COVID-19: Technology-Supported Remote Assessment of Pediatric Asthma at Home

Remote Patient Monitoring and Teleconsultation to Improve Health Outcomes and Reduce Health Care Utilization of Pediatric Asthma (ALPACA Study): Protocol for a Randomized Controlled Effectiveness Trial

BACKGROUND

Childhood asthma is imposing a great financial burden on the pediatric health care system. Asthma costs are directly related to the level of asthma control. A substantial part of these costs may be preventable by the timely and adequate assessment of asthma deterioration in daily life and proper asthma management. The use of eHealth technology may assist such timely and targeted medical anticipation.

OBJECTIVE

This paper describes the Ambulatory Pediatric Asthma Care (ALPACA) study protocol to investigate the effectiveness of an eHealth intervention consisting of remote patient monitoring and teleconsultation integrated into the daily clinical care of pediatric patients with asthma. This intervention aims to reduce health care utilization and costs and improve health outcomes compared to a control group that receives standard care. In addition, this study aims to improve future eHealth pediatric asthma care by gaining insights from home-monitoring data.

METHODS

This study is a prospective randomized controlled effectiveness trial. A total of 40 participants will be randomized to either 3 months of eHealth care (intervention group) or standard care (control group). The eHealth intervention consists of remote patient monitoring (spirometry, pulse oximetry, electronic medication adherence tracking, and asthma control questionnaire) and web-based teleconsultation (video sharing, messages). All participants will have a 3-month follow-up with standard care to evaluate whether the possible effects of eHealth care are longer lasting. During the entire study and follow-up period, all participants will use blinded observational home monitoring (sleep, cough/wheeze sounds, air quality in bedroom) as well.

RESULTS

This study was approved by the Medical Research Ethics Committees United. Enrollment began in February 2023, and the results of this study are expected to be submitted for publication in July 2024.

CONCLUSIONS

This study will contribute to the existing knowledge on the effectiveness of eHealth interventions that combine remote patient monitoring and teleconsultation for health care utilization, costs, and health outcomes. Furthermore, the observational home-monitoring data can contribute to improved identification of early signs of asthma deterioration in pediatric patients. Researchers and technology developers could use this study to guide and improve eHealth development, while health care professionals, health care institutions, and policy makers may employ our results to make informed decisions to steer toward high-quality, efficient pediatric asthma care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05517096; https://clinicaltrials.gov/ct2/show/NCT05517096.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/45585.

Physical activity and asthma symptom control in children during COVID-19 lockdown: A feasibility study

Objective

The aim was to evaluate the impact of the COVID-19 lockdown on physical activity (PA) and asthma symptom control in children.

Methods

We conducted a single-cohort observational study on 22 children with a median age of 9 (8-11) years with a diagnosis of asthma being included in the study. Participants were asked to wear a PA tracker for 3 months; during the same 3-month period, the Paediatric Asthma Diary (PAD) was administered daily and the Asthma Control (AC) Questionnaire together with the mini-Paediatric Asthma Quality of Life (AQoL) Questionnaire administered at weekly intervals.

Results

Compared with the pre-lockdown period, there was a significant reduction in PA levels after the lockdown began. Daily total steps reduced by about 3000 steps (p < 0.001), very active minutes by 9 min (p < 0.001) and fairly active minutes almost halved (p < 0.001); while asthma symptom control marginally improved, with the AC and AQoL score improving by 0.56 (p < 0.005) and 0.47 (p < 0.05), respectively. Further, for those with AC score higher than 1, PA was positively associated with asthma control both before and after the lockdown.

Conclusions

This feasibility study suggests that PA engagement of children with asthma is negatively affected during the pandemic, but the beneficial effect of PA on asthma symptom control potentially sustains even during a lockdown period. These findings emphasize the importance of wearable device to monitor longitudinal PA and thus better management of PA for achieving the best outcome of asthma symptom control.

Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth

The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. This review discusses lessons learned during the pandemic, focusing on provider-to-patient virtual encounters. Recent evidence on education and training, developing and adapting clinical workflows, patient assessment and treatment, and family-centered care is reviewed. Opportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.