and physical activity. Longitudinal mixed effects models examining daily-level asthma and physical activity evaluated the association between asthma and MVPA, and the moderating effect of weight, and cultural/contextual factors on this association. RESULTS Average daily MVPA was below recommended guidelines. Differences in MVPA were found by racial/ethnic group (p = .04) and weight (p = .001). Poorer asthma status was associated with lower MVPA in Latino and Black participants (p's < .05), and in normal weight youth (p = .01). Body mass index (BMI) moderated the association between asthma and MVPA. Those with lower BMI had more optimal asthma status and higher MVPA levels, whereas associations attenuated for participants with higher BMI (p = .04). Caregivers' perceptions of neighborhood safety and fear of asthma were marginally associated with children's symptoms and MVPA: as perceptions of safety decreased and fear increased, associations between asthma and MVPA weakened (p's = .09 and .07, respectively). CONCLUSIONS Suboptimal asthma status is associated with less MVPA in urban children. Weight status and cultural/contextual factors play a role in the association and are worthy targets for future research and intervention.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Sheryl J Kopel
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Brown University School of Public Health
| | - Elizabeth L McQuaid
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Luis Gonzalez Miranda
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital
| | | | - Nico Vehse
- Warren Alpert Medical School of Brown University
| | - Elissa Jelalian
- Warren Alpert Medical School of Brown University.,Diabetes and Weight Control Research Center, The Miriam Hospital
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14
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Lee S, Lasky-Su JA, Lange C, Kim W, Kumar PL, McDonald MLN, Vaz Fragoso CA, Laurie C, Raby BA, Celedón JC, Cho MH, Won S, Weiss ST, Hecker J. A novel locus for exertional dyspnoea in childhood asthma. Eur Respir J 2021; 57:2001224. [PMID: 32855217 PMCID: PMC8185954 DOI: 10.1183/13993003.01224-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Most children diagnosed with asthma have respiratory symptoms such as cough, dyspnoea and wheezing, which are also important markers of overall respiratory function. A decade of genome-wide association studies (GWAS) have investigated genetic susceptibility to asthma itself, but few have focused on important respiratory symptoms that characterise childhood asthma.Using whole-genome sequencing (WGS) data for 894 asthmatic trios from a Costa Rican cohort, we performed family-based association tests (FBATs) to assess the association between genetic variants and multiple asthma-relevant respiratory phenotypes: cough, phlegm, wheezing, exertional dyspnoea and exertional chest tightness. We tested whether genome-wide significant associations were replicated in two additional studies: 1) 286 asthmatic trios from the Childhood Asthma Management Program (CAMP), and 2) 2691 African American current or former smokers from the COPDGene study.In the 894 Costa Rican trios, we identified a genome-wide significant association (p=2.16×10-9) between exertional dyspnoea and the single nucleotide polymorphism (SNP) rs10165869, located on chromosome 2q37.3, that was replicated in the CAMP cohort (p=0.023) with the same direction of association (combined p=3.28×10-10). This association was not found in the African American participants from COPDGene. We also found suggestive evidence for an association between SNP rs10165869 and the atypical chemokine receptor 3 (ACKR3).Our finding encourages the secondary association analysis of a wider range of phenotypes that characterise respiratory symptoms in other airway diseases/studies.
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Affiliation(s)
- Sanghun Lee
- Dept of Medical Consilience, Division of Medicine, Graduate
School, Dankook University, Yongin, South Korea
- Dept of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Jessica Ann Lasky-Su
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Christoph Lange
- Dept of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Wonji Kim
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Preeti Lakshman Kumar
- Division of Pulmonary, Allergy and Critical Care Medicine,
University of Alabama at Birmingham, Birmingham, AL, USA
| | - Merry-Lynn N. McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine,
University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Cecelia Laurie
- Dept of Biostatistics, University of Washington, Seattle,
WA, USA
| | - Benjamin A. Raby
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, UPMC
Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Sungho Won
- Dept of Public Health Science, Seoul National University,
Seoul, South Korea
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Julian Hecker
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
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15
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Lack S, Schechter MS, Everhart RS, Thacker Ii LR, Swift-Scanlan T, Kinser PA. A mindful yoga intervention for children with severe asthma: A pilot study. Complement Ther Clin Pract 2020; 40:101212. [PMID: 32891288 DOI: 10.1016/j.ctcp.2020.101212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Children with severe asthma may benefit from non-pharmacological approaches to symptom management, yet little is known regarding the impact of mind-body approaches such as mindful yoga in this population. This pilot study examined the tolerability, feasibility, acceptability and immediate effects of a mindful yoga intervention in children with severe asthma. METHOD Fifteen children ages 7-11 with severe asthma participated in a single mindful yoga session, followed by semi-structured interviews with the child and caregiver. Vital signs and pulmonary function tests were collected pre- and post-intervention. RESULTS All children reported positive experiences and caregivers were generally supportive of their participation. One child experienced self-limited bronchoconstriction with asthma symptoms. There was no significant change in lung function or vital signs after the mindful yoga session. DISCUSSION Our results warrant additional larger studies to evaluate the safety and benefits of mindful yoga in children with severe asthma.
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Affiliation(s)
- Sharon Lack
- Virginia Commonwealth University, School of Nursing, 1100 E. Leigh Street, Richmond, VA, 23298, USA.
| | - Michael S Schechter
- Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, VA, 23298, USA
| | - Robin S Everhart
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, 23298, USA
| | - Leroy R Thacker Ii
- Virginia Commonwealth University, Department of Biostatistics, Richmond, VA, 23298, USA
| | - Theresa Swift-Scanlan
- Virginia Commonwealth University, School of Nursing, 1100 E. Leigh Street, Richmond, VA, 23298, USA
| | - Patricia A Kinser
- Virginia Commonwealth University, School of Nursing, 1100 E. Leigh Street, Richmond, VA, 23298, USA.
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16
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Eisenberg SR, Jelalian E, Farrow M, Kopel SJ, Vehse N, Mitchell P, Dunsiger S, Koinis-Mitchell D. Perceptions of Asthma and Exercise, and Associations With Weight Status and Asthma Morbidity in Urban Children. Acad Pediatr 2020; 20:55-62. [PMID: 31301420 DOI: 10.1016/j.acap.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Given the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group. OBJECTIVE To examine in urban children with persistent asthma, 1) differences in asthma indicators (eg, FEV1% predicted) by weight status, and by ethnic group/weight status, 2) caregivers' fears about their child's asthma by weight status, and by ethnic group/weight status, and 3) the proportion of children who qualified for exercise-induced bronchospasm (EIB) via exercise challenge test among those whose caregivers endorse exercise as a trigger for asthma. METHODS In this sample of urban children (aged 7-9; N = 147), subjective measures included child/caregiver daily report of asthma symptoms and caregiver fears about their child's asthma. Objective lung function was measured twice daily via handheld spirometer and EIB was confirmed via exercise challenge test. RESULTS In the overall sample, a greater proportion of normal-weight children reported asthma symptoms compared to overweight/obese children. Caregiver fears about asthma were more prevalent among Latino caregivers. Non-Latino White children whose caregivers were afraid their child may die when having asthma reported more days with asthma symptoms. Very few children had confirmed EIB compared to the proportion of caregivers who endorsed exercise as a dangerous trigger for asthma. CONCLUSIONS Caregiver fear about asthma and misperceptions of exercise as a dangerous trigger for asthma should be addressed during health care visits with families of children with asthma and interventions including urban children with asthma.
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Affiliation(s)
- Staci R Eisenberg
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Alpert Medical School (SR Eisenberg, E Jelalian, SJ Kopel, S Dunsiger, and D Koinis-Mitchell), Brown University, Providence, RI; Department of Pediatrics (SR Eisenberg, E Jelalian, M Farrow, P Mitchell, and D Koinis-Mitchell), Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Elissa Jelalian
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Alpert Medical School (SR Eisenberg, E Jelalian, SJ Kopel, S Dunsiger, and D Koinis-Mitchell), Brown University, Providence, RI; Department of Pediatrics (SR Eisenberg, E Jelalian, M Farrow, P Mitchell, and D Koinis-Mitchell), Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Michael Farrow
- Department of Pediatrics (SR Eisenberg, E Jelalian, M Farrow, P Mitchell, and D Koinis-Mitchell), Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Alpert Medical School (SR Eisenberg, E Jelalian, SJ Kopel, S Dunsiger, and D Koinis-Mitchell), Brown University, Providence, RI
| | - Nico Vehse
- University of Massachusetts Medical School (N Vehse), Worcester, MA
| | - Patricia Mitchell
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Department of Pediatrics (SR Eisenberg, E Jelalian, M Farrow, P Mitchell, and D Koinis-Mitchell), Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Shira Dunsiger
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Alpert Medical School (SR Eisenberg, E Jelalian, SJ Kopel, S Dunsiger, and D Koinis-Mitchell), Brown University, Providence, RI
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center (SR Eisenberg, E Jelalian, SJ Kopel, P Mitchell, S Dunsiger, and D Koinis-Mitchell), Providence, RI; Alpert Medical School (SR Eisenberg, E Jelalian, SJ Kopel, S Dunsiger, and D Koinis-Mitchell), Brown University, Providence, RI; Department of Pediatrics (SR Eisenberg, E Jelalian, M Farrow, P Mitchell, and D Koinis-Mitchell), Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI.
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17
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Arcoleo KJ, McGovern C, Kaur K, Halterman JS, Mammen J, Crean H, Rastogi D, Feldman JM. Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Use. Ann Am Thorac Soc 2019; 16:715-723. [PMID: 30860858 PMCID: PMC6543480 DOI: 10.1513/annalsats.201807-462oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Researchers tend to study Latinos as a single group, but recent asthma research confirmed differences among Latino subgroups. Variations in controller medication adherence may be a factor in the observed health disparities between Mexican and Puerto Rican children. Adherence is not a stable phenomenon; however, there is a paucity of data on patterns of adherence, sociodemographic predictors of patterns, and variations in asthma-related acute healthcare use by adherence pattern among Latino subgroups. Objectives: To identify patterns of inhaled corticosteroid medication adherence over 12 months among Mexican and Puerto Rican children with persistent asthma, to examine sociodemographic predictors of adherence patterns by ethnicity, and to investigate asthma-related acute healthcare use based on these patterns. Methods: We analyzed controller medication Doser data from Mexican and Puerto Rican children (n = 123; ages 5-12 yr) with persistent asthma who participated with their caregivers in a longitudinal nonintervention study (Phoenix, AZ, and Bronx, NY). Interview and medical record data were collected at enrollment and at 3, 6, 9, and 12 months after enrollment. Results: Forty-seven to fifty-three percent of children had poor adherence (<50%) over each of the follow-up periods (cross-sectional). Children with lowest adherence were Puerto Rican, from nonpoor families, or female. Longitudinal latent class analysis yielded four adherence classes: poor, moderate, decreasing adherence, and increasing adherence. Puerto Rican children had significantly higher odds of "decreasing" (odds ratio [OR], 2.86; 95% confidence interval [CI], 0.40 to 20.50) and "poor" (OR, 5.62; 95% CI, 1.44 to 21.90) adherence than Mexican children. Females had significantly greater odds of "decreasing" (OR, 4.80; 95% CI, 0.73 to 31.74) and "poor" (OR, 5.20; 95% CI, 1.77 to 15.30) adherence group membership than males. The "decreasing" adherence group was comprised of only poor children. Children in the "poor" adherence class had the highest mean number of acute visits and emergency department visits/hospitalizations across all assessment periods. Conclusions: This study demonstrated that unique ethnicity within Latino populations may be associated with different risk levels for suboptimal controller medication adherence, which may be a factor in the observed asthma health disparities between Mexican and Puerto Rican children. Increased understanding of and attention to children's controller medication adherence patterns will provide evidence needed to identify children at highest risk for acute healthcare use and offer more-intensive intervention using less-intensive approaches for those at low risk. Clinical trial registered with www.clinicaltrials.gov (NCT01099800).
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Affiliation(s)
| | - Colleen McGovern
- 2 School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Karenjot Kaur
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jill S Halterman
- 4 Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Jennifer Mammen
- 5 School of Nursing, University of Rhode Island, Providence, Rhode Island; and
| | | | - Deepa Rastogi
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jonathan M Feldman
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
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18
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Koinis-Mitchell D, Kopel SJ, Farrow ML, McQuaid EL, Nassau JH. Asthma and academic performance in urban children. Ann Allergy Asthma Immunol 2019; 122:471-477. [PMID: 30872028 PMCID: PMC6538301 DOI: 10.1016/j.anai.2019.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urban minority children experience high levels of asthma morbidity. Poor school performance can be an indicator that asthma is in poor control. Little attention has been paid to examining real-time links between asthma and academic performance, particularly in high-risk groups. OBJECTIVE Examine 1) academic performance across a range of indicators in a group of urban children with asthma and urban children without chronic illness and ethnic differences in these associations, and 2) associations between asthma and academic performance in the group of urban children with asthma and ethnic differences in these associations. METHODS Two hundred sixteen black/African American (33%), Latino (46%), and non-Latino white (21%) urban children, ages 7 to 9 years completed a clinic- and home-based protocol that assessed asthma and allergy status, objective measurements of lung function, and academic functioning. RESULTS Analyses revealed that children with asthma experienced a higher number of school absences when compared with healthy controls. Greater disparities in academic outcomes emerged when examining ethnic differences within the groups of children with and without asthma. Poor academic outcomes were observed in Latino children with asthma. Furthermore, a strong correspondence of poor asthma outcomes and decrements in academic performance were seen in the full sample, and these associations emerged across ethnic groups. CONCLUSION Asthma activity contributes to poorer academic outcomes across a range of indicators, and urban minority children with asthma, particularly Latino children, may be at heightened risk for poorer academic performance. School management guidelines for asthma need to be consistently implemented and tailored for school staff, caregivers, and students with asthma to address challenges of managing asthma within the urban school setting.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island; Department of Child Psychiatry and Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island
| | - Michael L Farrow
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island; Department of Child Psychiatry and Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island
| | - Jack H Nassau
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island
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Mammen J, Rhee H, Norton SA, Butz AM, Halterman JS, Arcoleo K. An integrated operational definition and conceptual model of asthma self-management in teens. J Asthma 2018; 55:1315-1327. [PMID: 29351005 PMCID: PMC6053334 DOI: 10.1080/02770903.2017.1418888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model. METHODS Focal concepts were qualitatively extracted from 14-day self-management voice-diaries (n = 14) and 1-hour interviews (n = 42) with teens and parents (28 individuals) along with concepts found in the previous clinical/research oriented analysis. Conceptual structure and relationships were identified and key findings synthesized to develop a revised definition and model of adolescent asthma self-management. RESULTS There were two primary self-management constructs: processes of self-management and tasks of self-management. Self-management was defined as the iterative process of assessing, deciding, and responding to specific situations in order to achieve personally important outcomes. Clinically relevant asthma self-management tasks included monitoring asthma, managing active issues through pharmacologic and non-pharmacologic strategies, preventing future issues, and communicating with others as needed. Self-management processes were reciprocally influenced by intrapersonal factors (both cognitive and physical), interpersonal factors (family, social and physical environments), and personally relevant asthma and non-asthma outcomes. CONCLUSION This is the first definition of asthma self-management incorporating teen, parent, clinician, and researcher perspectives, which suggests that self-management processes and behaviors are influenced by individually variable personal and interpersonal factors, and are driven by personally important outcomes. Clinicians and researchers should investigate teens' symptom perceptions, medication beliefs, current approaches to symptom management, relevant outcomes, and personal priorities.
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Affiliation(s)
- Jennifer Mammen
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Hyekyun Rhee
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Sally A Norton
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Arlene M Butz
- b Johns Hopkins University, Pediatrics , Freeland , USA
| | - Jill S Halterman
- c University of Rochester School of Medicine and Dentistry, Pediatrics , Rochester , USA
| | - Kimberly Arcoleo
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
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20
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Forno E, Abraham N, Winger DG, Rosas-Salazar C, Kurland G, Weiner DJ. Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2018; 31:139-145. [PMID: 30283712 DOI: 10.1089/ped.2018.0906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022]
Abstract
Background: Under-perception of pulmonary dysfunction may delay appropriate treatment, while over-perception may result in unnecessary treatments. Objectives: To evaluate the ability of patients with asthma or cystic fibrosis and their subspecialty caregivers to assess changes in lung function based on their subjective clinical impressions. Methods: Patients were asked to qualitatively describe how they felt compared to their prior visit (same/better/worse) and to quantitatively estimate their forced expiratory volume in 1 s (FEV1) after being reminded of their FEV1 at the prior visit. Providers made similar estimates based on history and physical examination and knowledge of prior FEV1. After adjusting for relevant clinical covariates, lung function estimates were categorized as accurate (±5% of measured FEV1), overestimated (>5% above measured), and underestimated (>5% below measured). Results: One hundred nine patients estimated FEV1 on 179 occasions. Concordance between patient qualitative assessment and FEV1-based categories was low (κ = 0.08); 44% of patients reported feeling better than the FEV1-based category showed. Quantitatively, 56% of patient estimates were accurate, 18% were underestimated, and 26% overestimated; accuracy improved with age (odds ratio = 1.16, P = 0.01). Concordance between provider qualitative assessments and FEV1-based category was moderate (κ = 0.35); about 19% said their patient looked better than the FEV1-based category showed. Quantitatively, 65% of provider estimates were accurate, 16% were underestimated, and 19% were overestimated; accuracy improved with years of experience. Conclusions: Patients' and providers' perceptions of lung function were low to moderately accurate. Relying on subjective impression may place patients at risk for unnecessary treatments or increased morbidity. These findings highlight the importance of objective lung function assessment.
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Affiliation(s)
- Erick Forno
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Neethu Abraham
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel G Winger
- Department of Statistics, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christian Rosas-Salazar
- Division of Pediatric Allergy, Immunology and Pulmonology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Geoffrey Kurland
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel J Weiner
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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21
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Burbank AJ, Todoric K, Steele P, Rosen J, Zhou H, Frye M, Loughlin CE, Ivins S, Mills K, Massey LD, Reeve BB, Hernandez ML. Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics. Respir Res 2018; 19:152. [PMID: 30111326 PMCID: PMC6094875 DOI: 10.1186/s12931-018-0858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA. .,Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA.
| | - Krista Todoric
- Penn State Hershey Allergy, Asthma & Immunology, Hershey, PA, USA
| | - Pamela Steele
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Rosen
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haibo Zhou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Marcia Frye
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC, USA
| | - Sally Ivins
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | - Katherine Mills
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle L Hernandez
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
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22
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Abstract
The ability to perceive the onset and severity of symptoms of worsening asthma is important, not only for initial diagnosis but also for early identification of an asthma exacerbation and prompt management. There are subjective and objective methods for identifying symptoms. Symptom perception is affected by multiple mechanisms, and not all patients can accurately perceive symptoms of airflow limitation. Hyperperceivers will report substantial discomfort in the face of minimal bronchoconstriction, and poor perceivers will report no symptoms even in the presence of severe obstruction. The use of objective measures of airflow limitation is essential for such patients. Regimens for training perception in children and adults have been studied and are available.
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23
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Koinis-Mitchell D, Kopel SJ, Seifer R, LeBourgeois M, McQuaid EL, Esteban CA, Boergers J, Nassau J, Farrow M, Fritz GK, Klein RB. Asthma-related lung function, sleep quality, and sleep duration in urban children. Sleep Health 2017; 3:148-156. [PMID: 28526251 DOI: 10.1016/j.sleh.2017.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/14/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Examine (1) the extent to which changes in objectively measured asthma-related lung function (forced expiratory volume in 1 second) within a sleep period are associated with sleep quality and sleep duration during that sleep period in a group of urban children with persistent asthma, (2) associations between morning and evening asthma-related lung function and sleep quality and duration on the adjacent night, and (3) whether these associations differ by ethnic group. DESIGN Cross-sectional, multimethod approach. Children completed a clinic assessment of asthma and allergy status and used home-based objective measurements of asthma-related lung function and sleep. SETTING Children and their caregivers participated in a clinic assessment at an asthma and allergy clinic and completed additional assessments at home. PARTICIPANTS Two hundred and sixteen African American, Latino, and non-Latino white urban children, ages 7-9 years, and their primary caregivers. MEASUREMENTS Participants took part in a clinic assessment of asthma and allergy status, completed interview-based questionnaires including a diary to track asthma symptoms and sleep patterns, and used actigraphy and home-based spirometry daily across a 4-week period to assess sleep and lung function. RESULTS AND CONCLUSIONS Results from analyses using structural equation modeling revealed an association between worsening asthma-related lung function and poor sleep quality in the full sample, as well as better asthma-related lung function at night and more optimal sleep efficiency that night. Ethnic group differences emerged in the association with morning or nighttime lung function measurements and sleep quality. Urban minority children with asthma may be at heightened risk for poorer quality sleep. Timing of lung function worsening may be important when considering when and how to improve both asthma health outcomes and sleep quality within specific groups.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Ronald Seifer
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | | | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Cynthia A Esteban
- Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Julie Boergers
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Jack Nassau
- Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Michael Farrow
- Bradley/Hasbro Children's Research Center, Providence, RI; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Robert B Klein
- Alpert Medical School, Brown University, Providence, RI,; Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
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24
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Mammen JR, Rhee H, Norton SA, Butz AM. Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma. J Asthma 2017; 54:143-152. [PMID: 27337035 PMCID: PMC5182183 DOI: 10.1080/02770903.2016.1201835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
| | - Hyekyun Rhee
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Sally A Norton
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Arlene M Butz
- b Johns Hopkins University, School of Medicine , Baltimore , MD , USA
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25
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Steinberg DM, Serebrisky D, Feldman JM. Asthma in children of Caribbean descent living in the inner-city: comparing Puerto Rican and Afro-Caribbean children. PSYCHOL HEALTH MED 2016; 22:633-639. [PMID: 27666405 DOI: 10.1080/13548506.2016.1238490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ethnic minority children bear a disproportionate amount of the US asthma burden. We compared asthma morbidity and pulmonary function (%FEV1) in two Caribbean groups living in the Bronx, NY: Puerto Rican and Afro-Caribbean children. Caregiver-child dyads (Puerto Rican: n = 113, M age = 9.89 ± 2.05; Afro-Caribbean: n = 47, Mage = 10.35 ± 2.08) responded to sociodemographic and asthma-related questions, and children's %FEV1 was measured. Puerto Rican children had significantly greater (past year) asthma morbidity, yet there were no significant differences in %FEV1. This discrepancy between objective pulmonary function and asthma morbidity suggests the importance of considering sociocultural factors in pediatric asthma care.
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Affiliation(s)
- Dara M Steinberg
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
| | - Denise Serebrisky
- b Department of Pediatrics , Albert Einstein College of Medicine , Bronx , NY , USA.,c Division of Pediatric Pulmonology , Jacobi Medical Center , Bronx , NY , USA
| | - Jonathan M Feldman
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,b Department of Pediatrics , Albert Einstein College of Medicine , Bronx , NY , USA
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26
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The Interpretation of Dyspnea in the Patient with Asthma. Pulm Med 2015; 2015:869673. [PMID: 26819756 PMCID: PMC4706961 DOI: 10.1155/2015/869673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022] Open
Abstract
Physicians have noted dyspnea in severely ill asthmatic patients to be associated with fright or panic; in more stable patients dyspnea may reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea in 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed, dyspnea quantified (Borg scale), and panic assessed with a specialized measure of acute panic (the acute panic inventory (API)) in the 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were also administered. When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC) correlated with dyspnea. Multiple linear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41% of dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who described themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that interpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients.
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27
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Saito N, Itoga M, Tamaki M, Yamamoto A, Kayaba H. Cough variant asthma patients are more depressed and anxious than classic asthma patients. J Psychosom Res 2015; 79:18-26. [PMID: 25837530 DOI: 10.1016/j.jpsychores.2015.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/12/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many recent studies have indicated that depression and anxiety are more common in asthmatic patients than in the general population and psychological stress can lead to asthma exacerbations, but no study specifically targets cough variant asthma (CVA) patients. The purpose of this study was to evaluate depression and anxiety levels in CVA patients compared with classic asthma patients and to identify the psychological features of CVA patients. METHODS Fifty-nine outpatients with CVA and 128 outpatients with classic asthma were interviewed about psychosomatic and psychiatric symptoms, and they underwent three psychological tests: Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Comprehensive Asthma Inventory (CAI). They were ultimately screened for major and minor depression, dysthymia, panic disorder, generalized anxiety disorder, social anxiety disorder, and other anxiety disorders. RESULTS CVA patients showed higher SDS and STAI scores than classic asthma patients, and mood disorders and anxiety disorders were more common than in classic asthma outpatients. The psychological factors 'frustration', 'fright into illness', and 'distorted lifestyle' were more prominent in CVA patients than in classic asthma patients. CONCLUSION CVA patients are on average more depressed and anxious than classic asthma outpatients. Though CVA appears pathologically to be just an early stage of typical asthma, the psychological stress may often be more serious than in asthma controlled by medication, which may explain why CVA cannot be controlled by a bronchodilator alone and patients often require no less intense therapy than for severe asthma.
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Affiliation(s)
- Norihiro Saito
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan; Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan.
| | - Masamichi Itoga
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mami Tamaki
- Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan
| | - Ayako Yamamoto
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroyuki Kayaba
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Abstract
The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.
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Affiliation(s)
- Peter J Gergen
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA.
| | - Alkis Togias
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA
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29
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Rosser FJ, Forno E, Cooper PJ, Celedón JC. Asthma in Hispanics. An 8-year update. Am J Respir Crit Care Med 2014; 189:1316-27. [PMID: 24881937 PMCID: PMC4098086 DOI: 10.1164/rccm.201401-0186pp] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/05/2014] [Indexed: 01/25/2023] Open
Abstract
This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). This wide divergence in asthma morbidity among Hispanic subgroups is multifactorial, likely reflecting the effects of known (secondhand tobacco smoke, air pollution, psychosocial stress, obesity, inadequate treatment) and potential (genetic variants, urbanization, vitamin D insufficiency, and eradication of parasitic infections) risk factors. Barriers to adequate asthma management in Hispanics include economic and educational disadvantages, lack of health insurance, and no access to or poor adherence with controller medications such as inhaled corticosteroids. Although considerable progress has been made in our understanding of asthma in Hispanic subgroups, many questions remain. Studies of asthma in Hispanic America should focus on environmental or lifestyle factors that are more relevant to asthma in this region (e.g., urbanization, air pollution, parasitism, and stress). In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.
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Affiliation(s)
- Franziska J. Rosser
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip J. Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas Province, Ecuador; and
- Institute of Infection and Immunity, St. George’s University of London, London, United Kingdom
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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30
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McQuaid EL, Fedele DA, Adams SK, Koinis-Mitchell D, Mitchell J, Kopel SJ, Seifer R, Jandasek B, Fritz GK, Canino G. Complementary and alternative medicine use and adherence to asthma medications among Latino and non-Latino white families. Acad Pediatr 2014; 14:192-9. [PMID: 24602583 PMCID: PMC3950892 DOI: 10.1016/j.acap.2013.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/26/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study sought to evaluate patterns of complementary and alternative medicine (CAM) use in a sample of Latino and non-Latino white (NLW) children with asthma to determine whether parental beliefs about conventional medications and barriers to obtaining these medications were related to CAM use and to assess whether CAM use was associated with decreased adherence to controller medications. METHODS Participants included 574 families of children with asthma from NLW, Puerto Rican (PR), and Dominican backgrounds from Rhode Island (RI) and from Island PR. All parents completed a brief checklist of barriers to medication use and an assessment of CAM approaches. A subsample of 259 families had controller medication use monitored objectively for approximately 1 month by MDILog (fluticasone propionate), TrackCap (montelukast), or dosage counter (fluticasone/salmeterol combination). RESULTS Prevalence of CAM use was high among Latino families. Perceived barriers to obtaining medication were related to increased CAM use in PR families from RI. Elevated medication concerns were positively associated with CAM use among NLW and Island PR families. CAM use was positively related to objective adherence within NLW families, and unrelated in other groups. CONCLUSIONS CAM use is common among Latino families with asthma. Among some families, CAM use may be initiated as a way to cope with barriers to obtaining medication or when parents have concerns about conventional medications. Families who report CAM use do not appear to be substituting CAM for conventional asthma medication.
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Affiliation(s)
- Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI.
| | - David A Fedele
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Sue K Adams
- Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Jessica Mitchell
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Ronald Seifer
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Barbara Jandasek
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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Cabana MD, Kunselman SJ, Nyenhuis SM, Wechsler ME. Researching asthma across the ages: insights from the National Heart, Lung, and Blood Institute's Asthma Network. J Allergy Clin Immunol 2014; 133:27-33. [PMID: 24369796 PMCID: PMC3901784 DOI: 10.1016/j.jaci.2013.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/24/2022]
Abstract
Clinical asthma studies across different age groups (ie, cross-age studies) can potentially offer insight into the similarities, differences, and relationships between childhood and adult asthma. The National Institutes of Health's Asthma Research Network (AsthmaNet) is unique and innovative in that it has merged pediatric and adult asthma research into a single clinical research network. This combination enhances scientific exchange between pediatric and adult asthma investigators and encourages the application of cross-age studies that involve participants from multiple age groups who are generally not studied together. The experience from AsthmaNet in the development of cross-age protocols highlights some of the issues in the evaluation of cross-age research in asthma. The aim of this review is to summarize these challenges, including the selection of parallel cross-age clinical interventions, identification of appropriate controls, measurement of meaningful clinical outcomes, and various ethical and logistic issues.
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Affiliation(s)
- Michael D Cabana
- Departments of Pediatrics, Epidemiology, and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Calif.
| | | | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital and Health Sciences System, Chicago, Ill
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Coutinho MT, Koinis-Mitchell D, Kopel SJ, Romero-Bosch L, Lobato D, McQuaid EL, Seifer R, Fritz GK, Canino G. Factors associated with recruitment and retention of diverse children with asthma. CHILDRENS HEALTH CARE 2014; 43:132-150. [PMID: 25013244 PMCID: PMC4084850 DOI: 10.1080/02739615.2013.837821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examines factors associated with recruitment and retention of Latino, Dominican (DR) and mainland Puerto Rican (PR), and non-Latino white (NLW) families into a pediatric asthma study. Over eleven hundred (n=1185) families were screened, and 489 (n= 174 NLW, n= 160 DR, n= 155 PR) were enrolled. Rates of recruitment by source of recruitment and rates of retention differed by ethnic group. Families whose caregiver had never married had lower odds of completing the study. The findings highlight the need for further study to examine the effectiveness of specific recruitment and retention strategies with Latino and non-Latino white families.
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Affiliation(s)
- Maria Teresa Coutinho
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lilia Romero-Bosch
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Debra Lobato
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ronald Seifer
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
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Tosca MA, Silvestri M, Rossi GA, Ciprandi G. Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma. Allergol Immunopathol (Madr) 2013; 41:359-63. [PMID: 23141750 DOI: 10.1016/j.aller.2012.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/17/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Visual Analogue Scale (VAS) has been proposed as a useful tool for assessing the perception of asthma symptoms, a cornerstone in disease management. While airway flow limitation and its reversibility are thought to be a useful marker of disease severity, there are very few studies that evaluated the response to bronchodilation (BD) testing perception by VAS. To investigate whether VAS assessment of breathlessness perception could provide a useful tool to assess the response to BD testing in asthmatic children. METHODS This cross-sectional study included a total of 150 children (96 males, mean age 11.05 years) with asthma, 50 had bronchial obstruction (i.e. FEV1 <80% of predicted). Perception of breathlessness was assessed by VAS; lung function was measured by spirometry. BD testing was performed in all children. RESULTS In children with bronchial obstruction, VAS at baseline was 4.7 and significantly increased to 6.9 (p<0.001) after BD. In children without bronchial obstruction, VAS at baseline was 7.4, but further significantly increased to 8.4 after BD testing (p<0.01). There was a significant difference in Δ VAS between children with bronchial reversibility and children without it (p<0.0001). CONCLUSIONS The present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma, mainly with overt bronchial obstruction.
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Affiliation(s)
- Maria Angela Tosca
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy
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Koinis-Mitchell D, Esteban C, Kopel SJ, Jandasek B, Dansereau K, Fritz GK, Klein RB. Perceptual accuracy of upper airway compromise in children: Clinical relevance and future directions for research. ALLERGY & RHINOLOGY 2013; 4:e54-62. [PMID: 24124637 PMCID: PMC3793113 DOI: 10.2500/ar.2013.4.0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 80% of children with asthma have coexisting allergic rhinitis. The accurate recognition and assessment of asthma and rhinitis symptoms is an integral component of guideline-based treatment for both conditions. This article describes the development and preliminary evaluation of a novel paradigm for testing the accuracy of children's assessment of their upper airway (rhinitis) symptoms. This work is guided by our previous research showing the clinical efficacy of tools to evaluate children's perceptual accuracy of asthma symptoms and linking accurate asthma symptom perception to decreased asthma morbidity (Fritz G, et al., Ethnic differences in perception of lung function: A factor in pediatric asthma disparities? Am J Respir Crit Care Med 182:12-18, 2010; Klein RB, et al., The Asthma Risk Grid: Clinical interpretation of symptom perception, Allergy Asthma Proc 251-256, 2004). The pilot study tests a paradigm that allows for the examination of the correspondence of children's assessment of their upper airway functioning with actual values of upper airway flow through the use of a portable, handheld nasal peak flowmeter. Nine children with persistent asthma were evaluated over a 4-week period. The article describes the rhinitis perceptual accuracy paradigm and reviews the results of a pilot study, showing a large proportion of inaccurate rhinitis symptoms "guesses" by the sample of children with persistent asthma. Patterns of inaccuracy, rhinitis control, and asthma morbidity are also described. Directions for future work are reviewed. The development of clinical tools to evaluate children's accuracy of rhinitis symptoms are needed, given the central role of the self-assessment of symptoms in guideline-based care. Accurate perception of the severity of rhinitis symptoms may enhance rhinitis control, lessen the burden of asthma, and prevent unnecessary emergency use among this high-risk group of children.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Janssens T, Ritz T. Perceived triggers of asthma: key to symptom perception and management. Clin Exp Allergy 2013; 43:1000-8. [PMID: 23957335 PMCID: PMC3748392 DOI: 10.1111/cea.12138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/12/2013] [Accepted: 04/11/2013] [Indexed: 01/22/2023]
Abstract
Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this article, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targets for behavioural interventions that aim to improve the accuracy of asthma trigger identification and thereby enhance asthma control.
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Feldman JM, Steinberg D, Kutner H, Eisenberg N, Hottinger K, Sidora-Arcoleo K, Warman K, Serebrisky D. Perception of pulmonary function and asthma control: the differential role of child versus caregiver anxiety and depression. J Pediatr Psychol 2013; 38:1091-100. [PMID: 23873703 DOI: 10.1093/jpepsy/jst052] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To examine child and caregiver anxiety and depression as predictors of children's perception of pulmonary function, quick-relief medication use, and pulmonary function. METHOD 97 children with asthma, ages 7 to 11 years old, reported their anxiety and depressive symptoms and completed spirometry. Caregivers completed a psychiatric interview. Children's predictions of their peak expiratory flow were compared with actual values across 6 weeks. Quick-relief medication use was assessed by Dosers. RESULTS Children's anxiety symptoms were associated with over-perception of respiratory compromise and greater quick-relief medication use. Children's depressive symptoms were associated with greater quick-relief medication use, but not perception of pulmonary function. Children of caregivers with an anxiety or depressive disorder had lower pulmonary function than children of caregivers without anxiety or depression. CONCLUSIONS Child anxiety was associated with a subjective pattern of over-perception. Caregiver anxiety and depression were risk factors for lower lung function assessed by objective measurement.
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Affiliation(s)
- Jonathan M Feldman
- PhD, Ferkauf Graduate School of Psychology/Yeshiva University, Rousso Building, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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Ritz T, Meuret AE, Trueba AF, Fritzsche A, von Leupoldt A. Psychosocial factors and behavioral medicine interventions in asthma. J Consult Clin Psychol 2013; 81:231-50. [PMID: 23025250 PMCID: PMC6019133 DOI: 10.1037/a0030187] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. METHOD We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field. RESULTS Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management, including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proved particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further, more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs. CONCLUSION In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer toward an integrated biopsychosocial approach to disease management.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX 75275, USA.
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Shi Y, Aledia AS, Galant SP, George SC. Peripheral airway impairment measured by oscillometry predicts loss of asthma control in children. J Allergy Clin Immunol 2012; 131:718-23. [PMID: 23146376 DOI: 10.1016/j.jaci.2012.09.022] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/07/2012] [Accepted: 09/25/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND We previously showed that impulse oscillometry (IOS) indices of peripheral airway function are associated with asthma control in children. However, little data exist on whether dysfunction in the peripheral airways can predict loss of asthma control. OBJECTIVE We sought to determine the utility of peripheral airway impairment, as measured by IOS, in predicting loss of asthma control in children. METHODS Fifty-four children (age, 7-17 years) with controlled asthma were enrolled in the study. Spirometric and IOS indices of airway function were obtained at baseline and at a follow-up visit 8 to 12 weeks later. Physicians who were blinded to the IOS measurements assessed asthma control (National Asthma Education and Prevention Program guidelines) on both visits and prescribed no medication change between visits. RESULTS Thirty-eight (70%) patients maintained asthma control between 2 visits (group C-C), and 16 patients had asthma that became uncontrolled on the follow-up visit (group C-UC). There was no difference in baseline spirometric results between the C-C and C-UC groups, except for FEV1/forced vital capacity ratio (86% vs 82%, respectively; P < .01). Baseline IOS results, including resistance of the respiratory system at 5 Hz (R5; 6.4 vs 4.3 cm H2O · L(-1) · s), frequency dependence of resistance (difference of R5 and resistance of the respiratory system at 20 Hz [R5-20]; 2.0 vs 0.7 cm H2O · L(-1) · s), and reactance area (13.1 vs 4.1 cm H2O · L(-1)), of group C-UC were significantly higher than those of group C-C (P < .01). Receiver operating characteristic analysis showed baseline R5-20 and reactance area effectively predicted asthma control status at the follow-up visit (area under the curve, 0.91 and 0.90). CONCLUSION Children with controlled asthma who have increased peripheral airway IOS indices are at risk of losing asthma control.
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Affiliation(s)
- Yixin Shi
- Department of Biomedical Engineering, University of California, Irvine, CA 92697-2730, USA
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Steele AM, Meuret AE, Millard MW, Ritz T. Discrepancies between lung function and asthma control: asthma perception and association with demographics and anxiety. Allergy Asthma Proc 2012; 33:500-7. [PMID: 23394508 DOI: 10.2500/aap.2012.33.3611] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Understanding asthma symptom perception is necessary for reducing unnecessary costs both for asthma sufferers and society and will contribute to improving asthma management. The primary aim of this study was to develop and test a standardized method for classification of asthma perceiver categories into under-, normal, and overperceiver groups based on the comparison between self-report and lung function components of asthma control. Additionally, the degree to which demographic variables and anxiety contributed to the classification of patients into perceiver groups was examined. Patients underwent methacholine or reversibility testing to confirm asthma diagnosis. Next, participants completed lung function testing over 3 days before their next appointment. Finally, patients filled out demographic and self-report measures including the Asthma Control Test (ACT). Each self-report category of control assessed by the ACT (interference, shortness of breath, nighttime awakenings, rescue inhaler usage, and a composite total score) was compared with lung function measurements using a modified version of the asthma risk grid. Using the modified asthma risk grid to determine perceiver categorization, this sample included 14 underperceivers, 29 normal perceivers, and 36 overperceivers. A discriminant analysis was performed that indicated that a majority of underperceivers were characterized by being African American and having low asthma-specific anxiety. Normal perceivers in this sample tended to be older. Overperceivers tended to be female. Our findings encourage further research using the reported method of classifying asthma patients into perceiver categories.
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Affiliation(s)
- Ashton M. Steele
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
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Olazagasti MAR, Shrout PE, Yoshikawa H, Bird HR, Canino GJ. The longitudinal relationship between parental reports of asthma and anxiety and depression symptoms among two groups of Puerto Rican youth. J Psychosom Res 2012; 73:283-8. [PMID: 22980534 PMCID: PMC3444747 DOI: 10.1016/j.jpsychores.2012.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/12/2012] [Accepted: 07/13/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aims to examine the relationship between parental reports of child asthma and levels and slopes of anxiety and depression symptoms among two contrasting groups of Puerto Rican youth, and to determine whether asthma is a special risk above and beyond parents' reports of other youths' medical conditions. METHODS Two probability samples of youth in San Juan and Caguas, Puerto Rico (n=673) and in the south Bronx, New York (n=598), and their caretakers were interviewed in three yearly assessments. Parental reports of their children's asthma during each assessment were used to indicate whether youth had intermittent (PR=34%, NY=23%) or persistent (PR=7%, NY=16%) asthma. Youths' depression and anxiety symptoms were assessed using self reports to the DISC-IV. Information on youths' medical comorbidity was gathered through parental reports. RESULTS Multilevel analyses adjusting for comorbid medical conditions indicated that parental reports of youths' intermittent and persistent asthma were related to higher levels, but similar slopes, of anxiety and depression among youth in New York. In Puerto Rico, youth with persistent asthma experienced less improvement in anxiety over time than youth without asthma, but no other associations were found. CONCLUSION Having asthma, based on parental reports, represents a risk factor for Puerto Rican youths' internalizing symptoms, even after adjusting for comorbid medical conditions. This risk is more pronounced among youth living in New York, which highlights the importance of considering the social context in which youth develop and minority status when examining associations between physical health risk factors and mental health.
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Affiliation(s)
- Maria A. Ramos Olazagasti
- Phyllis Green and Randolph Cōwen Institute for Pediatric Neuroscience, Child Study Center, New York University, Langone Medical Center
| | | | | | | | - Glorisa J. Canino
- Department of Pediatrics, School of Medicine, University of Puerto Rico, Behavioral Sciences Research Institute
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Abstract
OBJECTIVE The aim of this study was to determine ethnic and site differences in quality of life (QOL) in a sample of Latino (Puerto Rican [PR] and Dominican) and non-Latino white caregivers of children with asthma in mainland US and Island PR. We also investigated ethnic and site differences in associations between caregiver QOL and indicators of asthma morbidity. METHOD Seven hundred and eighty-seven children with asthma (7-16 years of age) and their primary caregivers participated in the study. Primary caregivers completed a measure of QOL, child asthma control, and emergency department utilization, among other measures. RESULTS Ethnic and site differences were found on total QOL scores (ΔF(1,783) = 29.46, p < .001). Island PR caregivers reported worse QOL scores than Rhode Island (Rl) Latino and non-Latino white caregivers; Rl Latino caregivers reported significantly worse QOL scores than non-Latino white caregivers. In Rl Latino and Island PR children, worse caregiver QOL was associated with asthma that was not in control and with one or more emergency department visits. CONCLUSION Latino caregivers may be experiencing a greater level of burden related to their child's asthma than non-Latino white caregivers. Caregiver QOL in pediatric asthma may be a reflection of broader contextual stress that some Latino caregivers experience on a daily basis (e.g., cultural beliefs, acculturation). Future research should continue to investigate mechanisms that explain the burden associated with pediatric asthma in Latino families, as well as whether QOL assessments should consider the impact of everyday stressors on caregiver QOL in pediatric asthma.
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Calhoun WJ, Ameredes BT, King TS, Icitovic N, Bleecker ER, Castro M, Cherniack RM, Chinchilli VM, Craig T, Denlinger L, DiMango EA, Engle LL, Fahy JV, Grant JA, Israel E, Jarjour N, Kazani SD, Kraft M, Kunselman SJ, Lazarus SC, Lemanske RF, Lugogo N, Martin RJ, Meyers DA, Moore WC, Pascual R, Peters SP, Ramsdell J, Sorkness CA, Sutherland ER, Szefler SJ, Wasserman SI, Walter MJ, Wechsler ME, Boushey HA. Comparison of physician-, biomarker-, and symptom-based strategies for adjustment of inhaled corticosteroid therapy in adults with asthma: the BASALT randomized controlled trial. JAMA 2012; 308:987-97. [PMID: 22968888 PMCID: PMC3697088 DOI: 10.1001/2012.jama.10893] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT No consensus exists for adjusting inhaled corticosteroid therapy in patients with asthma. Approaches include adjustment at outpatient visits guided by physician assessment of asthma control (symptoms, rescue therapy, pulmonary function), based on exhaled nitric oxide, or on a day-to-day basis guided by symptoms. OBJECTIVE To determine if adjustment of inhaled corticosteroid therapy based on exhaled nitric oxide or day-to-day symptoms is superior to guideline-informed, physician assessment-based adjustment in preventing treatment failure in adults with mild to moderate asthma. DESIGN, SETTING, AND PARTICIPANTS A randomized, parallel, 3-group, placebo-controlled, multiply-blinded trial of 342 adults with mild to moderate asthma controlled by low-dose inhaled corticosteroid therapy (n = 114 assigned to physician assessment-based adjustment [101 completed], n = 115 to biomarker-based [exhaled nitric oxide] adjustment [92 completed], and n = 113 to symptom-based adjustment [97 completed]), the Best Adjustment Strategy for Asthma in the Long Term (BASALT) trial was conducted by the Asthma Clinical Research Network at 10 academic medical centers in the United States for 9 months between June 2007 and July 2010. INTERVENTIONS For physician assessment-based adjustment and biomarker-based (exhaled nitric oxide) adjustment, the dose of inhaled corticosteroids was adjusted every 6 weeks; for symptom-based adjustment, inhaled corticosteroids were taken with each albuterol rescue use. MAIN OUTCOME MEASURE The primary outcome was time to treatment failure. RESULTS There were no significant differences in time to treatment failure. The 9-month Kaplan-Meier failure rates were 22% (97.5% CI, 14%-33%; 24 events) for physician assessment-based adjustment, 20% (97.5% CI, 13%-30%; 21 events) for biomarker-based adjustment, and 15% (97.5% CI, 9%-25%; 16 events) for symptom-based adjustment. The hazard ratio for physician assessment-based adjustment vs biomarker-based adjustment was 1.2 (97.5% CI, 0.6-2.3). The hazard ratio for physician assessment-based adjustment vs symptom-based adjustment was 1.6 (97.5% CI, 0.8-3.3). CONCLUSION Among adults with mild to moderate persistent asthma controlled with low-dose inhaled corticosteroid therapy, the use of either biomarker-based or symptom-based adjustment of inhaled corticosteroids was not superior to physician assessment-based adjustment of inhaled corticosteroids in time to treatment failure. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00495157.
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Affiliation(s)
- William J Calhoun
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Shi Y, Tatavoosian AV, Aledia AS, George SC, Galant SP. Cut points for Asthma Control Tests in Mexican children in Orange County, California. Ann Allergy Asthma Immunol 2012; 109:108-13. [PMID: 22840251 DOI: 10.1016/j.anai.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/07/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) are validated measures of asthma control in which a score of 19 is defined as uncontrolled according to published reports. However, different cut points may exist in different ethnic populations. OBJECTIVE To determine the cut point for uncontrolled asthma in a Mexican descent population from Orange Country, California, compared with an age- and asthma severity-matched non-Hispanic cohort. METHODS The C-ACT (in children 6-11 years old) and ACT (in children 12-17 years old) scores were collected from 151 children of Mexican descent and 48 non-Hispanic controls with mild-to-moderate asthma who lived in Orange County. Physicians were masked to C-ACT and ACT scores while assessing control based on National Asthma Education and Prevention program guidelines. The receiver operating characteristic method was used to examine the screening accuracy of the tests to detect uncontrolled asthma. The optimal cut points were selected by maximizing the total sensitivity and specificity. RESULTS Cronbach α values for the C-ACT (0.76) and the ACT (0.80) confirmed that both tests were reliable in our study population. The C-ACT and ACT scores were statistically higher in children of Mexican descent than non-Hispanic children (P = .008). A cut point of 22 was optimal to detect uncontrolled asthma in children of Mexican descent 6 to 11 years old (group 1: sensitivity, 0.74; specificity, 0.86; area under the curve [AUC], 0.83) and children 12 to 17 years old (group 3: sensitivity, 0.78; specificity, 0.68; AUC, 0.79). For non-Hispanic controls, a cut point of 20 were optimal to detect uncontrolled asthma in children 6 to 11 years old (group 2: sensitivity, 0.70; specificity, 0.91; AUC, 0.86) and children 12 to 17 years old (group 4: sensitivity, 0.83; specificity, 0.87; AUC, 0.91). CONCLUSION In this cross-ethnic validation study, children of Mexican descent in Orange County seem to underreport asthma symptoms compared with a non-Hispanic population and may require higher C-ACT and ACT cut points to detect uncontrolled asthma.
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Affiliation(s)
- Yixin Shi
- Department of Biomedical Engineering, University of California, Irvine, California, USA
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McQuaid EL, Everhart RS, Seifer R, Kopel SJ, Mitchell DK, Klein RB, Esteban CA, Fritz GK, Canino G. Medication adherence among Latino and non-Latino white children with asthma. Pediatrics 2012; 129:e1404-10. [PMID: 22566417 PMCID: PMC3362901 DOI: 10.1542/peds.2011-1391] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, family-based, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico. METHODS Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7-16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence. RESULTS Medication adherence differed by ethnic group (F(2, 271) = 7.46, P < .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45). CONCLUSIONS Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.
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Affiliation(s)
| | | | | | | | | | - Robert B. Klein
- Hasbro Children’s Hospital/Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island; and
| | - Cynthia A. Esteban
- Hasbro Children’s Hospital/Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island; and
| | | | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Canino G, Garro A, Alvarez MM, Colón-Semidey A, Esteban C, Fritz G, Koinis-Mitchell D, Kopel SJ, Ortega AN, Seifer R, McQuaid EL. Factors associated with disparities in emergency department use among Latino children with asthma. Ann Allergy Asthma Immunol 2012; 108:266-70. [PMID: 22469447 PMCID: PMC3324101 DOI: 10.1016/j.anai.2012.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/18/2012] [Accepted: 02/01/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Significant disparities in emergency department (ED) rates exist for Latinos; however, few studies have investigated the factors that may account for these disparities. OBJECTIVES To examine individual/family and health system factors among Latino and non-Latino white (NLW) children with asthma to explain disparities in ED rates. METHODS The study was carried out in Puerto Rico (PR) and Rhode Island (RI) with the same design: a cross-sectional, observational approach with repeated measurements of selected variables. RESULTS The sample was composed of 804 children ages 7 to 15 years, with 405 from PR and 399 from RI. Latino children from both sites had significantly higher rates of ED use as compared with NLWs from RI. Regression analyses showed site, asthma control, parental reported severity of asthma and public insurance to be significantly associated with ED use. CONCLUSION Latino ethnicity and public insurance were among the most important factors related to frequent ED use. Revisions of the policies driving public insurance to assure better access to specialists, preventive education, and evidence-based treatment are needed. The results also suggest the need for the development of interventions in the ED that are geared toward educating families on how best to use emergency services.
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Affiliation(s)
- Glorisa Canino
- University of Puerto Rico, Medical Sciences Campus, Behavioral Sciences Research Institute, San Juan, Puerto Rico.
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Abstract
Identifying that health inequalities exist is not enough; nor does the knowledge that a patient has a high-risk genotype or comes from a higher risk socioeconomic background does not, by itself, help the patient. To thoroughly examine the origins of health disparities, a broad view of environmental and molecular influences must be included. As these factors are identified, it is important to focus on interventions that can change outcomes for patients. Tools for education, community involvement, literacy, and environmental safety need to be developed, tested and disseminated. The basic science of health disparities must move forward in a coordinated fashion by structuring research that is an integrated effort between basic sciences, clinical medicine and include all traditionally underserved communities. Only through these collaborations can we hope to eliminate health inequalities in the future.
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Affiliation(s)
- Kimberly Danieli Watts
- Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza Box # 43, Chicago, IL 60614, USA.
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Wechsler ME, Castro M, Lehman E, Chinchilli VM, Sutherland ER, Denlinger L, Lazarus SC, Peters SP, Israel E. Impact of race on asthma treatment failures in the asthma clinical research network. Am J Respir Crit Care Med 2011; 184:1247-53. [PMID: 21885625 PMCID: PMC3361331 DOI: 10.1164/rccm.201103-0514oc] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 08/30/2011] [Indexed: 01/26/2023] Open
Abstract
RATIONALE Recent studies suggest that people with asthma of different racial backgrounds may respond differently to various therapies. OBJECTIVES To use data from well-characterized participants in prior Asthma Clinical Research Network (ACRN) trials to determine whether racial differences affected asthma treatment failures. METHODS We analyzed baseline phenotypes and treatment failure rates (worsening asthma resulting in systemic corticosteroid use, hospitalization, emergency department visit, prolonged decrease in peak expiratory flow, increase in albuterol use, or safety concerns) in subjects participating in 10 ACRN trials (1993-2003). Self-declared race was reported in each trial and treatment failure rates were stratified by race. MEASUREMENTS AND MAIN RESULTS A total of 1,200 unique subjects (whites = 795 [66%]; African Americans = 233 [19%]; others = 172 [14%]; mean age = 32) were included in the analyses. At baseline, African Americans had fewer asthma symptoms (P < 0.001) and less average daily rescue inhaler use (P = 0.007) than whites. There were no differences in baseline FEV(1) (% predicted); asthma quality of life; bronchial hyperreactivity; or exhaled nitric oxide concentrations. A total of 147 treatment failures were observed; a significantly higher proportion of African Americans (19.7%; n = 46) experienced a treatment failure compared with whites (12.7%; n = 101) (odds ratio = 1.7; 95% confidence interval, 1.2-2.5; P = 0.007). When stratified by treatment, African Americans receiving long-acting β-agonists were twice as likely as whites to experience a treatment failure (odds ratio = 2.1; 95% confidence interval, 1.3-3.6; P = 0.004), even when used with other controller therapies. CONCLUSIONS Despite having fewer asthma symptoms and less rescue β-agonist use, African-Americans with asthma have more treatment failures compared with whites, especially when taking long-acting β-agonists.
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Affiliation(s)
- Shamsah Kazani
- Department of Medicine, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA 02115, USA
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