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Shacham E, Scroggins SE, Gilmore A, Cheng J, Nava R. Predictors of Pediatric Asthma Management: Identifying Actionable Results With Geographic Determinants. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00355. [PMID: 39259970 DOI: 10.1097/phh.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Pediatric asthma remains one of the most prominent chronic health conditions among US youth. Geographic determinants such as air pollutants have been identified as playing a role in asthma development and exacerbation. The purpose of this study was to determine geospatial predictors of pediatric asthma exacerbation events and to prioritize housing remediation resources. METHODS Electronic medical records were abstracted from a health plan in Southern California. The inclusion criteria that created a sample of 51 557 members were those aged 21 years and younger, who had at least 1 asthma-related encounter between January 2019 and December 2021. Diagnoses, age, number of clinic and emergency department visits, and home addresses were included. The air quality index from the closest monitoring station during the study period, residential distance from a primary roadway, and residential distance from manufacturing sites were included in the spatial analysis. RESULTS The average number of asthma-related clinic visits was 2 across the sample. Individuals with more asthma-related clinic visits residing in public housing were more likely to live within 4 km of industrial manufacturing locations (P < .001), reside closer to a major roadway (P < .001), and experience a higher number of poor air quality days (P < .001). Modeling results show these factors were also significantly predictive of an increase of asthma-related health care encounters. CONCLUSIONS The findings of this study were consistent with previous studies linking asthma and poor air quality and further highlighted some of the additive and potentially exponential challenges that public housing, major roadways, and manufacturing sites provide communities in their proximity. This research can guide environmental interventions, including the frequency of public housing inspections, community outreach, and the development of communication strategies, to reduce asthma-related experiences across neighborhoods.
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Affiliation(s)
- Enbal Shacham
- Author Affiliations: Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri (Drs Shacham and Scroggins and Mr Gilmore); and Inland Empire Health Plan Rancho Cucamonga, California (Mss Cheng and Nava)
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Aguilar R, Knudsen-Robbins C, Ehwerhemuepha L, Feaster W, Kamath S, Heyming TW. Pediatric Asthma Exacerbations: 14-Day Emergency Department Return Visit Risk Factors. J Emerg Med 2024; 67:e22-e30. [PMID: 38824038 DOI: 10.1016/j.jemermed.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Asthma, the most common chronic disease of childhood, can affect a child's physical and mental health and social and emotional development. OBJECTIVE The aim of this study was to identify factors associated with emergency department (ED) return visits for asthma exacerbations within 14 days of an initial visit. METHODS This was a retrospective review from Cerner Real-World Data for patients aged from 5 to 18 years and seen at an ED for an asthma exacerbation and discharged home at the index ED visit. Asthma visits were defined as encounters in which a patient was diagnosed with asthma and a beta agonist, anticholinergic, or systemic steroid was ordered or prescribed at that encounter. Return visits were ED visits for asthma within 14 days of an index ED visit. Data, including demographic characteristics, ED evaluation and treatment, health care utilization, and medical history, were collected. Data were analyzed via logistic regression mixed effects model. RESULTS A total of 80,434 index visits and 17,443 return visits met inclusion criteria. Prior ED return visits in the past year were associated with increased odds of a return visit (odds ratio [OR] 2.12; 95% CI 2.07-2.16). History of pneumonia, a concomitant diagnosis of pneumonia, and fever were associated with increased odds of a return visit (OR 1.19; 95% CI 1.10-1.29; OR 1.15; 95% CI 1.04-1.28; OR 1.20; 95% CI 1.11-1.30, respectively). CONCLUSIONS Several variables seem to be associated with statistically significant increased odds of ED return visits. These findings indicate a potentially identifiable population of at-risk patients who may benefit from additional evaluation, planning, or education prior to discharge.
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Affiliation(s)
- Ricardo Aguilar
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis Ehwerhemuepha
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California; School of Computational and Data Sciences, Chapman University, Orange, California
| | | | - Sunil Kamath
- Children's Hospital of Orange County, Orange, California
| | - Theodore W Heyming
- Children's Hospital of Orange County, Orange, California; Department of Emergency Medicine, University of California, Irvine, Orange, California.
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Qin X, Pate CA, Zahran HS. Factors associated with emergency department visits for asthma resulting in hospital admission-United States, 2020. J Asthma 2024; 61:717-724. [PMID: 38193801 PMCID: PMC11166518 DOI: 10.1080/02770903.2024.2303753] [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: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To identify risk factors associated with hospital admission following an ED visit for asthma at the time of discharge among U.S. children and adults. METHODS Asthma emergency department visits resulting in hospital admissions using discharge data among children (aged 0-17 years) and adults (aged 18 years or older) from the 2020 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality were examined. Risk factors associated with hospital admission following ED visits were identified using univariable and multi-variable logistic regression models. RESULTS Among children, hospital admission after asthma-related ED visits was higher for females, ages less than 12 years, and discharged in January-March or in October-December and lower for Black children, Hispanic children, Medicaid or Medicare beneficiaries, other/no charge/self-pay, and in metropolitan non-teaching or non-metropolitan hospitals. Among adults, asthma ED visits resulting in hospital admissions were higher for females, ages 35 years or older, discharged in January-March, and for Medicare beneficiaries and lower for Black adults, Hispanic adults, adults of other races, other/no charge/self-pay, in metropolitan non-teaching or non-metropolitan hospitals, and median household income quartiles for patient's ZIP Code of less than $59,000 were lower. CONCLUSIONS Sociodemographic factors, healthcare use, and household income were significantly associated with hospital admissions at the time of discharge from the ED. Examining hospital admission after an ED visit for asthma is important in identifying these groups and better addressing their healthcare needs.
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Affiliation(s)
- Xiaoting Qin
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia A. Pate
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hatice S. Zahran
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Haji T, Lyzwinski L, Dhaliwal C, Leung G, Giangioppo S, Radhakrishnan D. A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children's hospital: a retrospective cohort study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:37. [PMID: 38918807 PMCID: PMC11197375 DOI: 10.1186/s13223-024-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Despite asthma guidelines' recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent. METHODS We performed a retrospective cohort study of children aged 1-17 years presenting with asthma to the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 - August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not. RESULTS 1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28). CONCLUSIONS Patients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.
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Affiliation(s)
- Tahereh Haji
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | | | - Cara Dhaliwal
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Garvin Leung
- Children's Hospital of Eastern Ontario, Ontario, Canada
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Lee HM, Liu DY, Hsu HL, Yu TL, Yu TS, Shen TC, Tsai FJ. Risk of depression in patients with pneumoconiosis: A population-based retrospective cohort study. J Affect Disord 2024; 352:146-152. [PMID: 38369263 DOI: 10.1016/j.jad.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pneumoconiosis is an important occupational disease; the association between pneumoconiosis and depression was largely unknown. This study aimed to investigate the relationship between pneumoconiosis and the risk of subsequent depression. METHODS A retrospective cohort study was conducted using Taiwan's National Health Insurance database. The study included 16,795 patients diagnosed with pneumoconiosis between 2008 and 2018 and a comparison cohort of 67,180 individuals without pneumoconiosis, propensity score matched in a 1:4 ratio based on age, sex, monthly income, residential urbanization level, and date of pneumoconiosis diagnosis. The development of depression was monitored until the end of 2019. RESULTS The incidence of depression was 1.68 times higher in the pneumoconiosis cohort than that in the comparison cohort, with an incidence rate of 10.07 versus 5.99 per 1000 person-years (adjusted hazard ratio [aHR] = 1.84, 95 % confidence interval [CI] = 1.70-1.99). The risk of depression increased with an increased mean annual number of emergency department visits for pneumoconiosis, with aHRs of 1.34 (95 % CI = 1.13-1.59) and 2.31 (95 % CI = 1.94-2.76) for 1 ≤ n < 2, and n ≥ 2 compared to n < 1, respectively. LIMITATION The database lacked detailed socioeconomic history, family history, and clinical variables. CONCLUSION This study found that patients with pneumoconiosis have a significantly higher risk of depression than those without pneumoconiosis. Furthermore, the risk of depression increases with the frequency of emergency department visits for pneumoconiosis. Healthcare professionals should pay close attention to the mental health of patients with pneumoconiosis.
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Affiliation(s)
- Hsiu-Ming Lee
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - De-Yi Liu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Li Hsu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Ling Yu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Shen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Critical Care Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan.
| | - Fuu-Jen Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Alkhazali IE, Alrawashdeh A, Hashairi Fauzi M, Nik Ab Rahman NH. Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2024; 12:e26. [PMID: 38572217 PMCID: PMC10988188 DOI: 10.22037/aaem.v12i1.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Introduction The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care. Methods We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools. Results We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances. Conclusions A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.
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Affiliation(s)
- Islam E. Alkhazali
- School of Medical Sciences, Health Campus, USM, Kubang Kerian, 16150, Malaysia
| | - Ahmad Alrawashdeh
- Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid Jordan
| | - Mohd Hashairi Fauzi
- Department of Emergency Medicine, School of Medical Sciences, Health Campus, USM, Kubang Kerian, 16150, Malaysia
| | - Nik Hisamuddin Nik Ab Rahman
- Department of Emergency Medicine, School of Medical Sciences, Health Campus, USM, Kubang Kerian, 16150, Malaysia
- Administrative Block, Hospital USM, Health Campus, USM, Kubang Kerian, 16150, Malaysia
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Ishmael L, Apter A, Busse PJ, Calderon-Candelario R, Carroll JK, Casale T, Celedón JC, Cohen R, Coyne-Beasley T, Cui J, Ericson B, Hernandez P, Kaelber DC, Maher N, Merriman C, Mosnaim G, Nazario S, Phipatanakul W, Pinto-Plata V, Riley I, Shenoy K, Wisnivesky J, Yawn B, Israel E, Cardet JC. Asthma morbidity measures across Black ethnic subgroups. J Allergy Clin Immunol 2024; 153:408-417. [PMID: 38000696 PMCID: PMC10922293 DOI: 10.1016/j.jaci.2023.10.028] [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: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.
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Affiliation(s)
- Leah Ishmael
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Andrea Apter
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Paula J Busse
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Rubin Cohen
- Division of Pulmonary Critical Care and Sleep Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
| | - Tamera Coyne-Beasley
- Department of Adolescent Medicine, University of North Carolina, Chapel Hill, NC
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Paulina Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, Ohio; Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nancy Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Giselle Mosnaim
- Division of Allergy, Asthma, and Immunology, Northshore University Health System, Evanston, Ill
| | - Sylvette Nazario
- Allergy and Immunology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Wanda Phipatanakul
- Departments of Allergy and Immunology and Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victor Pinto-Plata
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minn
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
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Zhang X, Zhang T. Comment on "Evaluation of treatment of the exacerbation of asthma and wheezing in a pediatric emergency department". REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230615. [PMID: 37729379 PMCID: PMC10508939 DOI: 10.1590/1806-9282.20230615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Xinmei Zhang
- Gansu Provincial Maternity and Child-Care Hospital, Department of Pediatric Respiratory – Lanzhou, China
| | - Tingting Zhang
- Gansu Provincial Maternity and Child-Care Hospital, Department of Pediatric Respiratory – Lanzhou, China
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Abdelrahim R, Gao Z, Smith MJ, Newhook LA. The prevalence of pediatric asthma hospitalizations at different stages of the COVID-19 pandemic: A systematic review and meta-analysis study protocol. PLoS One 2023; 18:e0289538. [PMID: 37540656 PMCID: PMC10403069 DOI: 10.1371/journal.pone.0289538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Asthma is a highly prevalent chronic inflammatory lung disease and is a frequent cause of hospitalization in children. The COVID-19 pandemic has introduced several challenges that have impacted the delivery of care for vulnerable patients, including asthmatic children. Asthmatic children without immediate access to healthcare services can face severe and fatal consequences. Furthermore, various governmental restrictions and viral mutants have been introduced throughout the pandemic, affecting COVID-19 cases and hospitalization rates. OBJECTIVES To investigate the impact of the COVID-19 pandemic on the prevalence of asthma hospitalizations during various stages of the pandemic. We also aim to compare asthma hospital admissions during the pandemic to pre-pandemic periods. METHODS AND ANALYSIS The databases PubMed (MEDLINE), EMBASE, CINAHL, and the Cochrane library will be used to identify relevant articles between the start of the pandemic and the date of the search strategy. Studies will be included if they examine hospital admissions for pediatric (0 to 18 years) asthma patients, regardless of asthma severity, sex, ethnicity or race. Observational retrospective cohort, prospective cohort, and cross-sectional studies will be included. A meta-analysis will be conducted if there are ≥2 articles. Else, a narrative review will be used to report our results. TRIAL REGISTRATION PROSPERO registration number: CRD42022337606.
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Affiliation(s)
- Reem Abdelrahim
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Mary Jane Smith
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Leigh Anne Newhook
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Aggarwal S, Cepalo T, Gill S, Thipse M, Clifton KL, Higginson A, Vu J, Bijelić V, Barrowman N, Giangioppo S, Radhakrishnan D. Factors associated with future hospitalization among children with asthma: a systematic review. J Asthma 2023; 60:425-445. [PMID: 35522051 DOI: 10.1080/02770903.2022.2070762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. DATA SOURCES We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. RESULTS Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. CONCLUSIONS We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.
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Affiliation(s)
| | - Tanita Cepalo
- Faculty of Science, Carleton University, Ottawa, Canada
| | - Sana Gill
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Kerry-Lee Clifton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - James Vu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Vid Bijelić
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sandra Giangioppo
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada.,ICES, Ottawa, ON, Canada
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Rangachari P, Parvez I, LaFontaine AA, Mejias C, Thawer F, Chen J, Pathak N, Mehta R. Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1508. [PMID: 36674266 PMCID: PMC9864702 DOI: 10.3390/ijerph20021508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/10/2023]
Abstract
This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.
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Affiliation(s)
- Pavani Rangachari
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Imran Parvez
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | | | | | - Fahim Thawer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Niharika Pathak
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Renuka Mehta
- Division of Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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12
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Ogbu CE, Ravilla J, Okoli ML, Ahaiwe O, Ogbu SC, Kim ES, Kirby RS. Association of Depression, Poor Mental Health Status and Asthma Control Patterns in US Adults Using a Data-Reductive Latent Class Method. Cureus 2023; 15:e33966. [PMID: 36820113 PMCID: PMC9938719 DOI: 10.7759/cureus.33966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
Objectives To explore the association between depression, poor mental health status, and asthma control patterns among US adults using a latent class analysis (LCA) approach. Methods We used data from 10,337 adults aged 18 years and above from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey. Data-reductive LCA was used to derive asthma control patterns in the population using class variables indicative of asthma control. Besides univariate analysis, adjusted and unadjusted logistic regression models were used to examine the association of depression and poor mental health on the derived asthma control patterns. Results About 27.8% of adults aged <55 reported depression, while 27.3% aged ≥55 years were depressed. The latent class prevalence of asthma control patterns was 42.8%, 31.1%, and 26.1%, corresponding to good, fair, and poor asthma control patterns, respectively. In adults aged <55 years, odds of depression (OR=1.52, 95% CI=1.27-1.82) and poor mental health (OR=1.58, 95% CI=1.27-1.96) were higher in the poor asthma control group compared to the good asthma control group. Odds for depression (OR=1.28, 95% CI=1.06-1.53) were also higher in the moderate asthma control group compared to the good asthma control group. Among those aged ≥55 years, depression odds (OR=1.57, 95% CI=1.31-1.87) were higher in only the poor asthma control group. Conclusions These findings may have public health implications. Detecting, screening, and treating depression and mental health disorders may help improve asthma control in people with asthma.
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Affiliation(s)
| | | | | | - Onyekachi Ahaiwe
- Epidemiology and Public Health, The University of Texas Health Science Center at Houston, Houston, USA
| | - Stella C Ogbu
- Biomedical Sciences, Tulane University School of Medicine, New Orleans, USA
| | - Eun Sook Kim
- College of Education, University of South Florida, Tampa, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, USA
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13
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Juhn YJ, Ryu E, Wi CI, King KS, Malik M, Romero-Brufau S, Weng C, Sohn S, Sharp RR, Halamka JD. Assessing socioeconomic bias in machine learning algorithms in health care: a case study of the HOUSES index. J Am Med Inform Assoc 2022; 29:1142-1151. [PMID: 35396996 PMCID: PMC9196683 DOI: 10.1093/jamia/ocac052] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Artificial intelligence (AI) models may propagate harmful biases in performance and hence negatively affect the underserved. We aimed to assess the degree to which data quality of electronic health records (EHRs) affected by inequities related to low socioeconomic status (SES), results in differential performance of AI models across SES. MATERIALS AND METHODS This study utilized existing machine learning models for predicting asthma exacerbation in children with asthma. We compared balanced error rate (BER) against different SES levels measured by HOUsing-based SocioEconomic Status measure (HOUSES) index. As a possible mechanism for differential performance, we also compared incompleteness of EHR information relevant to asthma care by SES. RESULTS Asthmatic children with lower SES had larger BER than those with higher SES (eg, ratio = 1.35 for HOUSES Q1 vs Q2-Q4) and had a higher proportion of missing information relevant to asthma care (eg, 41% vs 24% for missing asthma severity and 12% vs 9.8% for undiagnosed asthma despite meeting asthma criteria). DISCUSSION Our study suggests that lower SES is associated with worse predictive model performance. It also highlights the potential role of incomplete EHR data in this differential performance and suggests a way to mitigate this bias. CONCLUSION The HOUSES index allows AI researchers to assess bias in predictive model performance by SES. Although our case study was based on a small sample size and a single-site study, the study results highlight a potential strategy for identifying bias by using an innovative SES measure.
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Affiliation(s)
- Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, USA
- Artificial Intelligence Program of Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Euijung Ryu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, USA
- Artificial Intelligence Program of Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Momin Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - John D Halamka
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Platform, Rochester, Minnesota, USA
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14
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Pinto JM, Wagle S, Navallo LJ, Petrova A. Risk Factors and Outcomes Associated With Antibiotic Therapy in Children Hospitalized With Asthma Exacerbation. J Pediatr Pharmacol Ther 2022; 27:366-372. [DOI: 10.5863/1551-6776-27.4.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma.
METHODS
The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (β) with 95% CIs for regression analyses.
RESULTS
Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever.
CONCLUSIONS
Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.
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Affiliation(s)
- Jamie M. Pinto
- Department of Pediatrics (JMP, SW, LJN), Jersey Shore University Medical Center, Neptune, NJ
| | - Sarita Wagle
- Department of Pediatrics (JMP, SW, LJN), Jersey Shore University Medical Center, Neptune, NJ
| | - Lauren J. Navallo
- Department of Pediatrics (JMP, SW, LJN), Jersey Shore University Medical Center, Neptune, NJ
| | - Anna Petrova
- Department of Pediatrics (AP), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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15
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Lemire E, Samuels EA, Wang W, Haber A. Unequal Housing Conditions And Code Enforcement Contribute To Asthma Disparities In Boston, Massachusetts. Health Aff (Millwood) 2022; 41:563-572. [PMID: 35377754 DOI: 10.1377/hlthaff.2021.01403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Housing quality is a primary determinant of asthma disparities by race and social class in the US. We sought to assess how housing code enforcement systems in Boston, Massachusetts, address tenants' reports of asthma triggers. After adjustment for income and other neighborhood characteristics, racial demographics were significantly associated with asthma trigger incidence. For each 10 percent decrease in neighborhood proportion of White residents, trigger incidence increased by 3.14 reports per thousand residents. These disparities persisted during the study period (from 2011 through 2021), and for mold, which is an established asthma trigger, regressions showed that racial disparities are widening. The municipal response also demonstrated disparities: In neighborhoods with the fewest White residents compared to neighborhoods with the most White residents, adjusted models showed a 17 percent (3.51 days) slower median time until cases (tenant requests for inspections to the Inspectional Services Department) were closed, a 14 percent higher probability of being flagged as overdue, and a 54.4 percent lower probability of a repair. We found evidence that in Boston, despite several healthy housing initiatives, current regulatory systems are insufficient to address disparities in access to healthy housing. To reduce disparities in asthma burden, stronger inspectional standards and further enforcement policies to increase landlords' accountability and support tenants' rights to have repairs made are essential.
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Affiliation(s)
- Evan Lemire
- Evan Lemire, Harvard University, Boston, Massachusetts
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16
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Chao KY, Chien YH, Mu SC. High-flow nasal cannula in children with asthma exacerbation: A review of current evidence. Paediatr Respir Rev 2021; 40:52-57. [PMID: 33771473 DOI: 10.1016/j.prrv.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Asthma is the commonest obstructive airway disease and the leading cause of morbidity in children. In the pediatric population, acute exacerbations of asthma are a frequent cause of presentations and hospital admissions. An acute asthma exacerbation is potentially life-threatening; it is predominantly treated using conventional oxygen therapy with bronchodilators and systemic corticosteroids. The treatment of those who do not respond to conventional therapy is escalated to noninvasive positive pressure ventilation (NIPPV) before invasive ventilation. Although NIPPV has demonstrated benefits and safety, it still has limitations such as treatment intolerance caused mainly by discomfort and complications. High-flow oxygen therapy administered through a nasal cannula (HFNC) provides respiratory support with adequate airway humidity and has demonstrated safety and benefits in clinical practice. In the present review, we discuss HFNC and variations in HFNC use, focusing on its feasibility and current evidence of using it on children with asthma exacerbations.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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17
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Correia-DE-Sousa J, Vicente C, Brito D, Tsiligianni I, Kocks JW, Román-Rodriguez M, Baxter N, Maricoto T, Williams S. Managing asthma in primary healthcare. Minerva Med 2021; 112:582-604. [PMID: 34814633 DOI: 10.23736/s0026-4806.21.07277-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-to-date review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficult-to-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of Asthma Right Care.
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Affiliation(s)
- Jaime Correia-DE-Sousa
- ICVS/3B's Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal -
| | | | - Dinis Brito
- ICVS/3B's Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,.7 Fontes Family Health Unit, ACES Cávado I - ARS Norte, Braga, Portugal
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group, Edinburgh, UK.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W Kocks
- International Primary Care Respiratory Group, Edinburgh, UK.,General Practitioners Research Institute, Groningen, the Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Miguel Román-Rodriguez
- Primary Care Respiratory Research Unit, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Noel Baxter
- International Primary Care Respiratory Group, Edinburgh, UK
| | - Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Health Center, Aveiro, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Siân Williams
- International Primary Care Respiratory Group, Edinburgh, UK
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18
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Dunning HT, Boy C, Davis NL, Griffing E, Lasso-Pirot A. A hospital-based multidimensional intervention for high risk pediatric patients with asthma. J Asthma 2021; 59:1732-1741. [PMID: 34374617 DOI: 10.1080/02770903.2021.1963764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To determine the effects of a multi-dimensional intervention (consisting of education, recommendations for medical management, and short-term case management) provided by pulmonology nurse practitioners(NP) on inpatient and post-discharge outcomes for patients admitted with asthma exacerbations to a Pediatric Intensive Care Unit(PICU).Methods: A retrospective cohort study was completed on subjects with an asthma exacerbation admitted to the PICU from 01-01-2015 to 31-12-2018. Records were reviewed for 12-months post-discharge. We compared inpatient and post-discharge outcomes for those who did vs. did not receive NP consultation. The primary outcome evaluated was optimization of discharge medications. Rates of follow up, repeat ED visits and hospitalizations were also reviewed.Results: 222 subjects met inclusion and exclusion criteria; of those, 101(45.5%) patients received NP consultation and 121(54.5%) had PICU management only. Patients with NP consultation were more likely to have controllers initiated (34.6% vs. 15%) or adjusted (55.5% vs. 33.3%) per asthma guidelines (p < 0.001). The consult group were more likely to have an asthma follow-up appointment made prior to discharge (99% vs. 45%, p < 0.001), and were more likely to attend the appointment (51% vs. 21%, p < 0.001). There were no significant differences between groups for ED visits or readmission for asthma 12-months post-discharge.Conclusions: Patients with NP consultation were more likely to have controllers started or adjusted per guidelines and were more likely to attend specialty follow-up appointments post-discharge. No impact was seen on ED visits or readmissions. Implementation of such a program may aid in optimizing asthma management and continuity of care post hospitalization.
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Affiliation(s)
- Heather T Dunning
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christine Boy
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L Davis
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Griffing
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anayansi Lasso-Pirot
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
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19
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Uchima O, Taira DA, Ahn HJ, Choi SY, Okihiro M, Sentell T. Disparities in Potentially Preventable Emergency Department Visits for Children with Asthma among Asian Americans, Pacific Islanders, and Whites in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7096. [PMID: 34281033 PMCID: PMC8296946 DOI: 10.3390/ijerph18137096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
The cost burdens of potentially preventable emergency department visits for pediatric asthma were estimated for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2015-2016 data. The cost burden of the 3234 preventable emergency department visits over the study period was over $1.9 million. Native Hawaiians had the largest proportion (36.5%) of all preventable emergency department visits and accounted for the highest costs for the two years at $709,698. After adjusting for other factors, costs for preventable pediatric-asthma-related emergency department visits differed significantly by age, insurance provider, and island of residency. Reducing potentially preventable emergency department visits would not only improve health disparities among Native Hawaiians compared to other racial or ethnic populations in Hawai'i, but could also generate cost savings for public and private insurance payers.
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Affiliation(s)
- Olivia Uchima
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Honolulu, HI 96822, USA;
| | - Deborah A. Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA;
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, University of Hawai‘i at Manoa, 651 Ilalo Street, Medical Education Building, Honolulu, HI 96813, USA; (H.J.A.); (S.Y.C.)
| | - So Yung Choi
- Department of Quantitative Health Sciences, University of Hawai‘i at Manoa, 651 Ilalo Street, Medical Education Building, Honolulu, HI 96813, USA; (H.J.A.); (S.Y.C.)
| | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI 96813, USA;
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Honolulu, HI 96822, USA;
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20
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Tashkin DP, Ohar JA, Koltun A, Allan R, Ward JK. The Role of ICS/LABA Fixed-Dose Combinations in the Treatment of Asthma and COPD: Bioequivalence of a Generic Fluticasone Propionate-Salmeterol Device. Pulm Med 2021; 2021:8881895. [PMID: 33815843 PMCID: PMC7994080 DOI: 10.1155/2021/8881895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Both asthma and chronic obstructive pulmonary disease (COPD) are inflammatory chronic respiratory conditions with high rates of morbidity and mortality worldwide. The objectives of this review are to briefly describe the pathophysiology and epidemiology of asthma and COPD, discuss guideline recommendations for uncontrolled disease, and review a new generic option for the treatment of asthma and COPD. Although mild forms of these diseases may be controlled with as-needed pharmacotherapy, uncontrolled or persistent asthma and moderate or severe COPD uncontrolled by bronchodilators with elevated eosinophilia or frequent exacerbations may require intervention with combination therapy with inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs), according to international guidelines. Fixed-dose combinations of ICS/LABA are commonly prescribed for both conditions, with fluticasone propionate (FP) and salmeterol forming a cornerstone of many treatment plans. An oral inhalation powder containing the combination of FP and salmeterol has been available as Advair Diskus® in the United States for almost 20 years, and the first and only substitutable generic version of this product has recently been approved for use: Wixela™ Inhub™. Bioequivalence of Wixela Inhub and Advair Diskus has been established. Furthermore, the Inhub inhaler was shown to be robust and easy to use, suggesting that Wixela Inhub may provide an alternative option to Advair Diskus for patients with asthma or COPD requiring intervention with an ICS/LABA.
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Affiliation(s)
- Donald P. Tashkin
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jill A. Ohar
- Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Medicine at Wake Forest University School of Medicine, Winston-Salem, NC, USA
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21
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Joseph CLM, Mahajan P, Buzzelli-Stokes S, Jacobsen G, Johnson DA, Duffy E, Williams R, Havstad S, Zoratti E, Ownby DR, Johnson CC, Lu M. Participant-level characteristics differ by recruitment setting when evaluating a behavioral intervention targeting adolescents with asthma. J Asthma 2021; 58:370-377. [PMID: 31702415 PMCID: PMC10726210 DOI: 10.1080/02770903.2019.1690661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/03/2019] [Accepted: 11/05/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The recruitment setting plays a key role in the evaluation of behavioral interventions. We evaluated a behavioral intervention for urban adolescents with asthma in three randomized trials conducted separately in three different settings over the course of 8 years. We hypothesized that characteristics of trial participants recruited from the ED and clinic settings would be significantly different from that of youth participating in the school-based trials. The intervention evaluated was Puff City, a web-based program that uses tailoring to improve asthma management behaviors. METHODS The present analysis includes youth aged 13-19 years who reported a physician diagnosis of asthma and symptoms at trial baseline. In the three trials, all participants were randomized post-baseline to a web-based, tailored intervention (treatment) or generic web-based asthma education (control). RESULTS Compared to school-based trial participants, ED participants had significantly more acute-care visits for asthma (p < 0.001) and more caregiver depression (p < 0.001). Clinic-based participants were more likely to have computer/ internet access than participants from the school-based trial (p < 0.001). Both ED and clinic participants were more likely to report controller medication (p's < 0.001) and higher teen emotional support (p's < 0.01) when compared to the schools, but were less likely to report Medicaid (p's < 0.014) and exposure to environmental tobacco smoke (p < 0.001). CONCLUSION Compared to participants in the school-based trials, participants recruited from ED and clinic settings differed significantly in terms of healthcare use, as well as psychosocial and sociodemographic factors. These factors can inform intervention content, and may impact external validity of behavioral interventions for asthma.
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Affiliation(s)
| | - Prashant Mahajan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Elizabeth Duffy
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Renee Williams
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Edward Zoratti
- Division of Allergy and Immunology, Henry Ford Health System, Detroit, MI, USA
| | - Dennis R. Ownby
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | | | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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22
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Toledanes YD, Tran L, Lara J, Injijian N, Neeki A, Dong F, Mejia Aguilar MD, Borger K, Neeki MM. The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities. Cureus 2021; 13:e13351. [PMID: 33747652 PMCID: PMC7968705 DOI: 10.7759/cureus.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Asthma is a serious chronic lung disease with a significant economic burden. The population of the San Bernardino County Juvenile Detention and Assessment Centers have higher odds of asthma as compared to the general population. Research has shown that a significant number of patients with a prior history of asthma were misdiagnosed. A protocol using objective testing, along with the detailed patient's history, was successfully implemented to verify the diagnosis and guide more effective medical care. After the implementation of those steps, the prevalence of asthma was found to be lower with the new protocol, from 18.1% in the pre-protocol period to 11.2% in the post-protocol period. This decrease resulted in an associated reduction in both direct and indirect healthcare costs and more efficient medical care.
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Affiliation(s)
- Yvette D Toledanes
- Public Health, San Bernardino County Department of Probation, San Bernardino, USA
| | - Louis Tran
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Jocelyn Lara
- Public Health, San Bernardino County Department of Probation, San Bernardino, USA
| | - Natali Injijian
- Public Health, San Bernardino County Department of Probation, San Bernardino, USA
| | - Arianna Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Fanglong Dong
- Clinical Research, Arrowhead Regional Medical Center, Colton, USA
| | | | - Kylee Borger
- Public Health, California University of Science and Medicine, San Bernardino, USA
| | - Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA.,Emergency Medicine, San Bernardino County Department of Probation, San Bernardino, USA
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23
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Rangachari P, Chen J, Ahuja N, Patel A, Mehta R. Demographic and Risk Factor Differences between Children with "One-Time" and "Repeat" Visits to the Emergency Department for Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020486. [PMID: 33435304 PMCID: PMC7827100 DOI: 10.3390/ijerph18020486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Nishtha Ahuja
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.A.); (A.P.)
| | - Anjeli Patel
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.A.); (A.P.)
| | - Renuka Mehta
- Division of Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
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Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma. CHILDREN-BASEL 2020; 7:children7090107. [PMID: 32825507 PMCID: PMC7552762 DOI: 10.3390/children7090107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022]
Abstract
Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.
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25
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Chronic rhinosinusitis disease burden is associated with asthma-related emergency department usage. Eur Arch Otorhinolaryngol 2020; 278:93-99. [PMID: 32749608 DOI: 10.1007/s00405-020-06259-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) disease burden is associated with pulmonary status in asthmatic CRS patients. Asthma-related emergency department (ED) usage is a predictor of asthma-related mortality. We sought to determine whether measures of CRS disease burden are associated with asthma-related ED usage. METHODS We prospectively recruited 263 asthmatic CRS patients for this cross-sectional study. CRS burden was measured using the 22-item Sinonasal Outcome Test (SNOT-22), and patient-reported CRS-related antibiotic usage and CRS-related oral corticosteroids usage over the preceding year. Asthma-related ED visits over the prior year were also assessed. RESULTS Of all participants, 18.6% had at least 1 asthma-related ED visit (mean 0.3 ED visits for the whole cohort). Asthma-related ED usage was associated with SNOT-22 score [adjusted rate ratio (RR) = 1.02, 95% CI 1.01-1.03, p = 0.040] and CRS-related oral corticosteroids usage in the past year (RR = 1.52, 95% CI 1.26-1.83, p < 0.001). From the SNOT-22 score, asthma-related ED usage was only associated with the nasal subdomain score (RR = 1.08, 95% CI 1.03-1.13, p = 0.001). These measures of CRS disease burden could be used with good sensitivity and specificity to detect patients with asthma-related ED usage in the past year, the majority of whom were undertreated for their asthma. CONCLUSIONS Measures of CRS disease burden are associated with and can be used to detect, patients having asthma-related ED usage. These results further solidify the connection between CRS and asthma disease courses, and also present an opportunity to use CRS disease burden as a tool for identifying-and implementing greater treatment of-patients at highest risk for asthma-related mortality.
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Abstract
Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant costs associated with acute asthma exacerbations, which are increasingly prevalent in these high-risk populations. Telemedicine is a viable option when addressing barriers in access to care and cost-efficiency. Implementing telemedicine in schools and other local community settings, as well as implementing innovative technology such as smartphone applications, can reduce the burden of asthma; increase patient satisfaction; and, most importantly, improve pediatric asthma outcomes.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; Arkansas Children's Research Institute, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA.
| | - Callie A Margiotta
- Arkansas Children's Research Institute, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA
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Jafarnejad S, Khoshnezhad Ebrahimi H. Clinical guidelines on pediatric asthma exacerbation in emergency department, a narrative review. Eur J Transl Myol 2020; 30:8682. [PMID: 32499881 PMCID: PMC7254431 DOI: 10.4081/ejtm.2019.8682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022] Open
Abstract
Asthma has been known as a prevalent chronic-type inflammatory disease in children, because of their narrower respiratory airways. The present study aimed to identify guidelines for children asthma treatments. Extensive research was conducted on biomedical and pharmacological bibliographic database PubMed, EMBASE, MEDLINE, LILACS database, global independent network of Cochrane, Science Direct and global health library of Global Index Medicus. A comprehensive literature review was carried out using the terms Pediatric Asthma, epidemiology, management, and related clinical guidelines published from 2000 to 2019. After the primary assessment, quick diagnosis, clinical practice guidelines are useful tools for proper management of pediatric Asthma. By setting proper guidelines for this particular population, a higher improvement in quality of management of of pediatric Asthma is expected. Given the differences between the recommendations arisen by BTS/SIGN and NICE guidelines, critical comparison of the evidence-base guidelines provide suggestions that have more in common than what might seems at the first glance. The analysis of the variations presented in the present article will assist clinicians to make accurate decisions regarding their patients.
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Affiliation(s)
| | - Hamidreza Khoshnezhad Ebrahimi
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar Children Hospital, Tehran, Iran
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28
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Lack S, Kinser PA. The modification of three vulnerability theories to assist nursing practice for school-age children with severe asthma. J SPEC PEDIATR NURS 2020; 25:e12280. [PMID: 31749322 DOI: 10.1111/jspn.12280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Severe asthma is an inflammatory illness associated with adverse health outcomes and behaviors in children, such as decreased quality of life, impaired sleep, and increased medical costs and morbidity. CONCLUSIONS Children with severe asthma frequently exhibit a cycle of health and behaviors which contribute to these adverse health outcomes, consisting of decreased physical activity, increased stress, and increased airway inflammation and asthma exacerbations. School-age children, in particular, are a vulnerable population because they not only rely on others for their care but also suffer from a chronic illness and are at risk for unequal healthcare access and health outcomes. PRACTICE IMPLICATIONS Currently, there is no one nursing theory that adequately addresses the vulnerability, cycle of health and behaviors, and adverse health outcomes of children with severe asthma. By integrating key concepts from three vulnerability theories and presenting a modified conceptual framework, this paper aims to demonstrate how the use of this new conceptual framework may assist nurses in evaluating the unique needs of school-age children with severe asthma to provide best practices and develop appropriate interventions.
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Affiliation(s)
- Sharon Lack
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia
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29
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James P, Cornish A, Brady K, Morrison J, Giunta Y, Zuckerman B, Hahn B. Is There Benefit in Identifying Asthma Triggers During an Exacerbation? Clin Pediatr (Phila) 2020; 59:142-147. [PMID: 31718283 DOI: 10.1177/0009922819887399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction. Allergen-specific IgE (sIgE) testing provides an objective assessment of sensitization to an allergen. Goal. To identify the time when serum measurements of sIgE would be most sensitive. Methods. This was a prospective study conducted between September 1, 2015, and February 25, 2019. Subjects ≥5 and ≤18 years of age, seen in the ED or admitted with an asthma exacerbation, were tested for total IgE and 8 perennial sIgE levels. Subjects with elevated sIgE were tested again after symptom resolution. Results. A total of 104 subjects were enrolled; 50 subjects were eligible for inclusion in the analysis. There were statistically significant differences between the visits for all sIgE, except Alternaria alternatum. Conclusions. In pediatric patients, serum sIgE levels measured during an asthma exacerbation were elevated compared with when their asthma was in better control. sIgE testing during an asthma exacerbation may help identify asthma triggers, mitigate exposure, and hence improve asthma control.
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Affiliation(s)
- Pushpom James
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Anna Cornish
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Kaylan Brady
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Jennifer Morrison
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Yvonne Giunta
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Batya Zuckerman
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Barry Hahn
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
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30
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Pinto JM, Navallo LJ, Petrova A. Does participation in the community outreach for asthma care and healthy lifestyles (COACH) program alter subsequent use of hospital services for children discharged with asthma? J Asthma 2019; 58:231-239. [PMID: 31566040 DOI: 10.1080/02770903.2019.1672719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Transition from hospital to home is a challenging time for children with asthma and their caregivers because of the high risk for reutilization of acute hospital services. Detecting effective quality improvement initiatives to reduce utilization of urgent services in children discharged with asthma is an important clinical and public health question. This study was designed to identify the role of a multimodal, nurse-driven, inpatient initiated Community Outreach for Asthma Care and Healthy lifestyles (COACH) program on subsequent use of hospital services for pediatric patients with asthma.Methods: We utilized comparative effectiveness design to identify the difference in recurrent emergency department (ED) visits and/or admissions within 12-months after discharge between patients with asthma who engaged in the COACH program (Intervention group) and those who did not (Comparison group). We used administrative databases of hospitals included in the Meridian Health system to identify the number of and time to asthma-related readmissions and ED re-attendances.Results: We found no difference in the rate or number of recurrent hospital-based services used within 12 months, but found a reduction in ED re-visitation and/or readmission within 30 days for COACH program participants prior to and after adjustment for age, race/ethnicity, insurance status, and clinical presentation (Odd Ratio 0.44, 95% Confidence Interval 0.20, 0.93).Conclusion: Participation in the COACH program decreases the likelihood for subsequent use of hospital services within a month of discharge for children with asthma. Enhanced post-discharge interactions with families may reduce long-term reuse of hospital-based services for COACH program participants.
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Affiliation(s)
- Jamie M Pinto
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA.,Hackensack-Meridian Health School of Medicine, Nutley, NJ, USA
| | - Lauren J Navallo
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Anna Petrova
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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31
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Sharp M, Brown T, Chen E, Rand CS, Moller DR, Eakin MN. Psychological burden associated with worse clinical outcomes in sarcoidosis. BMJ Open Respir Res 2019; 6:e000467. [PMID: 31673367 PMCID: PMC6797341 DOI: 10.1136/bmjresp-2019-000467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Sarcoidosis is a multisystem granulomatous inflammatory disorder. Sarcoidosis is associated with significant morbidity and rising healthcare utilisation. Patients with sarcoidosis report higher psychological symptoms than the general population. We evaluated the association between depressive and anxiety symptoms and clinical outcomes in patients with pulmonary sarcoidosis requiring treatment. Methods Adult patients in the Johns Hopkins Sarcoidosis Clinic diagnosed with pulmonary sarcoidosis on treatment were eligible for enrollment. Questionnaires were administered to assess depressive and anxiety symptoms, healthcare utilisation and health-related quality of life (HRQoL). Results 112 participants were enrolled (57% women, 53% African American, median age: 57 years). 34% of participants screened positive for mild and 20% for moderate–severe depressive symptoms. 25% of participants screened positive for mild and 12% for moderate–severe anxiety symptoms. Participants with moderate–severe psychological symptoms had a higher odds of an emergency department visit in the previous 6 months (8.87 for depressive symptoms and 13.05 for anxiety symptoms) and worse HRQoL compared with participants without psychological symptoms. Participants with moderate–severe depressive symptoms had lower diffusion capacity of the lungs for carbon monoxide % predicted compared with those without depressive symptoms. There was no association between elevated psychological symptoms and the odds of hospitalisation, forced vital capacity % predicted and forced expiratory volume in 1 second % predicted. Conclusion Psychological symptoms may be associated with worse clinical outcomes in sarcoidosis. Improving the recognition through clinic screening and referral for treatment of depression and anxiety in sarcoidosis may reduce acute healthcare utilisation and improve HRQoL.
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Affiliation(s)
- Michelle Sharp
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Taylor Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward Chen
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David R Moller
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle N Eakin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Mohan A, Kearney GD, Miller AC. Single Maintenance and Reliever Therapy (SMART) Regimen for Management of Persistent Asthma. Acad Emerg Med 2019; 26:567-570. [PMID: 30408269 DOI: 10.1111/acem.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Arjun Mohan
- Department of Internal Medicine Division of Pulmonary, Critical Care and Sleep Medicine Vidant Medical Center, East Carolina University Brody School of Medicine Greenville NC
| | - Gregory D. Kearney
- Department of Public Health East Carolina University Brody School of Medicine Greenville NC
| | - Andrew C. Miller
- Department of Emergency Medicine Vidant Medical Center, East Carolina University Brody School of Medicine Greenville NC
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Volk AS, Marton SA, Richardson BS, Rauda L, Schwarzwald HL, Naik NM. Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic. Clin Pediatr (Phila) 2019; 58:151-158. [PMID: 30378445 DOI: 10.1177/0009922818809466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma, a chronic childhood disease, has resulted in increased emergency department (ED) visits with high costs. Many asthma ED visits are nonemergent and could be treated in outpatient clinics. Literature has concluded that a 2-day course of oral dexamethasone has comparable outcomes to a 5-day course of prednisone in the ED and hospital setting. A retrospective chart review was performed on children requiring in-house treatment with a corticosteroid (dexamethasone n = 23, prednisone n = 40) for acute asthma exacerbations at an ambulatory medical home. The rates of hospital admissions, ED visits, and symptom follow-up were similar between the 2 groups ( P > .05). The cost for a course of dexamethasone was US$1.28 versus US$16.20 for prednisolone. The average cost for an asthma exacerbation office visit was US$79.89 compared with US$3113.28 for an ED visit. A 2-day course of oral dexamethasone appears to be a promising clinical and cost-effective treatment for acute asthma exacerbations at the primary care level.
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Affiliation(s)
| | | | | | - Luis Rauda
- 3 Texas Children's Health Plan, Bellaire, TX, USA
| | | | - Neel M Naik
- 2 Baylor College of Medicine, Houston, TX, USA
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34
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Davis L, Kreashko LM, Allison V. Developing, Implementing, and Evaluating Personalized Education for Pediatric Patients Diagnosed With Asthma on an Observation Unit. J Pediatr Health Care 2019; 33:72-79. [PMID: 30181000 DOI: 10.1016/j.pedhc.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A quality improvement project was commenced to determine if personalized, patient-specific education can increase parent/guardian knowledge and reduce subsequent emergency department (ED) visits and inpatient admissions secondary to asthma. METHOD Pre- and post-education survey scores were analyzed for a change in knowledge. A retrospective electronic health record (EHR) chart review was performed one year following the education to determine if the patients had additional ED visits or inpatient admissions. RESULTS A statistically significant increase in post-education survey scores (p = 0.004) and decrease in post-education inpatient admissions was found (p = 0.005). There was no significant difference between the number of pre- and post-education ED visits. DISCUSSION Asthma is a chronic medical condition that often requires life-long home management. These results revealed that parent/guardian knowledge regarding asthma can be increased and optimal home management improved by personalized, patient-specific education.
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Affiliation(s)
- Lauren Davis
- Lauren Davis, Recent Doctor of Nursing Practice Graduate, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Lisa M Kreashko
- Lisa M. Kreashko, Assistant Professor, University of Pittsburgh School of Nursing, Pittsburgh, PA..
| | - Virginia Allison
- Virginia Allison, Assistant Professor, University of Pittsburgh School of Nursing, Pittsburgh, PA
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