Parental knowledge and attitudes regarding asthma in their children: Impact of an educational intervention in an Indian population

Perceptions, practices, and experiences of asthma patients and community pharmacists on short-acting beta-2 agonists inhaler use: A qualitative study

Background

Short-acting beta-2 agonists (SABA) are bronchodilators that offer rapid relief for asthma patients experiencing acute symptoms. The availability of SABA inhalers without a prescription may exacerbate the overuse of SABA. This study aimed to explore the perceptions, practices, and experiences of asthma patients and community pharmacists toward using SABA inhalers in Malaysia.

Methods

A qualitative study was conducted among eleven asthma patients and twelve community pharmacists using semi-structured individual interviews. All interviews were audio-recorded and transcribed verbatim and then analyzed by thematic analysis. The findings were reported using the COREQ checklist.

Results

Thematic analysis yielded eight major themes, (1) perceptions and understanding of good asthma control; (2) perceptions and experience towards asthma follow-up review; (3) perceptions of SABA's reliance; (4) practices towards the proper use of inhalers; (5) over-the-counter availability of SABA inhalers; (6) provision of pharmacists in SABA use assessment; (7) patients-healthcare professionals communication; and (8) recommendations for policymakers.

Conclusion

Most asthma patients and community pharmacists agreed that good asthma control was associated with reduced SABA usage and minimum asthma symptoms. The majority of patients claimed that visiting physicians for asthma follow-up reviews was unnecessary. Moreover, community pharmacists have raised concerns regarding patients' reliance on SABA inhalers due to the immediate relief effects, however, the majority of interviewed patients claimed that they did not rely on SABA inhalers. Additionally, community pharmacists were generally concerned about the frequency, dosage, and techniques using SABA inhalers. These concerns need to be addressed to improve the safe use of SABA inhalers. Language barriers, health literacy, long waiting times, and public education were the most important believed determinants of the safe use of SABA inhalers.

Effect of maternal knowledge of asthma management on quality of life and asthma control among children with asthma: a cross-sectional study

OBJECTIVE

This study aimed to evaluate the effect of mothers' knowledge about asthma management on quality of life and asthma control among children with asthma in Palestine.

METHODS

This cross-sectional study was carried out by mothers of children with asthma in Palestine in four major public hospitals. Mothers of a total of 220 were selected randomly via a computerized system. Data were collected using Pediatric Asthma Quality of Life (PAQLQ), an Asthma Control Test (ACT), and the mothers' Self-Practices and Knowledge (SPK) of asthma management questionnaire. Statistical analysis was performed using SPSS (V25).

RESULTS

A total of 220 mothers of children with asthma were randomly selected and invited to participate but 182 agreed to participate, with a response rate of 83%. The mean age of participant children was 9.7 ± 2.72 years, and the mean age of mothers was 34.5 ± 9.6 years. The mean score of the QoL was 3.91(SD ± 1.61) out of 7. Most participant children had uncontrolled asthma with a total mean score of 14.13(SD ± 5.23) on the ACT. The mean score of mothers' SPK level was 2.12(SD ± 0.83) with a total mean score of 42.13 ± 3.68 out of 68, which indicated a moderate level of knowledge and there was a strong correlation between mothers' SPK and children's QoL.

CONCLUSIONS

The investigation showed that mothers of children with asthma had moderate SPK, and the children had uncontrolled asthma with poor QoL. These findings suggest developing educational initiatives to enhance parents' asthma-related knowledge and skills to improve their children's asthma-related quality of life and asthma control.

European Respiratory Society statement on preschool wheezing disorders: updated definitions, knowledge gaps and proposed future research directions

Since the publication of the European Respiratory Society (ERS) task force reports on the management of preschool wheezing in 2008 and 2014, a large body of evidence has accumulated suggesting that the clinical phenotypes that were proposed (episodic (viral) wheezing and multiple-trigger wheezing) do not relate to underlying airway pathology and may not help determine response to treatment. Specifically, using clinical phenotypes alone may no longer be appropriate, and new approaches that can be used to inform clinical care are needed for future research. This ERS task force reviewed the literature published after 2008 related to preschool wheezing and has suggested that the criteria used to define wheezing disorders in preschool children should include age of diagnosis (0 to <6 years), confirmation of wheezing on at least one occasion, and more than one episode of wheezing ever. Furthermore, diagnosis and management may be improved by identifying treatable traits, including inflammatory biomarkers (blood eosinophils, aeroallergen sensitisation) associated with type-2 immunity and differential response to inhaled corticosteroids, lung function parameters and airway infection. However, more comprehensive use of biomarkers/treatable traits in predicting the response to treatment requires prospective validation. There is evidence that specific genetic traits may help guide management, but these must be adequately tested. In addition, the task force identified an absence of caregiver-reported outcomes, caregiver/self-management options and features that should prompt specialist referral for this age group. Priorities for future research include a focus on identifying 1) mechanisms driving preschool wheezing; 2) biomarkers of treatable traits and efficacy of interventions in those without allergic sensitisation/eosinophilia; 3) the need to include both objective outcomes and caregiver-reported outcomes in clinical trials; 4) the need for a suitable action plan for children with preschool wheezing; and 5) a definition of severe/difficult-to-treat preschool wheezing.

Assessment of acute asthma in children: do parents and healthcare providers speak the same language?

OBJECTIVE

Education and self-management plans enhance parents' self-efficacy in managing their child's asthma symptoms. By understanding how parents recognize and interpret acute asthma symptoms, we can compile patient information using terms that are familiar to parents.

METHOD

Semi-structured interviews were carried out with 27 parents of children with asthma aged 2-12 years. The interviewees were selected from three groups: parents of children admitted for acute asthma, parents of children receiving outpatient asthma care, and parents who had access to a self-management plan. Parents were invited to report symptoms they would associate with acute asthma. Subsequently, parents were queried about their recognition of symptoms from a predefined list and asked to explain how they would assess these symptoms in case their child would experience an attack of acute asthma.

RESULTS

The most frequently reported symptoms for acute asthma were shortness of breath (77.8%) and coughing (63%). Other signs such as retractions, nasal flaring, and wheezing were reported by less than 25% of the parents. All parents recognized shortness of breath, wheezing and gasping for breath from a predefined list of medical terms. Retractions and nasal flaring were recognized by 81.5% and 66.7% of the parents, respectively. Recognizing the medical terms did not necessarily translate into parents being able to explain how to assess these symptoms.

CONCLUSION

Parents and healthcare professionals do not always speak the same language concerning symptoms of acute asthma. This may hamper timely recognition and adequate self-management, highlighting the necessity to adjust current medical information about acute asthma.

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study

OBJECTIVE

We explored Jordanian caregivers' knowledge, attitudes, and practices (KAP) toward asthma in their children.

METHODS

This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants' characteristics were examined using the student-t test and ANOVA.

RESULTS

A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma's clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039).

CONCLUSION

While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

Association of Asthma Control With Caregivers' Knowledge and Practices for Children With Asthma in the Tabuk Region of Saudi Arabia: A Cross-Sectional Study

Introduction Asthma is a chronic heterogeneous inflammatory disease that affects millions of individuals around the globe. Standardized asthma management is crucial to maintain and control the disease. Caregivers are the leading players in managing asthma during childhood. Studies are lacking in the Tabuk region. The aim of this study was to elucidate knowledge levels and common practices of caregivers of pediatric patients with asthma in the Tabuk region of Saudi Arabia and its impact on asthma control. Methodology A validated cross-sectional survey of the population of the Tabuk region was conducted from July 1, 2022, to September 30, 2022. Convenience sampling via an internet-based questionnaire within the study area was deployed, followed by phone interviews. Results  A total of 393 caregivers completed the questionnaire, and the data were analyzed. The median age of asthmatic children was nine years, and most of them were males (60.8%). Most caregivers had a higher education (62.1%). The symptoms of allergic rhinitis were found in almost 80% of children. Pulmonary function tests were performed in 42.5% of children, and only one-third underwent radioallergosorbent (RAST) skin testing. About half the children had an asthmatic attack and an emergency department visit once during the previous 12 months, and most were hospitalized during that period. Most caregivers showed good knowledge (score=7) about symptoms of asthma and factors that could worsen the child's asthma, as well as good asthma control practices (score ≥7). Children with poorly controlled asthma were younger, had significant allergic rhinitis symptoms (30%), and underwent pulmonary function tests (60%). Conclusion  In the Tabuk region, the extent of asthma control was significantly associated with caregivers' knowledge and practices for children with asthma. Future public education campaigns should focus on closing the observed knowledge and practice gaps to reduce the impact of childhood asthma.

Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa

BACKGROUND

Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of 'asthma' defined by symptoms is high compared to 'doctor diagnosed asthma'. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges?

METHODS

The Arksey and O'Malley's framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The 'Preview, Question, Read, Summarise' system was used and a narrative report was used to summarise the findings.

RESULTS

A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening.

CONCLUSION

This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis.

Models of lifelong care for children and adolescents with chronic conditions in low-income and middle-income countries: a scoping review

Globally, non-communicable diseases (NCDs) or chronic conditions account for one-third of disability-adjusted life-years among children and adolescents under the age of 20. Health systems must adapt to respond to the growing burden of NCDs among children and adolescents who are more likely to be marginalised from healthcare access and are at higher risk for poor outcomes. We undertook a review of recent literature on existing models of chronic lifelong care for children and adolescents in low-income and middle-income countries with a variety of NCDs and chronic conditions to summarise common care components, service delivery approaches, resources invested and health outcomes.

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Mothers’ knowledge about childhood asthma influences management practices and disease control, but validating knowledge/practice questionnaires is difficult due to the lack of a gold standard. We hypothesized that Latent Class Analysis (LCA) could help identify underlying mother profiles with similar knowledge/practices. A total of 438 mothers of asthmatic children answered a knowledge/practice questionnaire. Using answers to the knowledge/practice questionnaire as manifest variables, LCA identified two classes: Class 1, “poor knowledge” (33%); Class 2, “good knowledge” (67%). Classification accuracy was 0.96. Mothers in Class 2 were more likely to be aware of asthma-worsening factors and indicators of attacks. Mothers in Class 1 were more likely to prevent exposure to tobacco smoke (91.1% vs. 78.8%, p = 0.005). For attacks, mothers in Class 2 were more likely to go to the emergency department and follow the asthma action plan. Mothers in Class 2 more frequently had a high education level (79.5% vs. 65.2%, p = 0.004). Children in Class 2 more frequently had fully controlled asthma (36.7% vs. 25.9%, p = 0.015) and hospitalizations for attacks in the previous 12 months (24.2% vs. 10.7%, p = 0.003). LCA can help discover underlying mother profiles and plan targeted educational interventions.