1
|
Stridsman C, Martinsen Ø, Selberg S, Ödling M, Konradsen JR. Uncontrolled asthma in school-aged children-a nationwide specialist care study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100227. [PMID: 38439947 PMCID: PMC10910119 DOI: 10.1016/j.jacig.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 03/06/2024]
Abstract
Background Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment. Objective Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care. Methods We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma. Results UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P = .001]). Conclusion UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.
Collapse
Affiliation(s)
- Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Øyvind Martinsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Selberg
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Maria Ödling
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jon R. Konradsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Goff SL, Shieh MS, Lindenauer PK, Ash AS, Krishnan JA, Geissler KH. Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance. Popul Health Manag 2024; 27:105-113. [PMID: 38574325 PMCID: PMC11001504 DOI: 10.1089/pop.2023.0244] [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] [Indexed: 04/06/2024] Open
Abstract
Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014-2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid.
Collapse
Affiliation(s)
- Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jerry A. Krishnan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
- Institute for Healthcare Delivery Design, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kimberley H. Geissler
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
| |
Collapse
|
3
|
Belhassen M, Nolin M, Jacoud F, Marant Micallef C, Van Ganse E. Trajectories of Controller Therapy Use Before and After Asthma-Related Hospitalization in Children and Adults: Population-Based Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e50085. [PMID: 37751244 PMCID: PMC10565628 DOI: 10.2196/50085] [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: 06/19/2023] [Revised: 07/19/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Inappropriate use of inhaled corticosteroids (ICSs) for asthma impairs control and may cause exacerbation, including asthma-related hospitalization (ARH). In prospective studies, ICS use peaked around ARH, but information on routine care use is limited. Since ARH is a major outcome, controller therapy use in routine care before and after ARH should be documented. OBJECTIVE This study aimed to distinguish ICS use typologies (trajectories) before and after ARH, and assess their relationships with sociodemographic, disease, and health care characteristics. METHODS A retrospective cohort study was performed using a 1% random sample of the French claims database. All patients hospitalized for asthma between January 01, 2013, and December 31, 2015, were classified as either children (aged 1-10 years) or teens/adults (aged ≥11 years). Health care resource use was assessed between 24 and 12 months before ARH. ICS use was computed with the Continuous Measures of Medication Acquisition-7 (CMA7) for the 4 quarters before and after ARH. Initially, the overall impact of hospitalization on the CMA7 value was studied using a segmented regression analysis in both children and teens/adults. Then, group-based trajectory modeling differentiated the groups with similar ICS use. We tested different models having 2 to 5 distinct trajectory groups before selecting the most appropriate trajectory form. We finally selected the model with the lowest Bayesian Information Criterion, the highest proportion of patients in each group, and the maximum estimated probability of assignment to a specific group. RESULTS Overall, 863 patients were included in the final study cohort, of which 447 (51.8%) were children and 416 (48.2%) were teens/adults. In children, the average CMA7 value was 12.6% at the start of the observation period, and there was no significant quarter-to-quarter change in the value (P=.14) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 34.9% (P=.001), before a significant decrease (P=.01) of 7.0% per quarter. In teens/adults, the average CMA7 value was 31.0% at the start, and there was no significant quarter-to-quarter change in the value (P=.08) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 26.9% (P=.002), before a significant decrease (P=.01) of 7.0% per quarter. We identified 3 and 5 trajectories before ARH in children and adults, respectively, and 5 after ARH for both groups. Trajectories were related to sociodemographic characteristics (particularly, markers of social deprivation) and to potentially inappropriate health care, such as medical management and choice of therapy. CONCLUSIONS Although ARH had an overall positive impact on ICS use trajectories, the effect was often transient, and patient behaviors were heterogeneous. Along with overall trends, distinct trajectories were identified, which were related to specific patients and health care characteristics. Our data reinforce the evidence that inappropriate use of ICS paves the way for ARH.
Collapse
Affiliation(s)
| | | | | | | | - Eric Van Ganse
- PELyon, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
| |
Collapse
|
4
|
Patel A, Cook S, Mattingly DT, Barnes GD, Arenberg DA, Levy DT, Meza R, Fleischer NL, Hirschtick JL. Longitudinal Association Between Exclusive and Dual Use of Cigarettes and Electronic Nicotine Delivery Systems and Asthma Among U.S. Adolescents. J Adolesc Health 2023; 73:437-444. [PMID: 37306645 DOI: 10.1016/j.jadohealth.2023.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/23/2023] [Accepted: 04/11/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Electronic Nicotine Delivery Systems (ENDS) use among adolescents has increased greatly over the past decade, but its impact on chronic respiratory health conditions, like asthma, is not fully understood. METHODS We examined data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study using discrete time hazard models to analyze the association between time-varying tobacco product use and incident diagnosed asthma among adolescents aged 12-17 years at baseline. We lagged the time-varying exposure variable by one wave and categorized respondents by current use status (1+ days in the past 30 days): never or non-current, exclusive cigarette, exclusive ENDS, and dual cigarette and ENDS use. We also controlled for sociodemographic (age, sex, race/ethnicity, parental education) and other risk factors (urban/rural setting, secondhand smoke exposure, household combustible tobacco use, body mass index). RESULTS At baseline, over half the analytic sample (n = 9,141) was 15-17 years old (50.4%), female (50.2%), and non-Hispanic White (55.3%). Adolescents who exclusively smoked cigarettes had a statistically significant higher risk of incident diagnosed asthma at follow-up (adjusted Hazard Ratio (aHR): 1.68, 95% confidence interval (CI): 1.21-2.32) compared to those not currently using cigarettes or ENDS, but adolescents using ENDS exclusively (aHR: 1.25, 95% CI: 0.77-2.04) or in combination with cigarettes (aHR: 1.54, 95% CI: 0.92-2.57) did not. DISCUSSION Short-term exclusive cigarette use was associated with a higher risk of incident diagnosed asthma over five years of follow-up among adolescents. We did not find conclusive evidence for an association between exclusive ENDS or dual use and incident diagnosed asthma.
Collapse
Affiliation(s)
- Akash Patel
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Steven Cook
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Delvon T Mattingly
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Geoffrey D Barnes
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Douglas A Arenberg
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jana L Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Sunther M, Marchon K, Gupta A. Tiotropium in the management of paediatric and adolescent asthma: Systematic review. Paediatr Respir Rev 2021; 38:58-62. [PMID: 33243704 DOI: 10.1016/j.prrv.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/25/2023]
Abstract
Tiotropium bromide is a long-acting muscarinic antagonist (LAMA) and is the only LAMA licensed for management for patients' ≥6 years old with severe asthma who have experienced one or more severe asthma exacerbations in the preceding year. Recent clinical trials have demonstrated that once-daily tiotropium is safe and efficacious in 6-17 year-olds with symptomatic asthma despite treatment with inhaled corticosteroids (ICSs), with or without additional controllers. In this paper, we review the evidence of the safety and efficacy of tiotropium add-on maintenance treatment in children and adolescents with symptomatic moderate and severe asthma.
Collapse
Affiliation(s)
- Meera Sunther
- Department of Respiratory Paediatrics, King's College Hospital, London, UK
| | - Keisha Marchon
- Department of Respiratory Paediatrics, King's College Hospital, London, UK
| | - Atul Gupta
- Department of Respiratory Paediatrics, King's College Hospital, London, UK; Institute for Women's and Children's Health, King's College London, London, UK.
| |
Collapse
|
7
|
Radhakrishnan D, Bota SE, Price A, Ouédraogo A, Husein M, Clemens KK, Shariff SZ. Comparison of childhood asthma incidence in 3 neighbouring cities in southwestern Ontario: a 25-year longitudinal cohort study. CMAJ Open 2021; 9:E433-E442. [PMID: 33947701 PMCID: PMC8101639 DOI: 10.9778/cmajo.20200130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Air pollution is a known trigger for exacerbations among individuals with asthma, but its role in the development of new-onset asthma is unclear. We compared the rate of new asthma cases in Sarnia, a city with high pollution levels, with the rates in 2 neighbouring regions in southwestern Ontario, Canada. METHODS Using a population-based birth cohort design and linked health administrative data, we compared the hazard of incident asthma among children 0 to 10 years of age between those born in Lambton (Sarnia) and those born in Windsor and London-Middlesex, for the period Apr. 1, 1993, to Mar. 31, 2009. We used Cox proportional hazards models to adjust for year of birth and exposure to air pollutants (nitrogen dioxide, sulphur dioxide [SO2], ozone and small particulate matter [PM2.5]), as well as maternal, geographic and socioeconomic factors. RESULTS Among 114 427 children, the highest incidence of asthma was in Lambton, followed by Windsor and London-Middlesex (30.3, 24.4 and 19.8 per 1000 person-years, respectively; p < 0.001). Relative to Lambton, the hazard of asthma, adjusted for socioeconomic and perinatal factors, was lower in Windsor (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.67-0.77) and London-Middlesex (HR 0.65, 95% CI 0.61-0.69). Inclusion of air pollutants attenuated this relative difference in both Windsor (HR 0.79, 95% CI 0.62-1.01) and London-Middlesex (HR 0.89, 95% CI 0.64-1.24). INTERPRETATION We identified a higher incidence of asthma among children born in Lambton (Sarnia) relative to 2 other regions in southwestern Ontario. Higher levels of air pollution (particularly SO2 and PM2.5) in this region, as experienced by children in their first year of life, may be contributory.
Collapse
Affiliation(s)
- Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont.
| | - Sarah E Bota
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - April Price
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Alexandra Ouédraogo
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Murad Husein
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Kristin K Clemens
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Salimah Z Shariff
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| |
Collapse
|
8
|
Cividini S, Sinha I, Donegan S, Maden M, Culeddu G, Rose K, Fulton O, Hughes DA, Turner S, Tudur Smith C. EstablishINg the best STEp-up treatments for children with uncontrolled asthma despite INhaled corticosteroids (EINSTEIN): protocol for a systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data (IPD). BMJ Open 2021; 11:e040528. [PMID: 33550231 PMCID: PMC7925932 DOI: 10.1136/bmjopen-2020-040528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Asthma affects millions of children worldwide-1.1 million children in the UK. Asthma symptoms cannot be cured but can be controlled with low-dose inhaled corticosteroids (ICSs) in the majority of individuals. Treatment with a low-dose ICS, however, fails to control asthma symptoms in around 10%-15% of children and this places the individual at increased risk for an asthma attack. At present, there is no clear preferred treatment option for a child whose asthma is not controlled by low-dose ICS and international guidelines currently recommend at least three treatment options. Herein, we propose a systematic review and individual participant data network meta-analysis (IPD-NMA) aiming to synthesise all available published and unpublished evidence from randomised controlled trials (RCTs) to establish the clinical effectiveness of pharmacological treatments in children and adolescents with uncontrolled asthma on ICS and help to make evidence-informed treatment choices. This will be used to parameterise a Markov-based economic model to assess the cost-effectiveness of alternative treatment options in order to inform decisions in the context of drug formularies and clinical guidelines. METHODS AND ANALYSIS We will search in MEDLINE, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, NICE Technology Appraisals and the National Institute for Health Research (NIHR) Health Technology Assessment series for RCTs of interventions in patients with uncontrolled asthma on ICS. All studies where children and adolescents were eligible for inclusion will be considered, and authors or sponsors will be contacted to request IPD on patients aged <18. The reference lists of existing clinical guidelines, along with included studies and relevant reviews, will be checked to identify further relevant studies. Unpublished studies will be located by searching across a range of clinical trial registries, including internal trial registers for pharmaceutical companies. All studies will be appraised for inclusion against predefined inclusion and exclusion criteria by two independent reviewers with disagreements resolved through discussion with a third reviewer. We will perform an IPD-NMA-eventually supplemented with aggregate data for the RCTs without IPD-to establish both the probability that a treatment is best and the probability that a particular treatment is most likely to be effective for a specific profile of the patient. The IPD-NMA will be performed for each outcome variable within a Bayesian framework, using the WinBUGS software. Also, potential patient-level characteristics that may modify treatment effects will be explored, which represents one of the strengths of this study. ETHICS AND DISSEMINATION The Committee on Research Ethics, University of Liverpool, has confirmed that ethics review is not required. The dissemination plan consists of publishing the results in an open-access medical journal, a plain-language summary available for parents and children, dissemination via local, national and international meetings and conferences and the press offices of our Higher Education Institutions (HEIs). A synopsis of results will be disseminated to NICE and British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN) as highly relevant to future clinical guideline updates. PROSPERO REGISTRATION NUMBER CRD42019127599.
Collapse
Affiliation(s)
- Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ian Sinha
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Katie Rose
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Stephen Turner
- Department of Child Health, University Court of the University of Aberdeen, Aberdeen, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Amaral R, Jácome C, Almeida R, Pereira AM, Alves-Correia M, Mendes S, Rodrigues JCC, Carvalho J, Araújo L, Costa A, Silva A, Teixeira MF, Ferreira-Magalhães M, Alves RR, Moreira AS, Fernandes RM, Ferreira R, Pinto PL, Neuparth N, Bordalo D, Bom AT, Cálix MJ, Ferreira T, Gomes J, Vidal C, Mendes A, Vasconcelos MJ, Silva PM, Ferraz J, Morête A, Pinto CS, Santos N, Loureiro CC, Arrobas A, Marques ML, Lozoya C, Lopes C, Cardia F, Loureiro CC, Câmara R, Vieira I, da Silva S, Silva E, Rodrigues N, Fonseca JA. Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031015. [PMID: 33498858 PMCID: PMC7908090 DOI: 10.3390/ijerph18031015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13–17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
Collapse
Affiliation(s)
- Rita Amaral
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Women’s and Children’s Health, Paediatric Research, Uppsala University, SE-751 05 Uppsala, Sweden
- Correspondence: ; Tel.: +351-917-006-669
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Magna Alves-Correia
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Sandra Mendes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
| | - José Carlos Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
| | - Luís Araújo
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Alberto Costa
- Serviço de Pediatria, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal; (A.C.); (A.S.)
| | - Armandina Silva
- Serviço de Pediatria, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal; (A.C.); (A.S.)
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Manuel Ferreira-Magalhães
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Rodrigo Rodrigues Alves
- Serviço de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal;
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal;
| | - Ricardo M. Fernandes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisboa, Portugal; (P.L.P.); (N.N.)
| | - Nuno Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisboa, Portugal; (P.L.P.); (N.N.)
- Pathophysiology, CHRC/CEDOC, High Burden and High Mortality Diseases Thematic Line Coordinator, Nova Medical School, 1150-190 Lisboa, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, 4780-371 Vila Nova de Famalicão, Portugal;
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Maria José Cálix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela–Viseu, 3504-509 Viseu, Portugal;
| | - Tânia Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, ACeS Baixo Mondego, 3060-716 Tocha, Portugal;
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal;
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, 15706 Santiago De Compostela, Spain;
| | - Ana Mendes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, 4200–319 Porto, Portugal;
| | | | - José Ferraz
- Imunoalergologia, Hospital Privado de Alfena, Trofa Saúde, 4445-243 Alfena, Portugal;
| | - Ana Morête
- Serviço de Imunoalergologia, Hospital Infante D. Pedro, Centro Hospitalar Baixo Vouga, 3814-501 Aveiro, Portugal;
| | - Claúdia Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, 5000-508 Vila Real, Portugal;
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, 8000-386 Portimão, Portugal;
| | | | - Ana Arrobas
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
| | - Cristina Lopes
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, ACES Dão Lafões, 3530-113 Mangualde, Portugal;
| | - Carla Chaves Loureiro
- Departamento de Pediatria, Serviço de Pediatria Ambulatória, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, 2834-003 Barreiro, Portugal;
| | - Inês Vieira
- UCSP Dr. Arnaldo Sampaio, ACES Pinhal Litoral, 2419-014 Leiria, Portugal;
| | - Sofia da Silva
- USF Cuidarte, Unidade Local de Saúde do Alto Minho, 4925-083 Portuzelo, Portugal;
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, ACeS Baixo Vouga, 3880-225 Ovar, Portugal;
| | - Natalina Rodrigues
- Unidade de Saúde Familiar Mondego, ACES Baixo Mondego, 3045-059 Coimbra, Portugal;
| | - João A. Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| |
Collapse
|
10
|
Viswanatha GL, Shylaja H, Nandakumar K, Venkataranganna MV, Prasad NBL. Efficacy and safety of inhalation budesonide in the treatment of pediatric asthma in the emergency department: a systematic review and meta-analysis. Pharmacol Rep 2020; 72:783-798. [PMID: 32227295 DOI: 10.1007/s43440-020-00098-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study was aimed to evaluate the beneficial role of inhalation budesonide(BUD) in improving the pulmonary functions, and reducing the hospital admission rate, worsening of asthma and commonly encountered adverse events in pediatric asthma. METHODS The electronic search was performed using PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases to identify the randomized control trials(RCTs). RESULTS 21 RCTs involving 12,787 subjects were included. The meta-analysis revealed that the BUD has reduced the hospitalization rate (Mantel-Haenszel (M-H), random effects odd ratio (RE-OR) of 0.34, p = 0.003, I2 = 75%), and worsening of asthma (M-H, RE-OR 0.38, p = 0.001, I2 = 73%); significantly improved the pulmonary functions such as FEV1 (Inverse variance (IV): 1.05, p < 0.0001, I2 = 94%), PEFR (IV: 1.40, p < 0.0001, I2 = 87%), morning PEF (IV: 1.04, p < 0.0001, I2 = 91%), and evening PEF (IV: 1.29, p < 0.0001, I2 = 92%) compared to control. Further, the incidences of adverse events like Pharyngitis (M-H, RE-OR 0.88, at 95% CI, p = 0.69, I2 = 0%), Sinusitis (M-H, RE-OR 0.78, p = 0.79, I2 = 0%), Respiratory infections (M-H, RE-OR 0.96, p = 0.46, I2 = 0%), Otitis media (M-H, RE-OR 0.82, p = 0.32, I2 = 12%) and Fever (M-H, RE-OR 0.78, p = 0.64, I2 = 0%) were almost same between BUD and control. CONCLUSION The outcomes of the meta-analysis suggest that high-dose inhalation BUD could benefit the pediatric patients in minimizing the worsening of asthma and hospitalization rate, along with improving the pulmonary functions, with negligible adverse drug reactions.
Collapse
Affiliation(s)
| | | | - Krishnadas Nandakumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal, 576104, India
| | | | | |
Collapse
|
11
|
Gao G, Liao Y, Mo L, Gong Y, Shao X, Li J. A randomized controlled trial of a nurse-led education pathway for asthmatic children from outpatient to home. Int J Nurs Pract 2020; 26:e12823. [PMID: 32012398 DOI: 10.1111/ijn.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/15/2019] [Accepted: 01/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Education for asthmatic children in the outpatient department is insufficient. AIM To evaluate the efficacy of a nurse-led education pathway, a standard education programme, on children with asthma. METHODS One hundred and eighty participants enrolled and were randomly assigned to either the control group or the intervention group. The intervention group received predetermined step-by-step education sessions based on the self-designed education pathway, while the control group received usual care. Asthma control, health-related quality of life, and health-care utilization measures were taken at baseline and at follow-up visits between February 2016 and May 2018. RESULTS Significantly higher scores for health-related quality of life and inhaler technique at the third-month visit and asthma control test at the sixth-month visit were seen in the intervention group. The numbers of unscheduled physician visits and school absences were lower in the intervention group than in the control group within 6 months. However, no significant differences were observed in emergency department visits and hospitalizations. CONCLUSION The nurse-led education pathway could be considered effective for children with asthma visiting the outpatient department.
Collapse
Affiliation(s)
- Guozhen Gao
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaoji Liao
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Lulu Mo
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yucui Gong
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Shao
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinying Li
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
12
|
Colborn KL, Helmkamp L, Bender BG, Kwan BM, Schilling LM, Sills MR. Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care. J Am Board Fam Med 2019; 32:37-49. [PMID: 30610140 PMCID: PMC6943943 DOI: 10.3122/jabfm.2019.01.180155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes. OBJECTIVE To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices. METHODS This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models. RESULTS The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures. CONCLUSIONS Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.
Collapse
Affiliation(s)
- Kathryn L Colborn
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS).
| | - Laura Helmkamp
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bruce G Bender
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bethany M Kwan
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Lisa M Schilling
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Marion R Sills
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| |
Collapse
|
13
|
Halwani R, Vazquez-Tello A, Horanieh N, Dulgom S, Al-Aseri Z, Al-Khamis N, Al-Sum Z, Al-Jahdali H, Al-Muhsen S. Risk factors hindering asthma symptom control in Saudi children and adolescents. Pediatr Int 2017; 59:661-668. [PMID: 28218986 DOI: 10.1111/ped.13268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/08/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maintaining good control of asthma symptoms can help to prevent exacerbations and its associated complications. The Asthma Control Test (ACT) can rapidly assess the effectiveness of asthma management plan and therapy. The aim of this study was therefore to identify risk factors associated with uncontrolled asthma symptoms in young Saudi asthmatic children (3-17 years old). METHODS In this cross-sectional hospital-based survey, the ACT was administered to 297 asthmatic children/adolescents, recruited at the emergency department (ED) of two major hospitals. RESULTS Most recruited patients had intermittent (63.5%) and mild persistent (27.6%) asthma; few had moderate persistent (8.9%) and none had severe asthma. These patients visited the ED four times (3.9 ± 3.2), on average. Almost half of the patients stated that they had not received education about asthma (47%) or education about medication use (43%). Most patients (60.3%) had uncontrolled symptoms (ACT score ≤19), of whom the intermittent asthma patients had better scores than those with more severe symptoms. Children ≤6 years old, with symptoms diagnosed <5 years previously and who were not attending school, had significantly worse control than older patients. Poor medication compliance and inappropriate inhaler device use were ascribed to younger patients (<12 years old) and worse scores; particularly in relation to stopping inhaled corticosteroid therapy when their symptoms improve. Patients with poor control also stated that they had not received education about inhaler device use. CONCLUSIONS Most Saudi asthmatic children/adolescents visiting the ED had poor control of symptoms; indeed, none achieved complete control, which is related to deficient medication compliance and improper medication inhaler device use; deficient knowledge about asthma was also another factor hindering control.
Collapse
Affiliation(s)
- Rabih Halwani
- Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alejandro Vazquez-Tello
- Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nour Horanieh
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Said Dulgom
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zohair Al-Aseri
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al-Khamis
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zubaida Al-Sum
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Department of Medicine, Pulmonary Division-ICU, King Saud University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Al-Muhsen
- Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Beydon N, Cochez M, Mahut B, Tarbé de Saint Hardouin AL, Gajdos V, Régnard D, Soussan-Banini V, de Pontual L, Delclaux C. Avoidable Emergency Visits for Acute Asthma in Children: Prevalence and Risk Factors. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2016; 29:130-136. [DOI: 10.1089/ped.2016.0646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires (EFR), Hôpital d'Enfants Armand-Trousseau, Paris, France
- INSERM U938 Centre de Recherche Saint Antoine, Paris, France
| | - Mélanie Cochez
- APHP, Hôpitaux Universitaires Paris Sud, Clamart, France
- Université Paris Sud, Le Kremlin Bicêtre, France
| | | | | | - Vincent Gajdos
- APHP, Hôpitaux Universitaires Paris Sud, Clamart, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Le Kremlin Bicêtre, France
| | - Delphine Régnard
- APHP, Hôpitaux Universitaires Paris Sud, Service d'Accueil des Urgences Pédiatriques, Le Kremlin Bicêtre, France
| | | | - Loïc de Pontual
- APHP, Service de Pédiatrie–Hôpital Jean Verdier, Bondy, France
- Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Christophe Delclaux
- APHP, Hôpital Robert Debré, Service de Physiologie Pédiatrique, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| |
Collapse
|
15
|
Belhassen M, Langlois C, Laforest L, Dima AL, Ginoux M, Sadatsafavi M, Van Ganse E. Level of Asthma Controller Therapy Before Admission to the Hospital. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:877-83. [PMID: 27452886 DOI: 10.1016/j.jaip.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In asthma, choice of controller therapy and adherence to treatment can affect the risk of future severe exacerbations leading to hospitalization. OBJECTIVE Our objective was to characterize treatment dispensation profiles before hospital admission for asthma. METHODS Using a 1/97th random sample of the national French claims data, patients with asthma aged 6 to 40 years were identified between 2006 and 2014. Patients with subsequent asthma-related hospitalization were selected. On the basis of controller therapy dispensed in the 12 months before admission, treatment profiles were categorized into clusters, using Ward's minimum-variance hierarchical clustering method. RESULTS Of 17,846 patients with asthma, we identified 275 patients (1.5%) with an asthma-related hospitalization. Three distinct clusters were identified. The first cluster (63.6%) included patients with few dispensations of any controller medication (<1 unit). The second cluster (32.4%) consisted of patients with frequent dispensations of long-acting beta agonists (LABAs)/inhaled corticosteroids (ICS) in fixed-dose combinations. The third cluster (4%) comprised patients receiving free combinations of ICS and LABAs, with more dispensations of LABAs than of ICS. CONCLUSIONS In France, before an asthma-related hospitalization, more than 60% of patients received little controller therapy and 4% were exposed to higher dispensation of LABAs than of ICS. These results indicate that a large fraction of asthma-related hospitalizations can potentially be prevented with better pharmacotherapy.
Collapse
Affiliation(s)
- Manon Belhassen
- PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France.
| | - Carole Langlois
- PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France
| | - Laurent Laforest
- PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France
| | - Alexandra Lelia Dima
- Department of Communication Science, ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Marine Ginoux
- PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France
| | - Mohsen Sadatsafavi
- Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Eric Van Ganse
- PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
| |
Collapse
|
16
|
Suruki RY, Boudiaf N, Ortega HG. Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients. World Allergy Organ J 2016; 9:18. [PMID: 27298711 PMCID: PMC4893900 DOI: 10.1186/s40413-016-0109-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background Asthma is the most common chronic disease in childhood and places a significant burden on public and private health systems. This retrospective cohort analysis utilised administrative healthcare claims data (US Clinformatics™ Multiplan database; compliant with the US Department of Health & Human Services Health Insurance Portability and Accountability Act) to characterise asthma exacerbations requiring intervention in a US paediatric patient population. Methods Patients aged > 1–17 years with a recorded asthma diagnosis and receiving treatment were identified in the US Clinformatics™ Multiplan database over a 9-year period (2004–2012). Both incident and prevalent cases of asthma were included, with the most recently recorded asthma diagnosis designated as the index date. The 12-month period following the index date was analysed for asthma exacerbations, defined as an event requiring treatment with systemic corticosteroid or resulting in an asthma-related hospitalisation or emergency department visit. Results Data from 734,114 children with asthma (41.5 % females, 58.5 % males) were analysed, of this cohort 34.4 % experienced ≥ 1 exacerbation during the follow-up period. The proportion who experienced ≥ 1 exacerbation increased from 28.9 % in 2004 to 36.3 % in 2012, based on the reported index date. Their mean annual exacerbation frequency was 1.4; 85.8 % of exacerbations were defined by systemic corticosteroids use. A consistent trend of increased exacerbation incidence in the fall and early winter was observed, in particular exacerbations defined by systemic corticosteroid use. A greater proportion of asthma-related hospitalisations were associated with younger age. Conclusions Approximately one-third of children experienced ≥ 1 exacerbation in real-world clinical practice. A targeted treatment approach with a focus on those with a history of recurrent exacerbations is recommended to improve asthma control. This targeted approach could also minimise the frequent systemic corticosteroid exposure particularly at an early age when side effects of systemic corticosteroids are more pronounced.
Collapse
Affiliation(s)
- Robert Y Suruki
- UCB Biosciences Inc., 8010 Arco Corporate Drive, Raleigh, NC 27617 USA
| | - Nada Boudiaf
- GSK, Worldwide Epidemiology, Stockley Park West, Uxbridge, Middlesex UK
| | | |
Collapse
|
17
|
Pouessel G, Beaudouin E, Renaudin JM, Moneret-Vautrin AM, Deschildre A. Adherence to the guidelines for adrenaline auto-injector prescription should be improved. Pediatr Allergy Immunol 2016; 27:430-3. [PMID: 26845628 DOI: 10.1111/pai.12546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Pouessel
- Department of Pediatrics, Children's Hospital, Roubaix, France. .,Allergy Vigilance Network, Vandoeuvre les Nancy, France. .,Pediatric Pulmonology and Allergy Department, Pôle enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France.
| | - E Beaudouin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Department of Allergology, Emile Durkheim Hospital, Epinal, France
| | - J M Renaudin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Department of Allergology, Emile Durkheim Hospital, Epinal, France
| | - A M Moneret-Vautrin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Department of Allergology, Emile Durkheim Hospital, Epinal, France
| | - A Deschildre
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Pediatric Pulmonology and Allergy Department, Pôle enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France
| | | |
Collapse
|
18
|
Brand PLP, Mäkelä MJ, Szefler SJ, Frischer T, Price D. Monitoring asthma in childhood: symptoms, exacerbations and quality of life. Eur Respir Rev 2016; 24:187-93. [PMID: 26028631 DOI: 10.1183/16000617.00003614] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Monitoring asthma in children in clinical practice is primarily performed by reviewing disease activity (daytime and night-time symptoms, use of reliever medication, exacerbations requiring frequent use of reliever medication and urgent visits to the healthcare professional) and the impact of the disease on children's daily activities, including sports and play, in a clinical interview. In such an interview, most task force members also discuss adherence to maintenance therapy and the patients' (and parents') views and beliefs on the goals of treatment and the amount of treatment required to achieve those goals. Composite asthma control and quality of life measures, although potentially useful in research, have limited value in clinical practice because they have a short recall window and do not cover the entire spectrum of asthma control. Telemonitoring of children with asthma cannot replace face-to-face follow-up and monitoring because there is no evidence that it is associated with improved health outcomes.
Collapse
Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | |
Collapse
|
19
|
Carrillo G, Han D, Lucio RL, Seol YH, Chong-Menard B, Smith K. Impacting Environmental and Public Health through the Use of Dual Targeted and Tailored Asthma Educational Interventions. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2015; 2015:476173. [PMID: 26240576 PMCID: PMC4512578 DOI: 10.1155/2015/476173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/22/2015] [Indexed: 12/03/2022]
Abstract
Home-based asthma environmental education for parents of asthmatic children is needed since many health professionals lack the time to offer it. However, developing targeted and tailored education is important in order to address the individual needs of participants. This nonrandomized longitudinal study examined knowledge on asthma with an Asthma and Healthy Homes educational intervention training offered to parents of children from low income families who reside in the Rio Grande Valley of Texas. Eighty-nine parents received the training and pre- and posttest surveys were used to measure knowledge outcomes. A standardized assessment on asthma triggers was used to identify the different triggers each child was exposed to, and a follow-up survey was conducted 6 months after the educational intervention to identify how many parents reported household and behavior changes as a result of the training. Results showed significant changes in behavior by participants as a result of the training received. This study suggests that these behavioral changes are attributed to the dual "targeted" and "tailored" educational interventions delivered to parents which resulted in a greater understanding of how to manage asthma by eliminating asthma triggers in their respective homes.
Collapse
Affiliation(s)
- Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M Health Science Center, College Station, TX 77843, USA
| | - Daikwon Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843, USA
| | - Rose L. Lucio
- Texas A&M Health Science Center, McAllen Campus, 2101 South McColl Road, McAllen, TX 78503, USA
| | - Yoon-Ho Seol
- Department of Health Informatics, Georgia Regents University, Augusta, GA 30912-0400, USA
| | - Betty Chong-Menard
- Clinical Education, Respiratory Therapy Program, South Texas College, Dr. Ramiro R. Casso Nursing & Allied Health Campus, 1101 E. Vermont, McAllen, TX 78503, USA
| | - Kenneth Smith
- Respiratory Therapy Services, Rio Grande Regional Hospital, 101 E. Ridge Road, McAllen, TX 78503, USA
| |
Collapse
|
20
|
Hasegawa K, Ahn J, Brown MA, Press VG, Gabriel S, Herrera V, Bittner JC, Camargo CA, Aurora T, Brenner B, Calhoun W, Gough JE, Gutta RC, Heidt J, Khosravi M, Moore WC, Mould-Millman NK, Nonas S, Nowak R, Ahn J, Pei V, Probst BD, Ramratnam SK, Tallar M, Snipes C, Teuber SS, Trent SA, Villarreal R, Watase T, Youngquist S. Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit: a multicenter observational study. Ann Allergy Asthma Immunol 2015; 115:10-6.e1. [DOI: 10.1016/j.anai.2015.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/02/2015] [Accepted: 05/11/2015] [Indexed: 12/31/2022]
|
21
|
Al-Muhsen S, Horanieh N, Dulgom S, Aseri ZA, Vazquez-Tello A, Halwani R, Al-Jahdali H. Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children. Ann Thorac Med 2015; 10:123-31. [PMID: 25829964 PMCID: PMC4375741 DOI: 10.4103/1817-1737.150735] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department (ED) visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable. OBJECTIVE: The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children. METHODS: Asthmatic children (n = 297) between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals. RESULTS: Asthmatic patients visited the ED 3.9 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients (56.4%) reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available (40.9%), or that the ED staff is better qualified (27.8%). About half of patients (48.2%) visited the ED because of the convenience of being open 24 hours, or because they are received immediately (38.4%). Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better (OR:0.55; 95% CI:0.3-0.9; P = 0.04). CONCLUSION: This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and their parents/guardians.
Collapse
Affiliation(s)
- Saleh Al-Muhsen
- Prince Naif Center for Immunology Research and Asthma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nour Horanieh
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Said Dulgom
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zohair Al Aseri
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alejandro Vazquez-Tello
- Prince Naif Center for Immunology Research and Asthma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Prince Naif Center for Immunology Research and Asthma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Department of Medicine, Pulmonary Division-ICU, King Saud University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
22
|
Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
Collapse
Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
23
|
El Mahdi Boubkraoui M, Benbrahim F, Assermouh A, El Hafidi N, Benchekroun S, Mahraoui C. [Epidemiological profile and management of asthma exacerbations in children at the Rabat Children Hospital in Morocco]. Pan Afr Med J 2015; 20:73. [PMID: 26090031 PMCID: PMC4450034 DOI: 10.11604/pamj.2015.20.73.4031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 01/25/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Méthodes Résultats Conclusion
Collapse
Affiliation(s)
- Mohamed El Mahdi Boubkraoui
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Fadoua Benbrahim
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Abdellah Assermouh
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Naima El Hafidi
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Soumia Benchekroun
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Chafiq Mahraoui
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| |
Collapse
|
24
|
Kuhlen JL, Wahlquist AE, Nietert PJ, Bains SN. Identification of asthma phenotypes in a tertiary care medical center. Am J Med Sci 2014; 348:480-5. [PMID: 25319436 PMCID: PMC4482360 DOI: 10.1097/maj.0000000000000346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma affects 5% to 10% of the population and its severity is assessed using 4 parameters: lung function, symptom frequency, rescue inhaler use, and number of asthma exacerbations. Asthma is increasingly recognized as a clinical syndrome rather than a single disease. However, the current classification system fails to reflect the heterogeneous characteristics of the disease. METHODS A retrospective chart review of 139 patients with mild, moderate, and severe persistent asthma was performed. Variables including baseline and maximal forced expiratory volume over first second (percent predicted), and age of asthma onset were used to classify patients. RESULTS This yielded 5 clusters similar to Severe Asthma Research Program (SARP). Subjects in cluster 1 (n = 32) and cluster 2 (n = 47) had early-onset atopic asthma and reduced lung function but differed in medication requirement and health care utilization. Cluster 3 (n = 32) consisted of older obese women with late-onset asthma, less atopy, and mildly reduced forced expiratory volume over first second. Members of cluster 4 (n = 20) and cluster 5 (n = 8) had atopic asthma with severe obstruction but differed in bronchodilator response, age of onset, and oral corticosteroid use. Compared with SARP, our subjects were older, had a higher percentage of African Americans and obesity, and less severe asthma (P < 0.05). The observed clusters differed from SARP clusters in the following: (1) more frequent asthma exacerbations and medication use among cluster 1 and cluster 2; (2) lower medication use in cluster 3 and cluster 4; (3) although total health care utilization was similar, there were fewer emergency department visits in cluster 3 (P < 0.05). CONCLUSIONS The SARP algorithm may be used to classify diverse asthmatic populations into a clinically reproducible phenotypic cluster.
Collapse
Affiliation(s)
- James L Kuhlen
- Departments of Medicine (JLK) and Public Health Sciences (AEW, PJN), Medical University of South Carolina, Charleston, South Carolina; and Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine (SNB), Medical University of South Carolina, Charleston, South Carolina
| | | | | | | |
Collapse
|
25
|
Rodríguez-Martínez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Predictors of hospitalization for asthma in children: results of a 1-year prospective study. Pediatr Pulmonol 2014; 49:1058-64. [PMID: 24376022 DOI: 10.1002/ppul.22936] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 08/30/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although hospital admissions for pediatric asthma constitute a significant problem in high-income countries, they are an even greater health problem in low- and middle-income countries (LMIC). However, previous studies that aimed to identify predictors of hospital admission for asthma in children have mainly been conducted in high-income countries, and these findings might not be applicable to LMIC. METHODS In a prospective cohort study, we aimed to identify predictors of hospital admission for asthma, including measures of parental knowledge about asthma and maternal depression level, in a population of children aged 1-18 years living in urban Bogota, Colombia hospitalized for acute asthma symptoms, over a 6-month period. RESULTS Out of the total of 101 included patients, 37 (36.6%) had at least one hospital admission for asthma during the year following admission. After controlling for the age of the patients, dog ownership in the previous 12 months, asthma severity variables in the previous 6 months, maternal allergic rhinitis, level of maternal education, and measures of parental knowledge about asthma and maternal depression level, we found that maternal smoking (IRR, 3.12; 95% confidence interval [95% CI], 1.12-8.68; P = 0.029) was the only independent predictor of hospital admissions due to asthma exacerbations in the year following admission to the study. CONCLUSIONS In a population of asthmatic Latino children admitted to hospital for an asthma exacerbation, approximately one-third of the patients had at least one hospital admission for asthma during the year following admission, and maternal smoking was the only independent predictor of these hospitalizations.
Collapse
Affiliation(s)
- Carlos E Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Research Unit, Military Hospital of Colombia, Bogota, Colombia
| | | | | |
Collapse
|
26
|
Sauvaget E, Bresson V, Oudyi M, Bosdure E, Loundou AD, Chabrol B, Charrel R, Dubus JC. [Value of routine identification of respiratory infectious agents in children hospitalized with an acute asthma exacerbation]. Arch Pediatr 2014; 21:1173-9. [PMID: 25284733 PMCID: PMC7133295 DOI: 10.1016/j.arcped.2014.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 07/09/2014] [Accepted: 08/21/2014] [Indexed: 11/18/2022]
Abstract
Introduction Chez l’enfant les exacerbations d’asthme sont le plus souvent déclenchées par une infection respiratoire. L’objectif de cette étude était d’évaluer l’intérêt de l’identification des pathogènes respiratoires chez les enfants hospitalisés pour une exacerbation d’asthme. Patients et méthodes Il s’agit d’une étude rétrospective incluant tout enfant hospitalisé pour une exacerbation d’asthme dans notre unité entre janvier 2010 et décembre 2011 et analysant la prescription des examens microbiologiques, leurs indications, leur rendement, leur impact sur la prise en charge médicale et leur coût. Résultats Cent quatre-vingt-dix-sept enfants ont été inclus. Une recherche d’agent pathogène respiratoire avait été réalisée chez 157 enfants (79,7 %), surtout en cas d’infection oto-rhino-laryngologique (ORL), d’hypoxémie ou de pneumonie. Un virus avait été identifié chez 30 (23,8 %) des 126 enfants prélevés. Les analyses bactériologiques avaient eu un rendement faible puisque seulement 3,2 % des analyses par amplification génique (PCR) pour Mycoplasma pneumoniae avaient été positives (n = 4/125). Aucune autre bactérie n’avait été identifiée. Aucun lien n’a pu être établi entre les résultats microbiologiques et la gravité de l’exacerbation. La prise en charge thérapeutique avait été peu modifiée par ces résultats. Le coût global avait été de plus de 40 400 euros pour les 2 ans d’étude. Conclusion D’après nos résultats la recherche de pathogènes respiratoires au cours des exacerbations d’asthme a un intérêt modéré en dehors de l’aspect épidémiologique. L’impact du rhinovirus, du coronavirus, du bocavirus et de l’entérovirus, non recherchés en routine hospitalière, reste cependant à préciser.
Collapse
Affiliation(s)
- E Sauvaget
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - V Bresson
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - M Oudyi
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - E Bosdure
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - A-D Loundou
- Unité d'aide méthodologique à la recherche clinique, laboratoire de santé publique, faculté de médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex, France
| | - B Chabrol
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - R Charrel
- UMR_D 190 « émergence des pathologies virales », institut de recherche pour le développement (IRD), école des hautes études en santé publique (EHESP) & IHU méditerranée infection, hôpitaux de Marseille, Aix Marseille université, AP-HM, 13005 Marseille, France
| | - J-C Dubus
- Service de spécialités pédiatriques et de médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| |
Collapse
|
27
|
Halterman JS, Fagnano M, Tremblay PJ, Fisher SG, Wang H, Rand C, Szilagyi P, Butz A. Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial. JAMA Pediatr 2014; 168:e141983. [PMID: 25288141 PMCID: PMC4232370 DOI: 10.1001/jamapediatrics.2014.1983] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care. OBJECTIVE To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial in which 12 urban primary care practices were matched based on size and type and randomly allocated to the PAIR-UP intervention or usual care (UC). We enrolled 638 children aged 2 to 12 years with persistent or poorly controlled asthma in the waiting room prior to a visit with a clinician for any reason from October 2009 to January 2013. Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit and called them 2 and 6 months later to assess symptoms. INTERVENTIONS Children enrolled at PAIR-UP practices received prompts for the caregiver and clinician at the time of the visit that outlined the child's asthma severity or control as well as specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. The UC practices received copies of the asthma guidelines. MAIN OUTCOMES AND MEASURES The primary outcome was symptom-free days (SFDs) per 2 weeks at the 2-month follow-up. RESULTS We enrolled 638 children (participation rate of 80%; 36% were black, 36% were Hispanic, and 68% had Medicaid insurance). Groups were similar in demographic characteristics and asthma severity at baseline. At the index visit, more children in the PAIR-UP group received a preventive medication action (new medication, increased dose, recommendation to restart preventive medication) than in the UC group (58% vs 33%; odds ratio [OR] = 2.8; 95% CI, 1.9 to 3.9). More children in the PAIR-UP group than in the UC group received an asthma action plan (61% vs 23%; OR = 8.3; 95% CI, 3.7 to 18.7), discussions regarding asthma (93% vs 78%; OR = 4.5; 95% CI, 2.8 to 7.2), and secondhand smoke counseling (80% vs 63%; OR = 2.6; 95% CI, 1.2 to 5.5). At the 2-month follow-up, children in the PAIR-UP group had more SFDs per 2 weeks than those in the UC group (mean difference, 0.78 days; 95% CI, 0.29 to 1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference, 0.56; 95% CI, -0.14 to 1.25). CONCLUSIONS AND RELEVANCE The PAIR-UP intervention improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma at 2 months, but the improvement in SFDs was no longer significant at 6 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01105754.
Collapse
Affiliation(s)
- Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul J. Tremblay
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Susan G. Fisher
- Department of Clinical Sciences, Temple University, Philadelphia, PA
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Cynthia Rand
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Peter Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Arlene Butz
- Pediatrics, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
28
|
Deschildre A, Pin I, El Abd K, Belmin-Larrar S, El Mourad S, Thumerelle C, Le Roux P, Langlois C, de Blic J. Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating. Allergy 2014; 69:784-90. [PMID: 24725204 DOI: 10.1111/all.12402] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. AIM To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. METHODS Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. RESULTS Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled. CONCLUSION We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.
Collapse
Affiliation(s)
- A. Deschildre
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - I. Pin
- Pédiatrie, Pôle Couple Enfants, CHU de Grenoble; INSERM U823; Institut Albert Bonniot; Université Joseph Fourier; Grenoble France
| | - K. El Abd
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
- Pédiatrie; CHC Espérance - Montegnée; Liège Belgium
| | - S. Belmin-Larrar
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
| | - S. El Mourad
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - C. Thumerelle
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - P. Le Roux
- Pédiatrie, groupe hospitalier du Havre; Le Havre France
| | - C. Langlois
- Département de biostatistiques, CHRU de Lille; Université Nord de France; Lille France
| | - J. de Blic
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
| |
Collapse
|
29
|
Brand PLP, Klok T, Kaptein AA. Using communication skills to improve adherence in children with chronic disease: the adherence equation. Paediatr Respir Rev 2013; 14:219-23. [PMID: 23434178 DOI: 10.1016/j.prrv.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nonadherence to maintenance medication is common in paediatric chronic conditions. Despite the common belief that nonadherence is therapy-resistant, and the apparent lack of evidence for successful interventions to improve adherence, there is, in fact, a considerable body of evidence suggesting that adherence can be improved by applying specific communicative consultation skills. These can be summarized as the adherence equation: adherence=follow-up+dialogue+barriers and beliefs+empathy and education => concordance. Close follow-up of children with a chronic condition is needed to establish a therapeutic partnership with the family. Teaching self management skills is not a unidirectional process of providing information, but requires a constructive and collaborative dialogue between the medical team and the family. Identifying barriers to adherence can be achieved in a non-confrontational manner, by showing a genuine interest what the patient's views and preferences are. In particular, parental illness perceptions and medication beliefs should be identified, because they are strong drivers of nonadherence. Through empathic evidence-based education, such perceptions and beliefs can be modified. By applying these strategies, concordance between the child's family and the medical team can be achieved, resulting in optimal adherence to the jointly created treatment plan.
Collapse
Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre Groningen, the Netherlands.
| | | | | |
Collapse
|
30
|
Harrington KF, Haven KM, Nuño VL, Magruder T, Bailey WC, Gerald LB. Parent report and electronic medical record agreement on asthma education provided and children's tobacco smoke exposure. J Asthma 2013; 50:968-74. [PMID: 23883356 DOI: 10.3109/02770903.2013.828303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the concordance between parent report and electronic medical record documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma. METHODS Parents of children with asthma were recruited from two types of clinics using different electronic medical record systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medical records for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types. RESULTS Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (κ = 0.410 versus 0.205), asthma diagnosis/disease process (κ = 0.213 versus -0.016) and devices reviewed (κ = 0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medical records, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere. CONCLUSIONS We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.
Collapse
Affiliation(s)
- Kathleen F Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama , Birmingham, AL , USA
| | | | | | | | | | | |
Collapse
|
31
|
Delmas MC, Marguet C, Raherison C, Nicolau J, Fuhrman C. [Admissions for pediatric asthma in France]. Arch Pediatr 2013; 20:739-47. [PMID: 23731604 DOI: 10.1016/j.arcped.2013.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/08/2013] [Accepted: 04/20/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database. METHODS We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age<15years) between 2002 and 2010 in France (excluding French Guyana). RESULTS In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010. CONCLUSION The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.
Collapse
Affiliation(s)
- M-C Delmas
- Département des maladies chroniques, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | | | | | | | | |
Collapse
|
32
|
Wolfe I, Thompson M, Gill P, Tamburlini G, Blair M, van den Bruel A, Ehrich J, Pettoello-Mantovani M, Janson S, Karanikolos M, McKee M. Health services for children in western Europe. Lancet 2013; 381:1224-34. [PMID: 23541056 DOI: 10.1016/s0140-6736(12)62085-6] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of suffering are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany offer further insights into chronic care services in different health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of first-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible first-contact models in which child health professionals work closely together could offer a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems-practice (chronic care models, first-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and analysis of data, scale-up of child health research, anticipation of future child health needs), and policy (translation of high-level goals into actionable policies, open and transparent accountability structures, political commitment to delivery of improvements in child health and equity throughout Europe).
Collapse
Affiliation(s)
- Ingrid Wolfe
- European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Myles P, Nguyen-Van-Tam JS, Semple MG, Brett SJ, Bannister B, Read RC, Taylor BL, McMenamin J, Enstone JE, Nicholson KG, Openshaw PJ, Lim WS. Differences between asthmatics and nonasthmatics hospitalised with influenza A infection. Eur Respir J 2012; 41:824-31. [PMID: 22903963 PMCID: PMC3612580 DOI: 10.1183/09031936.00015512] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Asthmatics hospitalised because of influenza A infection are less likely to
require intensive care or die compared with nonasthmatics. The reasons for this
are unknown. We performed a retrospective analysis of data on 1520 patients admitted to 75 UK
hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model
was used to investigate reasons for the association between asthma and severe
outcomes (intensive care unit support or death). Asthmatics were less likely than nonasthmatics to have severe outcome
(11.2% versus 19.8%, unadjusted OR 0.51,
95% CI 0.36–0.72) despite a greater proportion requiring
oxygen on admission (36.4% versus 26%,
unadjusted OR 1.63) and similar rates of pneumonia (17.1%
versus 16.6%, unadjusted OR 1.04). The results
of multivariable logistic regression suggest the association of asthma with
outcome (adjusted OR 0.62, 95% CI 0.36–1.05;
p=0.075) are explained by pre-admission inhaled corticosteroid use
(adjusted OR 0.34, 95% CI 0.18–0.66) and earlier
admission (≤4 days from symptom onset) (adjusted OR 0.60,
95% CI 0.38–0.94). In asthmatics, systemic corticosteroids
were associated with a decreased likelihood of severe outcomes (adjusted OR
0.36, 95% CI 0.18–0.72). Corticosteroid use and earlier hospital admission explained the association of
asthma with less severe outcomes in hospitalised patients.
Collapse
|
34
|
Abstract
HDM allergy is associated with asthma, allergic rhinitis and atopic dermatitis. In many countries childhood asthma is predominantly found in HDM-allergic children with their probability of developing disease being proportional to their IgE antibody titers and the early development of Th2 responses. While the pathogenesis is complex and increasingly linked to infection the immunologically-based allergen immunotherapy and anti-IgE antibody therapy are highly beneficial. Immunotherapy could be a short-term treatment providing lifelong relief but the current regimens depend on repeated administration of allergen over years. Immunological investigations point to a contribution of responses outside the Th2 pathway and multiple potential but unproven control mechanisms. Over half of the IgE antibodies are directed to the group 1 and 2 allergens with most of remainder to the group 4, 5, 7 and 21 allergens. This hierarchy found in high and low responders provides a platform for introducing defined allergens into immunotherapy and defined reagents for investigation.
Collapse
Affiliation(s)
- Wayne R Thomas
- Centre for Child Health Research, University of Western Australia. wayne @ichr.uwa.edu.au
| |
Collapse
|