1
|
Gonsard A, Giovannini-Chami L, Cros P, Masson A, Menetrey C, Mordacq C, Cisterne C, Personnic J, Roy C, Poirault C, Abou Taam R, Hadchouel A, Pirojoc A, Delacourt C, Drummond D. Home use of short-acting beta agonists by children with asthma: a multicentre digital prospective study. Arch Dis Child 2025:archdischild-2024-327447. [PMID: 40169179 DOI: 10.1136/archdischild-2024-327447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 03/17/2025] [Indexed: 04/03/2025]
Abstract
OBJECTIVE To investigate real-life salbutamol use by children with asthma at home and compare it with their written asthma action plans (WAAPs). DESIGN Multicentre, observational prospective study. SETTING Five tertiary care hospitals in France. PATIENTS 120 children aged 3-11 years with asthma. INTERVENTIONS Parents used a smartphone application connected to a smart inhaler via Bluetooth to record salbutamol use and answer questionnaires about their child's asthma symptoms over 6 months. MAIN OUTCOME MEASURES The primary outcome was the median number of salbutamol puffs used in the first 2 hours after an asthma symptom occurred, depending on symptom type. Secondary outcomes included how families operationalised WAAP instructions and the proportion who administered more or less salbutamol than prescribed. RESULTS 43 families used the smart inhaler for asthma symptoms, recording 124 episodes of salbutamol use. The median number of puffs used in the first 2 hours was 3 (IQR 2-4, range 1-26), varying between 2 and 4 depending on the initial symptom type. The number of puffs used did not differ significantly between episodes with and without symptom resolution. 18 (42%) families used a number of salbutamol puffs similar to that in their WAAP, while 21 (49%) used fewer and only 4 (9%) used more. CONCLUSIONS Families typically use 2-4 puffs of salbutamol in the first 2 hours after an asthma symptom. Adjusting WAAPs to start with 2-4 puffs of salbutamol, to be repeated if necessary, would be more in line with family practice, and effective in most situations. TRIAL REGISTRATION NUMBER NCT04810169.
Collapse
Affiliation(s)
- Apolline Gonsard
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Lisa Giovannini-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, France
| | - Pierrick Cros
- Department of Paediatrics, University and Regional Hospital Centre Brest, Brest, Bretagne, France
| | | | | | | | | | | | - Charlotte Roy
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Clément Poirault
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Rola Abou Taam
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Alice Hadchouel
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandra Pirojoc
- Clinical Research Unit, University Hospital Necker-Enfants Malades, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
- Department HeKA Inserm UMR 1138, Centre de Recherche des Cordeliers, Paris, France
| |
Collapse
|
2
|
Yeung TY, Ewing C, Malanowska A, Zuberbuhler P, Balcom M, Liu J, Amirav I. Home Management of Childhood Asthma Exacerbations. Pulm Ther 2018; 4:149-157. [PMID: 32026392 PMCID: PMC6966973 DOI: 10.1007/s41030-018-0061-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Effective home management of childhood asthma by caregivers requires education along with a written asthma action plan (AAP), which should outline clear instructions for treatment during exacerbations. However, a large number of asthma exacerbations continue to be managed in the emergency department (ED) and in hospitals, particularly in Canada. The objective of this study was to assess caregiver management of acute asthma at home following the 2015 Global Initiative for Asthma (GINA) guidelines and to identify factors that may be associated with deviations from these guidelines. Methods 122 caregivers of children, aged 3–17 years, with physician diagnosed asthma, completed a paper-based questionnaire. Correct caregiver management (defined according to the GINA guidelines) of acute asthma as well as their use of an AAP were assessed. Results Out of all caregivers, 74.6% incorrectly treated their child’s asthma exacerbation in a home setting. Among those who used an AAP, we observed significantly more ED visits (0.9 ± 1.2 versus 0.5 ± 0.9, p = 0.04) and hospitalizations (0.2 ± 0.4 versus 0.0 ± 0.0, p = 0.02) when compared to non-AAP users in the past 1 year. Conclusions Caregivers of children with asthma in Canada may still lack skills for proper home management of asthma exacerbations. We found a higher number of ED visits and hospitalizations in those using an AAP compared to those who did not use an AAP. These data suggest that current AAPs may not be sufficient for home asthma management. Electronic supplementary material The online version of this article (10.1007/s41030-018-0061-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Telford Y Yeung
- Stollery Pediatric Pulmonary Clinic, 8440 112 Street, Edmonton, AB, Canada.,Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, Canada
| | | | - Anna Malanowska
- Stollery Pediatric Pulmonary Clinic, 8440 112 Street, Edmonton, AB, Canada
| | | | - Michelle Balcom
- Stollery Pediatric Pulmonary Clinic, 8440 112 Street, Edmonton, AB, Canada
| | - Janny Liu
- Stollery Pediatric Pulmonary Clinic, 8440 112 Street, Edmonton, AB, Canada
| | - Israel Amirav
- Stollery Pediatric Pulmonary Clinic, 8440 112 Street, Edmonton, AB, Canada. .,Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, Canada.
| |
Collapse
|
3
|
Mudd SS, Ogborn CJ, Bollinger ME, Morphew T, Kub J, Lewis-Land C, Bellin MH, Butz A. Parental decision making associated with pediatric emergency department use for asthma. Ann Allergy Asthma Immunol 2016; 117:490-494. [PMID: 27788877 PMCID: PMC5117360 DOI: 10.1016/j.anai.2016.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Disadvantaged minority children are disproportionately affected by asthma. This group is also known to frequently use the emergency department (ED) for asthma care. Understanding decisions for use of the ED is important to prevent high cost. OBJECTIVE To examine caregiver factors associated with the decision to use the ED for asthma care in inner-city children with asthma. METHODS One hundred fifty participants in a randomized clinical trial testing the effectiveness of a home-based asthma intervention were enrolled, and questionnaires were administered to caregivers during the child's ED asthma visit. Sociodemographics, health characteristic data, and caregiver interview data were examined to ascertain factors that affected caregiver decision making to use the ED for asthma care. A cluster analysis was performed to correlate caregiver reasons for the decision to use the ED for asthma care. RESULTS Three clusters emerged for decision making: urgency, preference for the use of the ED, and access to care issues. The perception of urgency was the most common reason reported by caregivers (91%) followed by reporting a preference for the ED for care (37%) and reporting access to care issues (31%). Access to care was primarily attributable to the inability to get a same-day appointment with their primary care practitioner (24%). CONCLUSION The caregiver factors involved in the decision to use the ED can provide a basis for further intervention and investigation. Such factors include caregiver asthma home management, improvement in relationships with primary care practitioners, and access to care-related issues.
Collapse
Affiliation(s)
- Shawna S Mudd
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.
| | - C Jean Ogborn
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Joan Kub
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Cassie Lewis-Land
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa H Bellin
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
4
|
Ducharme FM, Jensen ME, Mendelson MJ, Parkin PC, Desplats E, Zhang X, Platt R. Asthma Flare-up Diary for Young Children to monitor the severity of exacerbations. J Allergy Clin Immunol 2015; 137:744-9.e6. [PMID: 26341275 DOI: 10.1016/j.jaci.2015.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/18/2015] [Accepted: 07/03/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Few instruments exist to ascertain the severity of a preschool-aged child's asthma exacerbations managed at home. OBJECTIVE We sought to develop and validate a functional status instrument to assess asthma exacerbation severity in preschoolers. METHODS The parent-completed Asthma Flare-up Diary for Young Children (ADYC), which was developed systematically, comprises 17 items, each scored from 1 (best) to 7 (worst). The ADYC was completed daily from the onset of an upper respiratory tract infection (URTI) until asthma symptom resolution; the cumulative daily score was reported. The ADYC was examined for key psychometric properties in a randomized placebo-controlled trial of pre-emptive high-dose fluticasone in preschoolers with URTI-induced asthma. RESULTS In 121 children aged 2.7 ± 1.1 years (59.5% male), the ADYC's internal consistency (Cronbach α = .97), feasibility (97% completion), and test-retest reliability (r = 0.71; 95% CI, 0.59-0.80) were demonstrated. The ADYC was responsive to change between 2 consecutive days (Guyatt statistic = 0.77) with a minimal important difference of 0.22 (0.17-0.27). Of 871 episodes, the cumulative ADYC score was significantly higher during exacerbations than during URTIs (mean difference [MD], 7.6; 95% CI, 6.4-8.9) and for exacerbations with an acute-care visit (MD, 9.1; 95% CI, 7.6-10.7), systemic corticosteroids (MD, 10.1; 95% CI, 8.3-12.0), and hospitalization (MD, 6.8; 95% CI, 2.9-10.7) versus those without. In children receiving fluticasone, the ADYC score was significantly lower versus that in the placebo group (MD, 5.1; 95% CI, 1.8-8.3). CONCLUSIONS The 17-item ADYC proved feasible, responsive to day-to-day changes, and discriminative across exacerbations of different severities. In a trial testing effective therapy in preschoolers, it identified a significant reduction in asthma exacerbation severity.
Collapse
Affiliation(s)
- Francine M Ducharme
- Departments of Pediatrics and Social and Preventive Medicine, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada; Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada.
| | - Megan E Jensen
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada
| | | | - Patricia C Parkin
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eve Desplats
- Unité de recherche clinique appliquée, Research Center, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Harrington KF, Zhang B, Magruder T, Bailey WC, Gerald LB. The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:20-26. [PMID: 25852967 DOI: 10.1089/ped.2014.0379] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/17/2014] [Indexed: 11/12/2022]
Abstract
Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider (p=0.007) and the ACQ (p=0.013), despite only moderate concordance between ratings (ρ=0.408, p<0.0001). Lower parent health literacy also was associated with less asthma knowledge, which was associated with worse asthma control. Conclusions: Higher parent health literacy was associated with more parent asthma knowledge and better child asthma control. Pediatric providers should consider tailoring education or treatment plans or utilizing universal precautions for low health literacy.
Collapse
Affiliation(s)
- Kathleen F Harrington
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Teresa Magruder
- Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - William C Bailey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health and the Arizona Respiratory Center, University of Arizona , Tucson, Arizona
| |
Collapse
|