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Šafran V, Lin S, Nateqi J, Martin AG, Smrke U, Ariöz U, Plohl N, Rojc M, Bēma D, Chávez M, Horvat M, Mlakar I. Multilingual Framework for Risk Assessment and Symptom Tracking (MRAST). SENSORS (BASEL, SWITZERLAND) 2024; 24:1101. [PMID: 38400259 PMCID: PMC10892413 DOI: 10.3390/s24041101] [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: 12/19/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
The importance and value of real-world data in healthcare cannot be overstated because it offers a valuable source of insights into patient experiences. Traditional patient-reported experience and outcomes measures (PREMs/PROMs) often fall short in addressing the complexities of these experiences due to subjectivity and their inability to precisely target the questions asked. In contrast, diary recordings offer a promising solution. They can provide a comprehensive picture of psychological well-being, encompassing both psychological and physiological symptoms. This study explores how using advanced digital technologies, i.e., automatic speech recognition and natural language processing, can efficiently capture patient insights in oncology settings. We introduce the MRAST framework, a simplified way to collect, structure, and understand patient data using questionnaires and diary recordings. The framework was validated in a prospective study with 81 colorectal and 85 breast cancer survivors, of whom 37 were male and 129 were female. Overall, the patients evaluated the solution as well made; they found it easy to use and integrate into their daily routine. The majority (75.3%) of the cancer survivors participating in the study were willing to engage in health monitoring activities using digital wearable devices daily for an extended period. Throughout the study, there was a noticeable increase in the number of participants who perceived the system as having excellent usability. Despite some negative feedback, 44.44% of patients still rated the app's usability as above satisfactory (i.e., 7.9 on 1-10 scale) and the experience with diary recording as above satisfactory (i.e., 7.0 on 1-10 scale). Overall, these findings also underscore the significance of user testing and continuous improvement in enhancing the usability and user acceptance of solutions like the MRAST framework. Overall, the automated extraction of information from diaries represents a pivotal step toward a more patient-centered approach, where healthcare decisions are based on real-world experiences and tailored to individual needs. The potential usefulness of such data is enormous, as it enables better measurement of everyday experiences and opens new avenues for patient-centered care.
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Affiliation(s)
- Valentino Šafran
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Simon Lin
- Science Department, Symptoma GmbH, 1030 Vienna, Austria (A.G.M.)
- Department of Internal Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jama Nateqi
- Science Department, Symptoma GmbH, 1030 Vienna, Austria (A.G.M.)
- Department of Internal Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Umut Ariöz
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Nejc Plohl
- Department of Psychology, Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia;
| | - Matej Rojc
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Dina Bēma
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia;
| | - Marcela Chávez
- Department of Information System Management, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium;
| | - Matej Horvat
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | - Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
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O’Sullivan B, Ounpraseuth S, James L, Majure M, Lang J, Hu Z, Simon A, Bickel S, Ely B, Faricy L, Garza M, Greer M, Hsia D, Jefferson A, Knight L, Lee J, Liptzin D, Abul MH, Perry TT, Prior F, SanGiovanni C, Tam-Williams J, Wu B, Snowden J. Vitamin D Oral Replacement in Children With Obesity Related Asthma: VDORA1 Randomized Clinical Trial. Clin Pharmacol Ther 2024; 115:231-238. [PMID: 37926939 PMCID: PMC10990434 DOI: 10.1002/cpt.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023]
Abstract
Children with asthma and obesity are more likely to have lower vitamin D levels, but the optimal replacement dose is unknown in this population. The objective of this study is identifying a vitamin D dose in children with obesity-related asthma that safely achieves serum vitamin D levels of ≥ 40 ng/mL. This prospective multisite randomized controlled trial recruited children/adolescents with asthma and body mass index ≥ 85% for age/sex. Part 1 (dose finding), evaluated 4 oral vitamin D regimens for 16 weeks to identify a replacement dose that achieved serum vitamin D levels ≥ 40 ng/mL. Part 2 compared the replacement dose calculated from part 1 (50,000 IU loading dose with 8,000 IU daily) to standard of care (SOC) for 16 weeks to identify the proportion of children achieving target serum 25(OH)D level. Part 1 included 48 randomized participants. Part 2 included 64 participants. In Part 1, no SOC participants achieved target serum level, but 50-72.7% of participants in cohorts A-C achieved the target serum level. In part 2, 78.6% of replacement dose participants achieved target serum level compared with none in the SOC arm. No related serious adverse events were reported. This trial confirmed a 50,000 IU loading dose plus 8,000 IU daily oral vitamin D as safe and effective in increasing serum 25(OH)D levels in children/adolescents with overweight/obesity to levels ≥ 40 ng/mL. Given the critical role of vitamin D in many conditions complicating childhood obesity, these data close a critical gap in our understanding of vitamin D dosing in children.
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Affiliation(s)
- Brian O’Sullivan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Song Ounpraseuth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Laura James
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marc Majure
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jason Lang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Zhuopei Hu
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alan Simon
- National Institutes of Health Office of the Director, Bethesda, Maryland, USA
| | - Scott Bickel
- Norton Children’s and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Brian Ely
- West Virginia University, Morgantown, West Virginia, USA
| | - L.E. Faricy
- University of Vermont, Burlington, Vermont, USA
| | - Maryam Garza
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melody Greer
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daniel Hsia
- Pennington Biomedical Research Institute, Baton Rouge, Louisiana, USA
| | - Akilah Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lisa Knight
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Mehtap Haktanir Abul
- Hasbro Children’s Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tamara T. Perry
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fred Prior
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Brian Wu
- Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, USA
| | - Jessica Snowden
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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MacDonell KK, Dailey R, Gibson-Scipio W, Wang B, Dinaj-Koci V, Bruzzese JM. Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma. HEALTH EDUCATION & BEHAVIOR 2023; 50:131-135. [PMID: 33813923 DOI: 10.1177/10901981211001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
African American emerging adults (age 18-29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.
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Affiliation(s)
| | | | | | - Bo Wang
- University of Massachusetts, Amherst, MA, USA
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Zhang A, Fagnano M, Frey SM, Halterman JS. The relationship between teen-reported nocturnal asthma symptoms and daily functioning. J Asthma 2022; 59:1878-1884. [PMID: 34424114 PMCID: PMC8898318 DOI: 10.1080/02770903.2021.1968426] [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: 05/07/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to identify associations between nocturnal asthma awakenings and functional health outcomes in a cohort of teenagers with asthma. METHODS We analyzed baseline data from teenagers enrolled in SB-ACT, an NIH-funded RCT. During an at-home baseline survey, teenagers with asthma answered questions about demographics, recent asthma symptoms, and functional health outcomes. We conducted regression analyses to explore the relationship between persistent nocturnal asthma symptoms (≥2 nights of nocturnal asthma awakenings in the past 14 days) and functional health measures. RESULTS Of the 430 teens enrolled (Participation rate = 79%, Mean Age = 13.4), 30% reported persistent nocturnal asthma symptoms. Compared to teens with intermittent nocturnal asthma symptoms, teens with persistent nocturnal asthma symptoms were more likely to report physical limitation during strenuous activities (OR = 1.9, 1.3-3.0), moderate activities (OR = 1.9, 1.2-3.1), and school gym (OR = 2.4, 1.5-3.8). They were also more likely to report depressive symptoms (OR = 2.3, 1.5-3.6), more asthma-related school absenteeism in the past 14 days (0.81 vs 0.12, p < 0.01) and poorer quality of life (4.6 vs 5.9, p < 0.01). These findings remained significant when controlling for daytime asthma symptoms, weight status, race, ethnicity, gender, age, and smoke exposure. CONCLUSIONS In this cross-sectional study, persistent nighttime asthma symptoms were associated with poor functional health outcomes among teens, independent of day-time symptoms. Identifying nighttime symptoms and improving asthma control at night may positively impact daily functioning for these teens.
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Affiliation(s)
- Anne Zhang
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Sean M. Frey
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
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Griffiths P, Williams A, Brohan E. How do the number of missing daily diary days impact the psychometric properties and meaningful change thresholds arising from a weekly average summary score? Qual Life Res 2022; 31:3433-3445. [PMID: 35930136 PMCID: PMC9362484 DOI: 10.1007/s11136-022-03198-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life research often collects daily information and averages this over a week, producing a summary score. When data are missing, arbitrary rules (such as requiring at least 4/7 observations) are used to determine whether a patient's summary score is created or set to missing. This simulation work aimed to assess the impact of missing data on the estimates produced by summary scores, the psychometric properties of the resulting summary score estimates and the impact on interpretation thresholds. METHODS Complete longitudinal data were simulated for 1000 samples of 400 patients with different day-to-day variability. Data were deleted from these samples in line with missingness mechanisms to create scenarios with up to six days of missing data. Summary scores were created for complete and missing data scenarios. Summary score estimates, psychometric properties and meaningful change estimates were assessed for missing data scenarios compared to complete data. RESULTS In most cases, the 4/7 day rule was supported, but this depended on daily variability. Fewer days of data were sometimes acceptable, but this was also dependent on the proportion of patients with missing data. Tables and figures allow researchers to assess the potential impact of missing data in their own studies. CONCLUSIONS This work suggests that the missing data rule used to create summary scores impacts on the estimate, measurement properties and interpretation thresholds. Although a general rule of 4/7 days is supported, the way the summary score is derived does not have a uniform impact across psychometric analyses. Recommendations are to use the 4/7 rule, but plan for sensitivity analyses with other missing data rules.
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Affiliation(s)
- Pip Griffiths
- Patient Centric Services, IQVIA France, Tour D2, 17 bis Passerelle des Reflets, 92400, Courbevoie, France.
| | - Abi Williams
- Patient Centric Services, IQVIA UK, 3 Forbury Place, 23 Forbury Rd, Reading, RG1 3JH, UK
| | - Elaine Brohan
- Formerly of Patient Centered Outcomes, Adelphi Values, Bollington, UK
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Shamasunder B, Chan M, Navarro S, Eckel S, Johnston JE. Mobile daily diaries to characterize stressors and acute health symptoms in an environmental justice neighborhood. Health Place 2022; 76:102849. [PMID: 35780656 DOI: 10.1016/j.healthplace.2022.102849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
Low-income communities and communities of color face multiple, cumulative environmental and social burdens. Methods development in environmental justice research has largely focused on spatial and quantitative approaches. Less attention has been paid to developing methodologies that help collect information on everyday stressors and quality of life experiences for residents in overburdened communities. Mixed methods approaches can be one way to structure study designs that help consider how residents experience environmental and socioeconomic impacts in a localized community context. In neighborhoods burdened by cumulative stressors, traditional cross-sectional epidemiological research designs can also be challenging, as well as limited or narrow in their application. However, repeat sampling of measures within a vulnerable population can approach a quasi-experimental design and help consider variations within residents in a single neighborhood as well as better parse relationships between exposures and outcomes. Through a community-academic partnership with university partners, local community partners, and a local promotores de salud (community health workers) network, we pilot tested a novel mobile daily diary approach in both English and Spanish in an urban, predominantly immigrant community in South Los Angeles as a potential method to collect information on daily stress, environmental quality, and health status/symptoms. We collected resident responses via a once per day 7-day SMS/text messaging survey. We sought to gather granular data on daily resident experiences of air pollution and environmental hazards. Residents reported acute health symptoms and stressors, with repeat measures demonstrating how residents might rank, categorize, or cope with stressors. We find that residents in environmental justice communities record variation in their daily diary responses and document changes in environmental quality, stressors, and odors. Refining this type of method could enable a more rigorous examination of co-occurrences of environmental quality and acute health symptoms. This approach supports the inclusion of residents in the research process and helps more systematically integrate open-ended environmental health relevant data in environmental justice efforts. Used with measured data such as air monitoring or health measures, mixed methods generated data can help support efforts that aim to alleviate sources of daily stress, alongside efforts to reduce overall pollution burdens. Mobile daily diaries can be one way to capture variable responses to environmental quality, acute health symptoms, and stressors.
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Affiliation(s)
- Bhavna Shamasunder
- Urban & Environmental Policy Department and Public Health Program, Occidental College, Los Angeles, CA, USA.
| | - Marissa Chan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Bldg. 1, 14th Floor, Boston, MA, 02115, USA.
| | | | - Sandrah Eckel
- Division of Biostatistics, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Jill E Johnston
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Stevens DR, Rohn MCH, Hinkle SN, Williams AD, Kumar R, Lipsky LM, Grobman W, Sherman S, Kanner J, Chen Z, Mendola P. Maternal body composition and gestational weight gain in relation to asthma control during pregnancy. PLoS One 2022; 17:e0267122. [PMID: 35442986 PMCID: PMC9020691 DOI: 10.1371/journal.pone.0267122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial. OBJECTIVE Examine associations of body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299). METHODS Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)). RESULTS Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)). CONCLUSIONS Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.
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Affiliation(s)
- Danielle R. Stevens
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Matthew C. H. Rohn
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Stefanie N. Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Andrew D. Williams
- UND School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Rajesh Kumar
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Leah M. Lipsky
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - William Grobman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Seth Sherman
- The Emmes Company, Rockville, MD, United States of America
| | - Jenna Kanner
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Zhen Chen
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
- School of Public Health and Health Professions, University at Buffalo, Buffalo NY, United States of America
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Determining the Clinical Course of Asthma in Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:793-802.e10. [PMID: 34656801 DOI: 10.1016/j.jaip.2021.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease affecting pregnancy, and poor asthma control has been associated with adverse pregnancy outcomes. However, the trajectory of asthma control during pregnancy is not well understood or characterized. OBJECTIVE To identify and characterize trajectories of gestational asthma control in a US-based prospective pregnancy cohort. METHODS A k-means algorithm for joint longitudinal data was used to cluster pregnant women with and without asthma into gestational asthma control trajectories on the basis of daily activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms. RESULTS Among 308 women with asthma, 2 trajectories of gestational asthma control were identified and labeled "same" (n = 184; 59.5%) or "worse" (n = 124; 40.5%). Contrary to previous studies, we did not observe women with better asthma control in pregnancy. Women belonging to the "worse" trajectory experienced frequent and stable activity limitation and inhaler use, as well as frequent and increasing nighttime symptoms (∼3 d/gestational week) and respiratory symptoms (∼5 times/wk). Women belonging to the "same" trajectory experienced infrequent and stable activity limitation, inhaler use, and respiratory symptoms, as well as infrequent and slightly increasing (∼1 d/gestational week) nighttime symptoms. Results from pregnant women without asthma (n = 107) suggest that pregnancy alone was not responsible for changes in symptoms over time. CONCLUSIONS In this US-based obstetric cohort receiving care according to standard clinical practice, gestational asthma control worsened for about 40% of women.
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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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Enhancing validity, reliability and participation in self-reported health outcome measurement for children and young people: a systematic review of recall period, response scale format, and administration modality. Qual Life Res 2021; 30:1803-1832. [PMID: 33738710 PMCID: PMC8233251 DOI: 10.1007/s11136-021-02814-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Introduction Self-report is the gold standard for measuring children’s health-related outcomes. Design of such measures is complex and challenging. This review aims to systematically appraise the evidence on recall period, response scale format, mode of administration and approaches needed to enable children and young people < 19 years to participate in valid and reliable self-reporting of their health outcomes. Method PsycInfo, Medline, CINAHL and Embase were searched from 1 January 1990 to 15 March 2020, and citation searching undertaken in Scopus. Articles were included if they were primary research or case reports of ≥ 3 participants reporting the following: recall period, response scale selection, administration modality. Quality was assessed using QualSyst, and results synthesised narratively. This review was conducted and reported according to PRISMA guidelines. Results 81 of 13,215 retrieved articles met the inclusion criteria. Children < 5 years old cannot validly and reliably self-report health outcomes. Face scales demonstrate better psychometric properties than visual analogue or Likert scales. Computerised and paper scales generally show equivalent construct validity. Children prefer computerised measures. Children ≤ 7 years old think dichotomously so need two response options. Those > 8 years old can reliably use a 3-point scale. Conclusion The results of this review have both clinical and research implications. They can be used to inform appropriate choice of PROM for use with CYP in the clinical setting. We also give eight recommendations for future development of self-reported outcome measures for children and young people. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02814-4.
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Krieger-Grübel C, Hutter S, Hiestand M, Brenner I, Güsewell S, Borovicka J. Treatment efficacy of a low FODMAP diet compared to a low lactose diet in IBS patients: A randomized, cross-over designed study. Clin Nutr ESPEN 2020; 40:83-89. [PMID: 33183577 DOI: 10.1016/j.clnesp.2020.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE A low FODMAP diet (LFD) has become a standard treatment in irritable bowel syndrome (IBS) patients. Compliant adherence to a LFD is challenging. We investigated the effect of a LFD compared to a less restrictive low lactose diet (LLD) in a randomized cross-over trial with IBS patients. METHODS Twenty-nine IBS patients were randomly assigned to two groups. After a run-in phase of 14 days, patients received 21 days of either a LFD or LLD. This intervention was followed by a washout period of 21 days before crossing over to the alternate diet. Dietician led diet instruction was given continuously. An IBS Severity Scoring System (IBS-SSS) was filled in at the end of each study period. To enhance study adherence, daily symptoms were assessed using a Visual Analog Scale (VAS). RESULTS IBS patients, irrespective of lactase deficiency, had a significantly reduced IBS-SSS score after both diets (LFD p = 0.002, LLD p = 0.007) without significant difference. On both diets, patients reported that IBS had less impact on their daily life compared to the time before the study (p < 0.01). On daily assessment, IBS patients on LFD reported significantly less abdominal pain (median VAS difference to baseline -0.8 (-2.8 to 2.7, p = 0.03) and less bloating (-0.5 (-4.1 to 3.4, p = 0.02) than patients on the LLD. CONCLUSION Both diets improved the overall IBS severity significantly and patients' preference of the two diets was similar. LFD but not LLD effectively reduced pain and bloating in patients with IBS.
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Affiliation(s)
- Claudia Krieger-Grübel
- Department of Gastroenterology/Hepatology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland.
| | - Senta Hutter
- Department of Internal Medicine, Spital Männedorf, Asylstrasse 10, Männedorf, 8708, Switzerland
| | - Mirjam Hiestand
- Department of Gastroenterology/Hepatology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland
| | - Isabella Brenner
- Department of Gastroenterology/Hepatology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland
| | - Sabine Güsewell
- Clinical Trial Unit, Kantonsspital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland
| | - Jan Borovicka
- Department of Gastroenterology/Hepatology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland
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Shetty V, Morrison D, Belin T, Hnat T, Kumar S. A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e17347. [PMID: 32579118 PMCID: PMC7380983 DOI: 10.2196/17347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/11/2020] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale. OBJECTIVE The aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings. METHODS We developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS. RESULTS Using a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI -0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues. CONCLUSIONS ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level.
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Affiliation(s)
- Vivek Shetty
- Section of Oral & Maxillofacial Surgery, Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Douglas Morrison
- Section of Oral & Maxillofacial Surgery, Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angles, CA, United States
| | - Thomas Belin
- Section of Oral & Maxillofacial Surgery, Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angles, CA, United States
| | - Timothy Hnat
- Department of Computer Science, The University of Memphis, Memphis, TN, United States
| | - Santosh Kumar
- Department of Computer Science, The University of Memphis, Memphis, TN, United States
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13
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Rijsbergen M, Niemeyer‐van der Kolk T, Rijneveld R, Pinckaers J, Meshcheriakov I, Bouwes Bavinck J, van Doorn M, Hogendoorn G, Feiss G, Cohen A, Burggraaf J, van Poelgeest M, Rissmann R. Mobile e-diary application facilitates the monitoring of patient-reported outcomes and a high treatment adherence for clinical trials in dermatology. J Eur Acad Dermatol Venereol 2020; 34:633-639. [PMID: 31419338 PMCID: PMC7064941 DOI: 10.1111/jdv.15872] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Assessment of treatment effects in clinical trials requires valid information on treatment adherence, adverse events and symptoms. Paper-based diaries are often inconvenient and have limited reliability, particularly for outpatient trials. OBJECTIVES To investigate the utility of an electronic diary (e-diary) application for patients with skin diseases in outpatient clinical trials. METHODS An e-diary application was developed and technically validated. Treatment adherence was defined as topical administration by the patient, and patient-reported outcomes, i.e. pain and itch, were evaluated by the e-diary in six clinical trials on newly tested topical drugs. Additionally, the proportion of patients capturing the applied topical drug by camera and filling in the pain and itch scores was defined as e-diary adherence, and patients' perception of usefulness and acceptability of the e-diary were evaluated. RESULTS Treatment adherence rates of the included 256 patients were high (median 98%, range 97-99%). E-diary adherence was also high with a median of 93% (range 87-97%) for capturing the applied drug by camera, and 89% (range 87-96%) and 94% (range 87-96%) for entering respectively the itch and pain score. Daily symptom scores provided good insights into the disease burden, and patients rated the e-diary as good to excellent with respect to user acceptability. CONCLUSIONS The results suggest that the e-diary is an excellent way to ensure proper treatment administration, indicated by both the high user acceptability scores and high treatment adherence. Moreover, the e-diary may also be valuable for frequent and reliable monitoring of patient-reported outcomes in daily clinical practice.
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Affiliation(s)
| | | | - R. Rijneveld
- Centre for Human Drug ResearchLeidenThe Netherlands
| | | | | | - J.N. Bouwes Bavinck
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - M.B.A. van Doorn
- Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - G. Feiss
- Cutanea Life ScienceWaynePennsylvaniaUSA
| | - A.F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands
| | - J. Burggraaf
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - M.I.E. van Poelgeest
- Centre for Human Drug ResearchLeidenThe Netherlands
- Department of Gynecology and ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - R. Rissmann
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
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Castner J, Jungquist CR, Mammen MJ, Pender JJ, Licata O, Sethi S. Prediction model development of women's daily asthma control using fitness tracker sleep disruption. Heart Lung 2020; 49:548-555. [PMID: 32089295 DOI: 10.1016/j.hrtlng.2020.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Night-time wakening with asthma symptoms is an important indicator of disease control and severity, with no gold-standard objective measurement. OBJECTIVE The study objective was to use fitness tracker sleep data to develop predictive models of daily disease control-related asthma-specific wakening and FEV1 in working-aged women with poorly controlled asthma. METHODS A repeated measures panel design included data from 43 women with poorly controlled asthma. Two components of asthma control were the primary outcomes, measured daily as (1) self-reported asthma-specific wakening and (2) self-administered spirometry to measure FEV1. Data were analyzed using generalized linear mixed models. RESULTS Our models demonstrated predictive value (AUC=0.77) for asthma-specific night-time wakening and good predictive value (AUC=0.83) for daily FEV1. CONCLUSIONS: Fitness tracker sleep efficiency and wake counts demonstrate clinical utility as predictive of asthma-specific night-time wakening and daily FEV1. Fitness tracker sleep data demonstrated predictive capability for daily asthma outcomes.
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Affiliation(s)
- Jessica Castner
- The Rockefeller Heilbrunn Family Center for Research Nursing Nurse Scholar, New York, NY, USA; University at Buffalo, Buffalo, NY, USA; Castner Incorporated, Grand Island, NY 14072, USA.
| | | | - Manoj J Mammen
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - John J Pender
- University at Buffalo School of Nursing Graduate, Buffalo, NY, USA
| | - Olivia Licata
- Department of Biomedical Engineering & Department of Materials Design and Innovation, University at Buffalo School of Engineering and Applied Sciences, Buffalo, NY, USA
| | - Sanjay Sethi
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Harel-Sterling M, Dai R, Moraes TJ, Boutis K, Eiwegger T, Narang I, Lepine C, Brydges MG, Dubeau A, Subbarao P, Schuh S. Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations. Pediatr Pulmonol 2020; 55:338-345. [PMID: 31909572 DOI: 10.1002/ppul.24601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/29/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The test for respiratory and asthma control in kids (TRACK score) is a standardized questionnaire tool validated to identify poor symptom control in children with stable preschool wheeze. This study determined if TRACK score measured within 5 days of an Emergency Department (ED) visit for acute wheezing predicts a subsequent wheezing exacerbation requiring an ED visit and/or treatment with systemic corticosteroids within 3 months. METHODS This was a single-center prospective cohort study of children aged 36 to 71 months who presented to the ED with an acute episode of wheezing and had TRACK score measured at a clinic visit within 5 days of the index ED encounter, focused on information about symptoms occurring before the onset of the current acute episode. The outcomes were the independent association of a repeat wheezing exacerbation with the overall TRACK score (primary) and with mutually uncorrelated TRACK items (secondary), adjusted for sex and atopy. RESULTS We enrolled 102 children; median age 52.3 (44.1, 59.9) months, 59% males. Of these, 33 (32.4%) had further wheezing exacerbations. For each 10 unit decrease in TRACK, the odds of a future exacerbation was 1.38 (95% CI, 1.10-1.75); male sex demonstrated OR, 5.13 (1.84-14.33). A model that included TRACK items reflecting more than equal to 1 awakenings for wheezing in the past 4 weeks, receipt of more than equal to 2 courses of corticosteroids in the last year and male sex was predictive of wheezing exacerbations: OR, 6.43 (2.18-19.00). CONCLUSION In preschoolers with acute wheezing episodes in the ED, we have identified the TRACK score components which, together with male sex, can be used to identify children at risk of future exacerbations requiring referral for specialized care. These results need to be confirmed and validated in other populations enrolled at multiple sites before they can be implemented in practice.
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Affiliation(s)
- Maya Harel-Sterling
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ruixue Dai
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Thomas Eiwegger
- Division of Immunology & Allergy, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Claire Lepine
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - May Grace Brydges
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, and Department of Physiology, University of Toronto, Toronto, Canada
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, Department of Paediatrics, and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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16
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Fitzpatrick AM, Szefler SJ, Mauger DT, Phillips BR, Denlinger LC, Moore WC, Sorkness RL, Wenzel SE, Gergen PJ, Bleecker ER, Castro M, Erzurum SC, Fahy JV, Gaston BM, Israel E, Levy BD, Meyers DA, Teague WG, Bacharier LB, Ly NP, Phipatanakul W, Ross KR, Zein J, Jarjour NN. Development and initial validation of the Asthma Severity Scoring System (ASSESS). J Allergy Clin Immunol 2019; 145:127-139. [PMID: 31604088 DOI: 10.1016/j.jaci.2019.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tools for quantification of asthma severity are limited. OBJECTIVE We sought to develop a continuous measure of asthma severity, the Asthma Severity Scoring System (ASSESS), for adolescents and adults, incorporating domains of asthma control, lung function, medications, and exacerbations. METHODS Baseline and 36-month longitudinal data from participants in phase 3 of the Severe Asthma Research Program (NCT01606826) were used. Scale properties, responsiveness, and a minimally important difference were determined. External replication was performed in participants enrolled in the Severe Asthma Research Program phase 1/2. The utility of ASSESS for detecting treatment response was explored in participants undergoing corticosteroid responsiveness testing with intramuscular triamcinolone and participants receiving biologics. RESULTS ASSESS scores ranged from 0 to 20 (8.78 ± 3.9; greater scores reflect worse severity) and differed among 5 phenotypic groups. Measurement properties were acceptable. ASSESS was responsive to changes in quality of life with a minimally important difference of 2, with good specificity for outcomes of asthma improvement and worsening but poor sensitivity. Replication analyses yielded similar results, with a 2-point decrease (improvement) associated with improvements in quality of life. Participants with a 2-point or greater decrease (improvement) in ASSESS scores also had greater improvement in lung function and asthma control after triamcinolone, but these differences were limited to phenotypic clusters 3, 4, and 5. Participants treated with biologics also had a 2-point or greater decrease (improvement) in ASSESS scores overall. CONCLUSIONS The ASSESS tool is an objective measure that might be useful in epidemiologic and clinical research studies for quantification of treatment response in individual patients and phenotypic groups. However, validation studies are warranted.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Stanley J Szefler
- Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - David T Mauger
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Brenda R Phillips
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | | | - Wendy C Moore
- Department of Internal Medicine, Wake Forest University, Winston-Salem, NC
| | | | - Sally E Wenzel
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - Mario Castro
- Department of Internal Medicine, Washington University, St Louis, Mo
| | | | - John V Fahy
- Department of Medicine, San Francisco, Calif
| | - Benjamin M Gaston
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Elliot Israel
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Bruce D Levy
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - W Gerald Teague
- Department of Pediatrics, University of Virginia, Charlottesville, Va
| | | | - Ngoc P Ly
- Department of Pediatrics, University of California San Francisco, Cleveland, Ohio
| | | | - Kristie R Ross
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Joe Zein
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin, Madison, Wis
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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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Development and validation of a pain monitoring app for patients with musculoskeletal conditions (The Keele pain recorder feasibility study). BMC Med Inform Decis Mak 2019; 19:24. [PMID: 30683106 PMCID: PMC6347830 DOI: 10.1186/s12911-019-0741-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Assessing daily change in pain and related symptoms help in diagnosis, prognosis, and monitoring response to treatment. However, such changes are infrequently assessed, and usually reviewed weeks or months after the start of treatment. We therefore developed a smartphone application (Keele Pain Recorder) to record information on the severity and impact of pain on daily life. Specifically, the study goal was to assess face, content and construct validity of data collection using the Pain Recorder in primary care patients receiving new analgesic prescriptions for musculoskeletal pain, as well as to assess its acceptability and clinical utility. Methods The app was developed with Keele’s Research User Group (RUG), a clinical advisory group (CAG) and software developer for use on Android devices. The app recorded pain levels, interference, sleep disturbance, analgesic use, mood and side effects. In a feasibility study, patients aged > 18 attending their general practitioner (GP) with a painful musculoskeletal condition were recruited to use the app twice per day for 28 days. Face and construct validity were assessed through baseline and post-study questionnaires (Spearman’s rank correlation coefficient). Usability and acceptability were determined through post-study questionnaires, and patient, GP, RUG and CAG interviews. Results An app was developed which was liked by both patients and GPs. It was felt that it offered the opportunity for GPs to discuss pain control with their patients in a new way. All participants found the app easy to use (it did not interfere with their activities) and results easy to interpret. Strong associations existed between the first 3 days (Spearman r = 0.79) and last 3 days (r = 0.60) of pain levels and intensity scores on the app with the validated questionnaires. Conclusions Collaborating with patient representatives and clinical stakeholders, we developed an app which can be used to help clinicians and patients monitor painful musculoskeletal conditions in response to analgesic prescribing. Recordings were accurate and valid, especially, for pain intensity ratings, and it was easy to use. Future work needs to examine how pain trajectories can help manage changes in a patient’s condition, ultimately assisting in self-management. Electronic supplementary material The online version of this article (10.1186/s12911-019-0741-z) contains supplementary material, which is available to authorized users.
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Mendes FAR, França-Pinto A, Martins MA, Cukier A, Stelmach R, Giavina-Bianchi P, Carvalho CRF. Seasonal changes influence the improvement in asthma symptoms by exercise training in subjects with asthma* .. J Asthma 2018; 56:674-679. [PMID: 29972094 DOI: 10.1080/02770903.2018.1484131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether patients with moderate-to-severe asthma who commence an exercise training program in winter or summer show differences in exercise capacity, health-related quality of life (HRQoL) and asthma symptoms. METHODS Forty-two consecutive subjects visiting the outpatient clinic were enrolled in the 17-week rehabilitation program. One group of patients received the intervention from summer to winter (SWG, n = 21), and the other group participated from winter to summer (WSG, n = 21). Before and after the exercise training program, all patients were evaluated by cardiopulmonary exercise test, pulmonary function test, quality of life questionnaire and a daily diary that evaluated clinical asthma symptoms. RESULTS After the training period, both groups improved similarly in health-related quality of life (HRQoL) and aerobic capacity. The WSG patients had a greater increase that those in the SWG in asthma symptom-free days (p < 0.05). CONCLUSIONS Our results indicate that seasonal variations affect the improvement in asthma symptoms after an exercise training program but have no effect on health-related quality of life, exercise capacity or pulmonary function.
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Affiliation(s)
- Felipe A R Mendes
- a Department of Physical Therapy , Universidade Ibirapuera , São Paulo , Brazil.,b Department of Physical Therapy, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Andrezza França-Pinto
- c Department of Clinical Immunology and Allergy, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Milton A Martins
- d Department of Medicine, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Alberto Cukier
- e Department of Pulmonary Diseases, Heart Institute (Incor), Clinics Hospital, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Rafael Stelmach
- e Department of Pulmonary Diseases, Heart Institute (Incor), Clinics Hospital, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Pedro Giavina-Bianchi
- c Department of Clinical Immunology and Allergy, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Celso R F Carvalho
- b Department of Physical Therapy, School of Medicine , University of São Paulo , São Paulo , Brazil
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Teirlinck CH, Sonneveld DS, Bierma-Zeinstra SMA, Luijsterburg PAJ. Daily Pain Measurements and Retrospective Pain Measurements in Hip Osteoarthritis Patients With Intermittent Pain. Arthritis Care Res (Hoboken) 2018; 71:768-776. [PMID: 30022616 PMCID: PMC6593420 DOI: 10.1002/acr.23711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 07/17/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the value of daily pain measurements in patients with hip osteoarthritis (OA), and whether the reliability of retrospective measurements was lower in patients with intermittent pain than in patients with more constant pain. METHODS We used data from a randomized controlled trial that investigated the effectiveness of general practitioner care plus exercise therapy in 203 patients with hip OA. During the first 6 weeks, patients scored their pain each day. These daily measurements were available for 185 patients. At 6-week follow-up, patients filled in a questionnaire rating their pain during the previous week. We examined whether the daily measurements provided results for pain other than those provided by retrospective measurements, using a linear mixed-effects model. We also explored differences between subgroups, based on the frequency and severity of intermittent pain, during the pain course and reliability between retrospective measurements and daily measurements. RESULTS Daily measurements showed no different effect of exercise therapy on pain compared with retrospective measurements. We found statistical differences (by analysis of variance) during the course of pain between the subgroups based on the intensity of intermittent pain. Reliability between retrospective and daily measurements was lower in the subgroup with severe intermittent pain (Cronbach's α = 0.642) than in other subgroups (Cronbach's α >0.843). CONCLUSION In this specific trial, daily measurements did not yield more precise or additional information compared with retrospective measurements at the 6-week follow-up. However, reliability of retrospective measurements may be lower in patients with a higher intensity of intermittent pain.
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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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22
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Adler J, Saeed SA, Eslick IS, Provost L, Margolis PA, Kaplan HC. Appreciating the Nuance of Daily Symptom Variation to Individualize Patient Care. EGEMS 2016; 4:1247. [PMID: 27376097 PMCID: PMC4909374 DOI: 10.13063/2327-9214.1247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Improving symptoms for patients with chronic illness is difficult due to poor recall and imprecise assessments of therapeutic response to inform treatment decisions. Daily variation in symptoms may obscure subtle improvement or lead to erroneous associations between symptom changes and alteration in medication or dietary regimens. This may lead to mistaken impressions of treatment efficacy (or inefficacy). Mobile health technologies that collect daily patient reported outcome (PRO) data have the potential to improve care by providing more detailed information for clinical decision-making in practice and may facilitate conducting single subject (n-of-1) trials. Methods: Interrupted time series to prototype mobile health enabled data collection for three patients. We recruited pediatric patients with established inflammatory bowel disease who had persistent symptoms. Based on their self-identified most troubling symptoms, patients were sent customized, daily-automated text messages to assess the extent of their symptoms. Standardized, PRO Measurement Information System (PROMIS) surveys were deployed weekly. Individual statistical process control charts were used to assess variation. Patients met with physicians regularly to interpret their data jointly. Results: We report the experience of 3 patients with inflammatory bowel disease, each with different symptoms. Daily symptom monitoring uncovered important patterns, some of which even patients were unaware before reviewing their symptom data. Important associations were found between symptom variation and changes in medications and diet. PROMIS survey results assessed longitudinally accurately reflected changes in patient symptoms. Conclusions: We demonstrated how PROs can be implemented in practice. Monitoring and analyzing daily symptom data, using both customized and standard PROs, has the potential to detect meaningful variation in symptom patterns, which can inform clinical decision-making or can facilitate conducting formal n-of-1 trials to further improve outcomes.
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23
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Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WT, Yang CL, Zelman M. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Paediatr Child Health 2015; 20:353-71. [PMID: 26526095 DOI: 10.1093/pch/20.7.353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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Affiliation(s)
- Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec
| | - Sharon D Dell
- Department of Pediatrics and IHPME, The Hospital for Sick Children, University of Toronto, Toronto
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, Children's Hospital, London Health Sciences, Western University, London, Ontario
| | - Roland M Grad
- Department of Family Medicine, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Wade Ta Watson
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
| | - Connie L Yang
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - Mitchell Zelman
- Department of Pediatrics, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Dalhousie University, Halifax, Nova Scotia
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24
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Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WTA, Yang CL, Zelman M. Le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire : document de principes de la Société canadienne de thoracologie et de la Société canadienne de pédiatrie. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.7.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Francine M Ducharme
- Départements de pédiatrie et de médecine sociale et préventive, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montréal (Québec)
| | - Sharon D Dell
- Département de pédiatrie, The Hospital for Sick Children et Institute of Health Policy, Management and Evaluation, université de Toronto, Toronto (Ontario)
| | - Dhenuka Radhakrishnan
- Département de pédiatrie, Children’s Hospital, London Health Sciences Centre, université de Western Ontario, London (Ontario)
| | - Roland M Grad
- Département de médecine de famille, Hôpital général juif, Université McGill, Montréal (Québec)
| | - Wade TA Watson
- Département de pédiatrie, IWK Health Centre, université Dalhousie, Halifax (Nouvelle-Écosse)
| | - Connie L Yang
- Département de pédiatrie, British Columbia Children’s Hospital, université de la Colombie-Britannique, Vancouver (Colombie-Britannique)
| | - Mitchell Zelman
- Département de pédiatrie, Queen Elizabeth Hospital, Charlottetown (Île-du-Prince-Édouard), université Dalhousie, Halifax (Nouvelle-Écosse)
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25
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Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Can Respir J 2015; 22:135-43. [PMID: 25893310 DOI: 10.1155/2015/101572] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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26
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Voorend-van Bergen S, Vaessen-Verberne AA, de Jongste JC, Pijnenburg MW. Asthma control questionnaires in the management of asthma in children: A review. Pediatr Pulmonol 2015; 50:202-8. [PMID: 25187271 DOI: 10.1002/ppul.23098] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/01/2014] [Accepted: 06/03/2014] [Indexed: 11/06/2022]
Abstract
Several self-administered questionnaires have been developed to assess childhood asthma control in a simple and standardized way. This review discusses the most commonly used questionnaires and explores their usefulness in asthma management in children. We conclude that the use of asthma control questionnaires in daily practice and in research contributes to the standardized evaluation of children with asthma and helps to track asthma symptoms, but validation studies in a wider range of settings are needed.
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Affiliation(s)
- S Voorend-van Bergen
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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27
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Koinis-Mitchell D, Kopel SJ, Boergers J, Ramos K, LeBourgeois M, McQuaid EL, Esteban CA, Seifer R, Fritz GK, Klein R. Asthma, allergic rhinitis, and sleep problems in urban children. J Clin Sleep Med 2015; 11:101-10. [PMID: 25515273 DOI: 10.5664/jcsm.4450] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/21/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVES In this study, we examine the association of asthma (asthma symptoms, asthma control, lung function) and sleep problems in a group of urban children. The role of allergic rhinitis (AR), a comorbid condition of asthma, on children's sleep problems is also examined. Finally, we investigate whether sleep hygiene moderates the association between asthma and sleep problems, and whether there are differences in these associations based on ethnic background. METHODS Non-Latino White, Latino, and African American urban children with asthma (n = 195) ages 7-9 (47% female) and their primary caregivers participated in a baseline visit involving interview-based questionnaires on demographics, asthma and rhinitis control, and caregiver report of children's sleep problems and sleep hygiene. Children and their caregivers participated in a clinical evaluation of asthma and AR, followed by a month monitoring period of children's asthma using objective and subjective methods. RESULTS Total sleep problem scores were higher in children of the sample who were from African American and Latino backgrounds, compared to non-Latino white children. Poor asthma control was predictive of higher levels of sleep problems in the entire sample. Poorer AR control also was related to more sleep problems, over and above children's asthma in the sample. This association was more robust in non-Latino white children. Poor sleep hygiene heightened the association between poor asthma control and sleep problems in the entire sample and in African American children. CONCLUSIONS Multidisciplinary interventions integrating the co-management of asthma, AR, and the effects of both illnesses on children's sleep, need to be developed and tailored to children and their families' ethnic background.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Julie Boergers
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kara Ramos
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Monique LeBourgeois
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Cynthia A Esteban
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Roald Seifer
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Robert Klein
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, RI
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28
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Yoshida K, Adachi Y, Sasaki M, Furukawa M, Itazawa T, Hashimoto K, Odajima H, Akasawa A. Time-dependent variation in the responses to the web-based ISAAC questionnaire. Ann Allergy Asthma Immunol 2014; 113:539-43. [PMID: 25216972 DOI: 10.1016/j.anai.2014.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/23/2014] [Accepted: 07/25/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Epidemiologic studies have shown seasonal variations in responses to the written questionnaire for rhinitis symptoms. OBJECTIVE To evaluate whether the timing of data collection affected responses to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in a Web-based study. METHODS The Web-based ISAAC questionnaires were completed by parents with children 6 to 12 years old using an online research system. The authors conducted surveys of asthma symptoms every month for 1 year and surveys of rhinitis and eczema symptoms every season throughout 1 entire year. RESULTS There was a significant fluctuation in the positive responses to questions about wheezing in the past 12 months (P < .001) but not in the positive responses to questions about exercise-induced wheezing in the past 12 months and asthma ever (P = .75 and P = .15, respectively). The positive responses to questions about rhinitis and allergic rhinoconjunctivitis in the past 12 months and pollinosis ever exhibited significant seasonal variations (P = .002, P < .001, and P < .001, respectively). In contrast, there were no significant variations in positive responses regarding eczema in the past 12 months and eczema ever (P = .33 and P = .55, respectively). CONCLUSION There were time-dependent fluctuations in responses to the Web-based questionnaire regarding allergic symptoms. Timing of data collection should be taken into account when evaluating prevalence of asthma and rhinitis in children.
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Affiliation(s)
- Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Mari Sasaki
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Mayumi Furukawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiko Itazawa
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Koji Hashimoto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, Fukuoka National Hospital, Fukuoka, Japan
| | - Akira Akasawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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29
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Dowling PJ, Anvari S. Is there a better way? Ann Allergy Asthma Immunol 2014; 113:242-3. [PMID: 25065573 DOI: 10.1016/j.anai.2014.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Paul J Dowling
- Division of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri.
| | - Sara Anvari
- Division of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri
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30
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van Vliet D, van Horck M, van de Kant K, Vaassen S, Gulikers S, Winkens B, Rosias P, Heynens J, Muris J, Essers B, Jöbsis Q, Dompeling E. Electronic monitoring of symptoms and lung function to assess asthma control in children. Ann Allergy Asthma Immunol 2014; 113:257-262.e1. [PMID: 24950912 DOI: 10.1016/j.anai.2014.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/22/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asthma remains poorly controlled in children. Home monitoring of asthma control may help to improve the level of asthma control. OBJECTIVES To compare 2 methods to assess asthma control: (1) prospective home monitoring, based on daily assessment of forced expiratory volume in 1 second (FEV1) and electronic symptom score, and (2) Asthma Control Questionnaire (ACQ) with retrospective assessment of symptoms and FEV1. METHODS Ninety-six children with asthma were prospectively followed up during 1 year. Asthma control was assessed by home monitoring, including an electronic symptom score based on Global Initiative for Asthma (GINA) criteria and FEV1 measurements. In the hospital, the ACQ was completed and FEV₁ was measured. Kappa analysis was performed to assess levels of agreement between the 2 methods. RESULTS Agreement between the 2 methods was low (κ coefficient of 0.393). In 29 children (37%), prospective home monitoring was less optimistic than the retrospective assessment of asthma control by the ACQ. CONCLUSION This study found low agreement between asthma control based on GINA criteria by means of prospective home monitoring and the hospital ACQ. The prospective home monitor detected more cases of less well-controlled asthma than the ACQ. However, optimization of adherence to home monitor use is necessary. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01239238.
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Affiliation(s)
- Dillys van Vliet
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Marieke van Horck
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kim van de Kant
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sanne Vaassen
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sjoerd Gulikers
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Philippe Rosias
- Department of Pediatrics, Orbis Medical Center, Sittard, the Netherlands
| | - Jan Heynens
- Department of Pediatrics, Orbis Medical Center, Sittard, the Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Brigitte Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Quirijn Jöbsis
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Pediatric Pulmonology, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
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31
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Everhart RS, Kopel SJ, Esteban CA, McQuaid EL, Klein R, McCue CE, Koinis-Mitchell D. Allergic rhinitis quality of life in urban children with asthma. Ann Allergy Asthma Immunol 2014; 112:365-70.e1. [PMID: 24589166 DOI: 10.1016/j.anai.2014.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urban children with asthma and allergic rhinitis (AR) are at risk for experiencing worse AR-related quality of life (QOL). Although AR may be underdiagnosed and undertreated in urban minority children, research has not considered which illness-related indicators (eg, AR control) may contribute to AR QOL in this population. OBJECTIVE To examine associations among AR control, asthma control, allergy symptoms, asthma symptoms, and AR QOL in a sample of 195 urban caregivers and their children with asthma (7-9 years of age) from African American, Latino, and non-Latino white backgrounds. Racial and ethnic differences in AR QOL were also examined. METHODS Families resided in 1 of 4 cities selected as recruitment sources because of their high concentrations of ethnic minority and non-Latino white, urban families. Caregivers and children completed a series of interview-based and clinician-based assessments across one academic year and 4-week periods to track daily asthma and nasal symptoms. RESULTS Better AR control was associated with higher AR QOL (β = -.32, P < .01) and all QOL subscales. AR control predicted AR QOL over and above asthma control (β = -.28, P < .01). Controlling for AR control, non-Latino white children reported better QOL related to practical problems than both Latino and African American children (P < .05). CONCLUSION Findings suggest that strategies to enhance AR control in urban children with asthma may assist in improving AR QOL. Non-Latino white children may experience less impairment of their AR QOL because of practical problems (eg, blow nose) than African American or Latino children with asthma.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cynthia A Esteban
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Robert Klein
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christine E McCue
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
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32
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Nuijsink M, De Jongste JC, Pijnenburg MW. Will symptom-based therapy be effective for treating asthma in children? Curr Allergy Asthma Rep 2014; 13:421-6. [PMID: 23775350 DOI: 10.1007/s11882-013-0364-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Traditionally, symptoms are important patient-oriented outcomes in asthma treatment, and assessment of symptoms is an essential component of assessing asthma control. However, variable airways obstruction, airways hyperresponsiveness and chronic inflammation are key components of the asthma syndrome, and correlations among these hallmarks and symptoms are weak or even absent. Therefore, it might be questioned if symptom-based therapy is effective for treating asthma in (all) children. To date, there is no firm indication that monitoring asthma based on repetitive lung function measurement or markers of airway inflammation is superior to monitoring based on symptoms only. In the majority of patients, symptom-based asthma management may well be sufficient, and in preschool children, symptoms are presently the only feasible outcome. Nevertheless, there is some evidence that selected groups might benefit from an approach that takes into account individual phenotypic characteristics. In patients with poor perception, those with a discordant phenotype and those with persistent severe asthma, considering lung function, airways hyperresponsiveness and inflammatory markers in treatment decisions might improve outcomes.
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Affiliation(s)
- Marianne Nuijsink
- Department of Paediatrics, Juliana Children's Hospital, The Hague, The Netherlands,
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Chauhan BF, Ducharme FM. Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma. Cochrane Database Syst Rev 2014; 2014:CD003137. [PMID: 24459050 PMCID: PMC10514761 DOI: 10.1002/14651858.cd003137.pub5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Asthma patients who continue to experience symptoms despite taking regular inhaled corticosteroids (ICS) represent a management challenge. Long-acting beta2-agonists (LABA) and anti-leukotrienes (LTRA) are two treatment options that could be considered as add-on therapy to ICS. OBJECTIVES To compare the safety and efficacy of adding LABA versus LTRA to the treatment regimen for children and adults with asthma who remain symptomatic in spite of regular treatment with ICS. We specifically wished to examine the relative impact of the two agents on asthma exacerbations, lung function, symptoms, quality of life, adverse health events and withdrawals. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register until December 2012. We consulted reference lists of all included studies and contacted pharmaceutical manufacturers to ask about other published or unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) conducted in adults or children with recurrent asthma that was treated with ICS along with a fixed dose of a LABA or an LTRA for a minimum of four weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of included studies and extracted data. We sought unpublished data and further details of study design when necessary. MAIN RESULTS We included 18 RCTs (7208 participants), of which 16 recruited adults and adolescents (6872) and two recruited children six to 17 years of age (336) with asthma and significant reversibility to bronchodilator at baseline. Fourteen (79%) trials were of high methodological quality.The risk of exacerbations requiring systemic corticosteroids (primary outcome of the review) was significantly lower with the combination of LABA + ICS compared with LTRA + ICS-from 13% to 11% (eight studies, 5923 adults and 334 children; risk ratio (RR) 0.87, 95% confidence interval (CI) 0.76 to 0.99; high-quality evidence). The number needed to treat for an additional beneficial outcome (NNTB) with LABA compared with LTRA to prevent one additional exacerbation over four to 102 weeks was 62 (95% CI 34 to 794). The choice of LTRA, the dose of ICS and the participants' age group did not significantly influence the magnitude of effect. Although results were inconclusive, the effect appeared stronger in trials that used a single device rather than two devices to administer ICS and LABA and in trials of less than 12 weeks' duration.The addition of LABA to ICS was associated with a statistically greater improvement from baseline in lung function, as well as in symptoms, rescue medication use and quality of life, although the latter effects were modest. LTRA was superior in the prevention of exercise-induced bronchospasm. More participants were satisfied with the combination of LABA + ICS than LTRA + ICS (three studies, 1625 adults; RR 1.12, 95% CI 1.04 to 1.20; moderate-quality evidence). The overall risk of withdrawal was significantly lower with LABA + ICS than with LTRA + ICS (13 studies, 6652 adults and 308 children; RR 0.84, 95% CI 0.74 to 0.96; moderate-quality evidence). Although the risk of overall adverse events was equivalent between the two groups, the risk of serious adverse events (SAE) approached statistical significance in disfavour of LABA compared with LTRA (nine studies, 5658 adults and 630 children; RR 1.33, 95% CI 0.99 to 1.79; P value 0.06; moderate-quality evidence), with no apparent impact of participants' age group.The following adverse events were reported, but no significant differences were demonstrated between groups: headache (11 studies, N = 6538); cardiovascular events (five studies, N = 5163), osteopenia and osteoporosis (two studies, N = 2963), adverse events (10 studies, N = 5977 adults and 300 children). A significant difference in the risk of oral moniliasis was noted, but this represents a low occurrence rate. AUTHORS' CONCLUSIONS In adults with asthma that is inadequately controlled by predominantly low-dose ICS with significant bronchodilator reversibility, the addition of LABA to ICS is modestly superior to the addition of LTRA in reducing oral corticosteroid-treated exacerbations, with an absolute reduction of two percentage points. Differences favouring LABA over LTRA as adjunct therapy were observed in lung function and, to a lesser extend, in rescue medication use, symptoms and quality of life. The lower overall withdrawal rate and the higher proportion of participants satisfied with their therapy indirectly favour the combination of LABA + ICS over LTRA + ICS. Evidence showed a slightly increased risk of SAE with LABA compared with LTRA, with an absolute increase of one percentage point. Our findings modestly support the use of a single inhaler for the delivery of both LABA and low- or medium-dose ICS. Because of the paucity of paediatric trials, we are unable to draw firm conclusions about the best adjunct therapy in children.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- Research Centre, CHU Sainte‐JustineClinical Research Unit on Childhood Asthma3175, Cote Sainte‐CatherineMontrealCanada
| | - Francine M Ducharme
- University of MontrealDepartment of PaediatricsMontrealQuébecCanada
- CHU Sainte‐JustineResearch CentreMontrealCanada
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Arga M, Sahbaz H, Bakirtas A, Turktas I, Demirsoy MS. Does self-monitoring by means of symptom diaries improve asthma control in children? J Asthma 2013; 51:299-305. [PMID: 24274828 DOI: 10.3109/02770903.2013.867974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Keeping symptom diaries on a regular basis may facilitate the execution of symptom-based action plans, enhance the patients' adherence to treatment program and finally allow better asthma control. We hypothesize that disease control in children who keep symptom diaries regularly would be better compared to children who do not keep symptom diaries regularly. METHODS Asthmatic children, aged between 6 and 17 years, who were monitored at least 2 years at our outpatient clinic and examined at least twice within the last year, were enrolled in this study. The patients were assigned to the following two groups: group I included the patients who keep symptom diaries regularly and group II included the patients who do not keep symptom diaries regularly. Asthma control parameters of patients during the last year were investigated. The number of asthma attacks require systemic corticosteroid use, the frequency of emergency department (ED) admissions and the number of attacks requiring hospitalization, forced expiratory volume in 1 s (FEV1) values and asthma control test (ACT) scores were compared. RESULTS 89 (26.2%) of 340 patients included in the study were identified to keep a symptom diary regularly. Although age (p = 0.20) and sex (p = 0.48) did not differ significantly between the groups, regular use of anti-inflammatory drug was found to be significantly higher in group I (p < 0.001). When all of the study parameters were compared using a multivariate analysis, the number of systemic corticosteroid use, ED visits, attacks requiring hospitalization and ACT scores and FEV1 did not differ significantly between the groups (p > 0.05 in all of the parameters). CONCLUSIONS Keeping a symptom diary on a regular basis in asthmatic children was shown to have neither beneficial effect on the day-to-day asthma control nor a decrease in the future risk of asthma control.
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Voorend-van Bergen S, Vaessen-Verberne AA, Landstra AM, Brackel HJ, van den Berg NJ, Caudri D, de Jongste JC, Merkus PJ, Pijnenburg MW. Monitoring childhood asthma: web-based diaries and the asthma control test. J Allergy Clin Immunol 2013; 133:1599-605.e2. [PMID: 24290276 DOI: 10.1016/j.jaci.2013.10.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from asthma diaries are frequently used as an end point in asthma studies; however, data on the validity of Web-based diaries are scarce. OBJECTIVES First, we examined the validity of a Web-based diary in assessing asthma control. Second, we determined the cutoff points for well-controlled asthma of the Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT), and calculated the minimal important difference for both tests. METHODS Children with asthma, ages 4-18 years (n = 228) completed a 4-week Web-based diary, C-ACT, ACT, and an asthma-related quality-of-life questionnaire at baseline and after 1-year follow-up. RESULTS The completion rate of the Web-based diaries was 89%. The diary scores correlated strongly with C-ACT and ACT scores (r = -0.73, P < .01; r = -0.64, P < .01, respectively) and the changes in diary scores correlated well with changes in C-ACT and ACT scores. The best cutoff points for well-controlled asthma were C-ACT ≥ 22 and ACT ≥ 23. The minimal important differences were 1.9 (95% CI, 1.3-2.5) for ACT and 1.6 (95% CI, 1.1-2.1) for C-ACT, and -0.7 points/d (95% CI, -1.1 to -0.4) for the Web-based diary. CONCLUSIONS Our Web-based diary was valid for recording asthma symptoms. Cutoff points of ≥22 (C-ACT) and ≥23 (ACT) define well-controlled asthma. We recommend a 2 C-ACT and ACT points difference as minimally important.
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Affiliation(s)
- Sandra Voorend-van Bergen
- Department of Pediatric Pulmonology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Anneke M Landstra
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Hein J Brackel
- Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Daan Caudri
- Department of Pediatric Pulmonology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatric Pulmonology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter J Merkus
- Department of Pediatric Pulmonology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Department of Pediatric Pulmonology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
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