Development and cross-sectional validation of the Childhood Asthma Control Test

Asthma control, its related factors, and impact on quality of life among pediatric patients at a tertiary center in Jordan: a cross-sectional study

INTRODUCTION

Pediatric asthma is a common respiratory disease that burdens affected patients, their caregivers, and the entire healthcare system. Uncontrolled asthma ultimately impacts patients' quality of life. There are limited studies examining the factors associated with asthma control and quality of life. Thus, this study aimed to explore factors associated with asthma control and examine the relationship between asthma control and quality of life in children with asthma.

METHODS

A cross-sectional study was conducted from October 2023 to January 2024 at the Jordan University Hospital, including 136 children aged 7-17 diagnosed with asthma. Asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS), and quality of life was evaluated using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).

RESULTS

Only 43.4% of patients had proper asthma control. The average quality of life and MMAS scores were 4.9 ± 1.5 and 4.2 ± 1.9, respectively. Uncontrolled asthma was associated with increased hospital admissions (p = 0.008), sensitivity to cold (p = 0.002), spring weather (p = 0.031), and infections (p = 0.001). Patients with controlled asthma had significantly higher quality of life (p < 0.001), but no significant differences in MMAS scores (p = 0.743). On multivariate analysis, QoL score was a positive predictor of control (p < 0.001), while sensitivity to infections were a negative predictor (p < 0.05).

CONCLUSION

Most pediatric patients with asthma at the Jordan University Hospital had poor asthma control. Quality of life remained a positive predictor of control irrespective of adherence to asthma treatment. This highlights the need for caregivers and physicians to focus greater attention on these cases, given the substantial clinical and social challanages they poses for affected children.

Relationship between the level of asthma control, lung function and bronchodilator response in asthmatic children on inhaled corticosteroids

This study evaluated tools for assessing asthma control in 149 children on inhaled corticosteroids, focusing on the Asthma Control Test (ACT) and the Global Initiative for Asthma criteria (GINAc). It also explored the role of lung function (LF) tests, including spirometry and bronchodilator response (BDR), in identifying uncontrolled asthma. The GINAc identified 65.8% of children as having uncontrolled asthma, compared to 25.9% by the ACT (p<0.001). Spirometry and BDR results did not differ significantly between controlled and uncontrolled asthma groups. However, abnormal LF was more frequent in children with uncontrolled asthma identified by GINAc (18.4%) than in those controlled (5.9%; p = 0.038). In ACT-identified uncontrolled cases, 18.2% had abnormal LF compared to 12.4% with controlled asthma (p=0.360). Similarly, BDR appeared in 17.3% of uncontrolled cases by GINAc and 11.8% in controlled cases, with 25% of ACT-identified uncontrolled cases showing BDR vs. 11.4% in controlled (p=0.037). Findings suggest GINAc detects more cases of uncontrolled asthma than ACT and highlights the potential value of including spirometry and BDR to complement asthma control questionnaires, mainly aiding in identifying controlled asthma cases with underlying abnormal LF or BDR.

Examining the Effects of the Protection Motivation Theory-Based Online Intervention on Improving the Cognitive Behavioral Outcomes of Caregivers of Children With Atopic Diseases: Quasi-Experimental Study

BACKGROUND

The increasing prevalence of pediatric atopic diseases in China poses substantial risks to children's physical health, mental well-being, and quality of life. Cognitive behavioral interventions for caregivers are effective in managing pediatric atopic diseases. Existing interventions are typically siloed and lack integration across the comorbidities of the atopic march. The protection motivation theory (PMT) could provide an integrated cognitive behavioral intervention framework for addressing shared pathophysiological mechanisms and unifying management strategies across atopic diseases, while online interventions offer advantages in accessibility, cost-effectiveness, and scalability, particularly for caregiver-mediated pediatric care.

OBJECTIVE

This study aimed to develop and evaluate a PMT-based cognitive behavioral online (PMT-CBO) intervention for caregivers of children with atopic diseases, assessing its effects on caregivers' protective motivation, behavioral intentions, preventive practices, and children's atopic disease outcomes.

METHODS

A quasi-experimental design was conducted in 3 health care institutions in Hangzhou, China, where 2 health care institutions were assigned to the PMT-CBO group (127/243, 52.3%) and 1 health care institution was assigned to the control group (116/243, 47.7%). Caregivers in the PMT-CBO group received a 4-week structured course comprising 16 online modules delivered via a WeChat mini-program, whereas controls received routine care with verbal education. Primary outcomes included caregivers' PMT dimensions (threat appraisal and coping appraisal), behavioral intentions, and preventive behaviors, and secondary outcomes involved children's symptom severity and medication adherence. The primary outcome scales or questionnaires were designed by the research team, while the secondary outcome scales were derived from established studies. All scales demonstrated good reliability and validity. Intention-to-treat analysis was used.

RESULTS

Compared to the control group, the PMT-CBO group demonstrated significant improvements in overall PMT scores (Z=-6.289; P<.001) and most subdimensions (response efficacy, self-efficacy, threat severity, and response cost, with P<.05), except susceptibility (Z=-1.321; P=.19) and reward appraisals (Z=-0.989; P=.32). In the intervention group, caregivers exhibited stronger intentions and partial behavioral optimization (eg, environmental allergen control, with Z=-3.025; P=.002) and children showed improved medication adherence (Z=-4.457; P<.001) and alleviated eczema (Z=-3.112; P=.002) and allergic rhinitis symptoms (Z=-3.277; P<.001), although no significant differences emerged in asthma control (Z=-.830; P=.41) or food allergy-related caregiver burden (Z=-1.693; P=.09).

CONCLUSIONS

The PMT-CBO intervention enhanced caregivers' motivation and intentions and children's medication adherence and eczema and rhinitis outcomes, with a 91.3% (116/127) completion rate via WeChat's scalable platform. Limited improvements in asthma control and food allergy management implied the future need for additional condition-specific plug-ins, beyond the core PMT-CBO modules. Moreover, merging this PMT-CBO intervention with implementation techniques or ecological frameworks could help address intention-behavior gaps and external barriers, thereby promoting equitable and precision-based allergy care.

Understanding the effectiveness and design of parent-oriented mobile health interventions: a systematic review and narrative synthesis

BACKGROUND

Parents of children with a health condition experience high levels of distress which can have long-term impact on the child and parent. Dyadic interventions have the potential to decrease this distress, however several barriers to access including time constraints have been reported. Mobile health (mHealth) interventions can address several of these barriers.

GOAL

The goal of this systematic review was to review and synthesize the literature examining the effects of parent-oriented mHealth interventions and their content and design.

METHODS

We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central databases from January 2013 to 2023 using a search strategy based on telemedicine and parents/caregivers. Included studies were randomized controlled trials assessing the effect of parent-oriented mHealth interventions on child and parent health. The Cochrane risk-of-bias tool was used to assess for bias in studies. Trial details and design and content features of interventions were extracted. Outcomes were organized using the Van Houtven's Framework for Informal Caregiver Interventions. Results are presented narratively.

RESULTS

Fifty papers pertaining to 49 unique studies met our inclusion criteria. More than half of the studies scored high-risk for bias. Interventions targeted a wide range of pediatric conditions. Intervention type included texting (n = 17) and investigator-developed mobile applications (n = 16). Interventions significantly improved parent psychological health and child health outcomes. Key intervention features and design included the use/application of codesign and a theory-driven intervention.

CONCLUSION

Parent-oriented mHealth interventions identified in this review significantly improved both parent and child health outcomes. Therefore, these interventions have the potential to support parents outside of a clinical setting.

Video directly observed therapy to improve inhaler technique among pediatric patients with persistent asthma

OBJECTIVE

To assess the feasibility of at-home video directly observed therapy (vDOT) among pediatric patients with asthma to learn and retain proper inhaler technique.

METHODS

We conducted a randomized pilot study with 22 children with persistent asthma aged 6-11 years who were newly prescribed an asthma controller inhaler. Patients underwent 1:1 randomization into one group receiving standard inhaler education during clinic and another receiving standard education plus vDOT for 30 days. vDOT is a method by which trained professionals observe patients self-administering medications through a virtual platform to monitor adherence and proper medication use. We measured inhaler technique, age-appropriate Asthma Control Test (ACT) score, symptom-free days, and healthcare utilization in both groups at 3 months.

RESULTS

Median inhaler technique accuracy percentage score was 88% (IQR 66, 100) for vDOT participants compared to 75% (IQR 38, 88) for controls (p = 0.11). Technique errors within the vDOT group included inadequate breath-holding (34%), inadequate breathing technique (29%), incorrect/no shaking of inhaler (22%) and failure to rinse mouth (15%). There was no difference between groups in change in ACT score, resource utilization or controller prescription refill rates. In the first 30 days, the median number of days until vDOT participants had no observed technique errors was 10 days (range 0-25).

CONCLUSION

vDOT is a viable technique to provide initial and continual education and real-time feedback on inhaler technique after the initial education provided in clinic.

School-based asthma therapy: Improving medication adherence, asthma control, and health care utilization

Background

Undertreatment and poor adherence remain prevalent for children with persistent asthma. School-based asthma therapy (SBAT) provides guideline-based treatment by systematic school-based asthma screenings and direct administration of daily controller medications.

Objective

We examined asthma control and health care utilization for children enrolled in the SBAT program in Columbus, Ohio, from 2013 to 2019.

Methods

Six-year retrospective medical records were reviewed for 1 year before and 1 year after SBAT enrollment for children aged 5 to 19 years from 2 metropolitan school districts. Asthma control was assessed by the Asthma Control Test (ACT) and health care provider (HCP) ratings. Information was collected regarding asthma-related health care utilization, including emergency department (ED), urgent care, and acute care visits; hospitalizations; and pediatric intensive care unit (PICU) admissions.

Results

Percentage increases in well-controlled asthma were 37% (ACT) and 56% (HCP). Asthma-related ED visits decreased by 49%, hospitalizations 50%, PICU admissions 71%, urgent care visits 41%, and acute care visits 38%. Black and Latino children had significant improvements. Black children saw 40% (ACT) and 66% (HCP) increases in well-controlled asthma, with reductions of 42% in ED and urgent care visits, 52% in acute care visits, and 49% and 67% declines in hospitalizations and PICU admissions, respectively. Latino children had 55% (ACT) and 33% (HCP) asthma control improvements, with 62%, 81%, and 50% drops in ED, urgent care, and acute care visits, respectively; hospitalizations decreased by 40% and PICU admissions by 100%.

Conclusions

The SBAT program would serve well as a model for enhancing controller medication adherence, reducing morbidity, and bridging the health disparities gap for children with poorly controlled asthma.

Home exposure to moisture and mold is associated with poorer asthma control in children: CHAMPIASTHMA study

Background

Deleterious indoor environment is a risk factor for poor asthma control in children.

Objective

We assessed the association between exposure to moisture and/or mold (EMM) and asthma control in children.

Methods

The CHAMPIASTHMA study is a multicenter cross-sectional observational study. Children with recurrent wheeze/asthma aged 1 to 17 years were stratified by EMM, as assessed by a standardized questionnaire administered to their parents. The primary outcome was asthma control according to Global Initiative on Asthma guidelines. Secondary outcomes were: control according to asthma control test or pediatric asthma control test score, exacerbations (unscheduled visits, oral corticosteroid receipt, and hospitalization), asthma treatment step, and mold sensitization. Clinical trial registration: NCT04918394.

Results

Four hundred twenty-four patients were included, among whom 146 (34%) noted EMM. Patients with EMM more frequently had disease that was not controlled according to Global Initiative on Asthma guidelines (64 [45%] vs 90 [33%]; P = .03), and had lower asthma control test scores (22 [19-25] vs 24 [21-25]; P = .02), more frequent unscheduled visits (65 [45%] vs 86 [32%]; P = .02), and a trend for higher oral corticosteroids receipt in the past year (53 [37%] vs 74 [27%]; P = .09). There was no difference in asthma treatment step and hospitalization for exacerbations. Forty-two (12%) of 341 children were sensitized to molds, with no difference between the EMM and non-EMM groups (P = .85).

Conclusion

The CHAMPIASTHMA study highlights that EMM is associated with poorer disease control and asthma outcomes in children. The search for EMM during scheduled visits should be systematic, especially in cases of uncontrolled asthma.

Early childhood lower-airway symptoms and airway hyperresponsiveness linked to school-age small-airway dysfunction

Background

The role of early airway hyperresponsiveness (AHR) in the subsequent small-airway lung function remains unclear.

Objective

We assessed via a prospective follow-up study the small-airway lung function of schoolchildren with early childhood lower-airway symptoms and AHR to methacholine and compared the findings to the measurements of reference children with no previous or current lung diseases.

Methods

During 2004-11, we measured atopic markers, lung function, and airway responsiveness to methacholine in 193 symptomatic children <3 years old. In 2016-18, a follow-up sample of 84 schoolchildren and 40 reference children were assessed for atopic parameters, spirometry, and small-airway lung function. Analysis was performed on the basis of early childhood AHR, early childhood atopy (defined as a positive skin prick test result), and exposure to parental smoking reported in a questionnaire. All the results were compared with those of the reference group.

Results

Schoolchildren with early childhood lower-airway symptoms and AHR had higher prebronchodilator area under the reactance curve (AX) z score, lower forced expiratory flow at 50% of forced vital capacity (FEF50%) z score, and higher lung clearance index (LCI) 2.5% compared with those without early childhood AHR and reference children. Moreover, AX and FEF50% z scores only partly improved after bronchodilation. Early childhood atopy and exposure to parental smoking were not associated with school-age small-airway dysfunction.

Conclusion

AHR in symptomatic young children associated with subsequent persistent small-airway dysfunction. Further studies with larger samples of symptomatic young children are warranted to determine whether this connection predicts the development of asthma or other obstructive pulmonary diseases as the children grow.

Comparison of Telemedicine versus In-Person Visit for Control of Asthma in Children aged 7-17 years: A Randomized Controlled Trial

OBJECTIVES

To compare asthma control between telemedicine and in-person visit in children aged 7 to 17 y.

METHODS

A non-inferiority randomized-controlled trial was conducted at a pediatric chest clinic, involving a total of 192 patients, with 96 children in each group of telemedicine and in-person follow-up.

RESULTS

There was a significant improvement in the mean asthma control test (ACT)/ Childhood asthma control test (C-ACT) scores from baseline to three months in both groups, with no significant difference in the change of means between the two groups. The mean difference in ACT/C-ACT score at three months in the telemedicine and in-person visit group was -0.35; 95% CI (-1.30 to +0.10) [p-value 0.09]. There was a significant change in the mean Pediatric Quality of Life index (PQLI) scores from 57.2 ± 10.2 to 66.82 ± 7.99 in the telemedicine group and from 56.1 ± 11.7 to 66.71 ± 4.66 in the in-person visit group, however the mean difference in PQLI score in both the groups was not significant (p = 0.91). There was no significant difference in the number of asthma exacerbations (4 vs. 1) between telemedicine and in-person visit (p = 0.10). The mean telemedicine satisfaction questionnaire score in this study was 3.8 ± 0.7, which indicates that most of the parents were satisfied with the telemedicine follow-up process.

CONCLUSIONS

This study revealed that telemedicine is non-inferior to in-person visit for follow-up of children with asthma and can be used as an alternative to in-person visit for the management of asthma, especially in remote settings and pandemic situations.

TAPAS-A Prospective, Multicentre, Long-Term Cohort Study in Children, Adolescents and Adults with Seasonal Allergic Rhinitis-Design and Early Results

Background/Objectives: The guideline on allergen-specific immunotherapy of the European Academy of Allergy and Clinical Immunology recommends subcutaneous allergen-specific immunotherapy for the treatment of allergic rhinitis in children and adults with moderate to severe symptoms. The five years cohort study described below was designed in 2020 to demonstrate non-inferiority in terms of safety, tolerability and efficacy in a paediatric population compared with adult patients treated with microcrystalline tyrosine-adsorbed allergoids for their tree and grass pollen allergy in a perennial setting. Here, we present the preliminary findings from the first year. Methods: The Combined Symptom and Medication Score was chosen as the primary endpoint of this therapy. Secondary endpoints include the Rhinoconjunctivitis Quality of Life Questionnaire, the retrospective Rhinoconjunctivitis score, the Asthma Control Test and the Rhinitis Control Test, as well as an analysis of adverse drug reactions. Results: A total number of 320 patients were enrolled into this study, with 129 of these patients in the age group between 5 and 17 years and 191 patients in the adult age group. Mean Combined Symptom and Medication Score values did not differ significantly between minors and adults in the first pollen season after treatment induction. The retrospective score showed a strong and significant reduction in rhinoconjunctivitis and asthma symptoms. Treatment was well tolerated, with more than 80% of patients reporting no adverse drug reactions. Conclusions: The validity of this study approach of a cohort study has been confirmed by this first interim analysis for the initial course of therapy in the first year.

Prevalence and associated factors of pediatric uncontrolled asthma in Vietnam

OBJECTIVE

Uncontrolled asthma profoundly affects quality of life and imposes a significant societal burden. However, reports on its prevalence and contributing factors in Vietnam remain limited. This study aimed to address this gap by investigating the prevalence and factors associated with uncontrolled asthma among children in Vietnam.

METHODS

An analytical cross-sectional study was conducted involving 344 pediatric asthma patients and their caregivers. The Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT) were used to assess asthma control in children aged 4-11 and 12-16 years, respectively. Data on patient, caregiver, and treatment characteristics were collected for analysis. Logistic regression analysis was employed to identify factors associated with uncontrolled asthma.

RESULTS

The prevalence of uncontrolled asthma was 40.1%. Factors significantly associated with uncontrolled asthma included previous admissions due to asthma (aOR = 2.80, 95% CI: 1.56-5.04, p < .001), inadequate caregiver knowledge (aOR = 2.86, 95% CI: 1.58-5.19, p < .001), and non-adherence to controller medication (aOR = 1.92, 95% CI: 1.07-3.48, p = .030).

CONCLUSIONS

The prevalence of uncontrolled asthma in Vietnamese children is quite high. Previous admissions due to asthma, inadequate caregiver knowledge, and controller medication non-adherence were identified as significant factors associated with uncontrolled asthma.

Determinants of Exercise Capacity in Children and Adolescents with Asthma: A Comparative Case-Control Study

BACKGROUND

Asthma is a chronic disease that may affect exercise capacity. Despite the variety of existing tools for assessing exercise capacity, whether patients with asthma have lower exercise capacity than healthy controls and its potential determinants are still poorly understood.

AIM

The primary aim of this study was to identify potential determinants of exercise capacity. The secondary aim was to compare exercise capacity, pulmonary function, and muscle strength of children and adolescents with asthma with healthy controls.

METHODS

Volunteers aged 7-17 participated in the study and were divided into two groups: the asthma (n = 60) and the healthy control (n = 40). Asthma control questionnaire, six-minute walk test, pulmonary function test, maximum inspiratory (MIP) and expiratory (MEP) pressure measurements, and 30-second sit-to-stand test (30-STST) were performed.

RESULTS

The study showed that exercise capacity and respiratory and peripheral muscle strength were significantly lower compared to controls (P < 0.001, P = 0.031, P = 0.001, P = 0.025, respectively). Another critical finding was MIP, 30-STST, and MEP were the determinants of exercise capacity in children with asthma (R2 = 0.403, P < 0.001).

CONCLUSION

Clinicians should not ignore that exercise capacity may be reduced in children and adolescents with asthma and add assessment and training of respiratory and peripheral muscle strength in pulmonary rehabilitation programs.

Association of sleep disordered breathing with severity and control of persistent asthma in Indian children

OBJECTIVE

To assess the association of pediatric sleep disordered breathing (SDB) with control and severity of asthma, and to evaluate the comorbidities associated with both.

METHODS

Based on the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5-15 years) with persistent asthma were classified as; with SDB (SDBS-PSQ≥0.33) and without SDB (SDBS-PSQ<0.33), in a cross-sectional study. Baseline characteristics were compared. Control of asthma into well-controlled, not-well, and poorly controlled was assessed using childhood - asthma control test (c-ACT). Comorbidities like adeno-tonsillar hypertrophy, gastroesophageal reflux disease (GERD), obesity and allergic rhinitis (AR) for presence of SDB in asthma were assessed.

RESULTS

Sixty asthmatics were included. Mild, moderate, and severe persistent asthma was observed in 26.67 %, 40 % and 33.33 % respectively, with 18.33 % asthmatics having SDB. 42.3 % of uncontrolled asthmatics had SDB. Baseline characteristics were similar in both groups. Asthmatics with SDB had higher frequency of severe persistent (63.6 % vs 26.5 %, p = 0.018) and uncontrolled asthma i.e. partly & poorly controlled (100 % vs 30.6 %, p < 0.001) versus asthmatics without SDB. Mean SDBS-PSQ score was higher in uncontrolled asthmatics compared to well-controlled asthmatics (0.255 ± 0.19 vs 0.047 ± 0.06, p < 0.001). Mean c-ACT score was lower with SDB (14.45 ± 3.20 vs 20.04 ± 4.56, p < 0.001), indicating poor control of asthma. A negative relationship was established between c-ACT and SDBS-PSQ (p < 0.001, r2 = -0.36). Higher occurrence of AR was found in asthmatics with SDB (72.7 % vs 20.4 %, p = 0.001).

CONCLUSION

SDB may be associated with poor control and worsening severity of asthma. Concomitant AR was found in asthmatic children with SDB.

The Effect of Asthma Education Program on Disease Management in Children with Asthma: A Retrospective Analysis

Aims/Background As a common chronic respiratory disease, asthma may lead to airway inflammation and accelerated, progressive loss of lung function, if not well controlled, posing risks to patients' life and health. This study evaluates the impact of asthma education program on enhancing asthma control, quality of life, and pulmonary function in children, addressing gaps in existing management approaches. Methods In this retrospective study, 60 patients who had undergone routine nursing mode at Beijing Shijitan Hospital affiliated to Capital Medical University from May 2022 to May 2023 were enrolled for the reference group; after excluding 3 patients, this study finally included 57 patients. Separately, 55 patients who had attended the child-oriented asthma education program on the basis of routine nursing care at the same hospital from May 2023 to May 2024 were enrolled for the observation group; after excluding 2 patients, this study eventually included 53 patients. The Childhood Asthma Control Test (C-ACT) score, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) score, pulmonary function index levels measured in terms of percentage of predicted forced vital capacity (FVC%), peak expiratory flow (PEF), forced vital capacity in one second/forced vital capacity (FEV1/FVC), and the disappearance time of clinical symptoms (dyspnea, chest tightness, cough, wheezing) were compared between the two groups. Results Before the management, there were no differences in the C-ACT and PAQLQ scores between the two groups (p > 0.05). After management, the C-ACT and PAQLQ scores of the observation group were significantly higher than those of the reference group (p < 0.001). There were no differences in FVC%, PEF, and FEV1/FVC between the two groups before management (p > 0.05). After management, the FVC%, PEF, and FEV1/FVC levels of the observation group were higher than those of the reference group (p < 0.001). The disappearance time of clinical symptoms such as dyspnea, chest tightness, cough and lung wheezing in the observation group was shorter than that in the reference group (p < 0.001). Conclusion The child-oriented asthma education program is beneficial to the disease management in children with asthma, improving asthma control, quality of life, lung function indexes, and shortening the time of symptom disappearance.

Patient-centred composite scores as tools for assessment of response to biological therapy for paediatric and adult severe asthma

BACKGROUND

We have previously developed Core Outcome Measures sets for Severe Asthma (COMSA) by multi-stakeholder consensus. There are no patient-centred tools to quantify response to biological therapies for severe asthma. We aimed to develop paediatric and adult CompOsite iNdexes For Response in asthMa (CONFiRM) incorporating clinical parameters and patient-reported quality of life.

METHODS

International expert healthcare professionals and patients with severe asthma were invited to 1) develop consensus levels of clinically relevant changes for each outcome measure within COMSA, 2) use multicriteria decision analysis to develop the CONFiRM scores and 3) assess their internal validity. A separate group of healthcare professionals evaluated CONFiRM's external validity.

RESULTS

Five levels of change for each COMSA outcome were agreed. Severe exacerbations and maintenance oral corticosteroid use were rated as the most important in determining both paediatric and adult CONFiRM scores. There was strong agreement between healthcare professionals and patients, although patients assigned greater importance to quality of life. The CONFiRM score quantified response to a biologic from -31 (deterioration) to 69 (best possible response). Paediatric and adult CONFiRMs had good discriminative ability for a sufficient (area under the curve ≥0.92) and a substantial (area under the curve ≥0.95) response to biologics. Both CONFiRMs demonstrated excellent external validity (Spearman correlation coefficients 0.9 and 0.8 for paediatric and adult, respectively; p<0.0001).

CONCLUSIONS

We have developed novel patient-centred paediatric and adult CONFiRMs that include quality of life measures. CONFiRMs should allow a more holistic understanding of response for the patient and a standardised assessment of the effectiveness of biologics between studies. Further research is needed to prospectively validate CONFiRM scores.

Integrated Mental Health Care in Specialty Clinics for Children with a Diagnosis of Asthma or Diabetes: A Mixed Methods Study

INTRODUCTION

Using patient-reported outcome measures (PROM) in a shared-space mental health-integrated specialty clinic, we explored the feasibility, acceptance, and experience of youth with asthma and diabetes, their families, and the healthcare team.

METHOD

Using mixed methods, we examined feasibility, acceptability, and experience of PROM inclusion in caring for youth with asthma (n = 7) and diabetes (n = 11), their families (n = 18), and healthcare providers (n = 13). Completion and receipt of PROM (feasibility), postvisit surveys (acceptance), and structured interviews (experience) between June 2019 and February 2020.

RESULTS

Targeted PROM met feasibility goals (80%) and exceeded youth and family acceptance (70%). Time and low confidence using PROM affected healthcare team acceptance (64%). Families' experiences included increased learning, trust, and partnership with the clinic team. Providers appreciated partnerships, resources, and mental health support for families.

DISCUSSION

Integrating PROM into clinical services promoted engagement, partnership, and individualized, strength-based care among youth, their parent/guardian (family), and their healthcare team.

Peak Flow Feedback Intervention Improves Underperception of Airflow Limitation in Pediatric Asthma: A Randomized Clinical Trial

Rationale: Underperception of asthma symptoms is associated with poor asthma outcomes. Objectives: We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes. Methods: A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling. Latino and Black adolescents with asthma ages 10-17 years old and caregivers were recruited from hospitals in the Bronx, New York. PEF feedback sessions reviewed accuracy of PEF guesses and medication adherence data and targeted behavior change using motivational interviewing and problem-solving skills training. The supportive counseling group received emotional support related to asthma. Both groups received three sessions across 6 weeks. All participants were blinded to PEF while guessing PEF before intervention and at 1, 6, and 12-month follow-up. Children in the PEF feedback group saw actual PEF after guesses were locked in during the 6-week intervention. Participants and assessors were blinded to group assignment. The primary outcome was underperception of airflow limitation (divergence between actual PEF and guesses) on home spirometers. Secondary outcomes included daily PEF and forced expiratory volume in 1 second (FEV1), inhaled corticosteroid adherence measured by electronic monitors, Asthma Control Test, and emergency health care use for asthma. Results: The sample comprised 354 children (mean = 13.2 ± 2.2 yr; 62% Latino, 38% Black) and caregivers. The PEF feedback group (N = 153 analyzed) demonstrated greater improvements at 1-month follow-up on underperception of airflow limitation (difference-in-differences, -12.64; 95% confidence interval [CI], -17.54 to -7.74), percent personal best PEF (9.89; 95% CI, 7.13 to 12.65), percent predicted FEV1 (4.93; 95% CI, 0.95 to 8.90), and inhaled corticosteroid adherence (16.02; 95% CI, 7.15 to 24.89) compared with the supportive counseling group (N = 152 analyzed). At 12-month follow-up, the PEF feedback group maintained improvements on underperception of airflow limitation (-13.87; 95% CI, -19.03 to -8.71), maintained higher percentage personal best PEF (14.23; 95% CI, 11.37 to 17.08) and percent predicted FEV1 (5.62; 95% CI, 1.56 to 9.67), and had smaller declines in inhaled corticosteroid adherence (17.51; 95% CI, 7.12 to 27.89) versus before intervention than the supportive counseling group. No between-group differences existed for asthma control or health care use. Conclusions: The efficacy and sustainability of PEF feedback was established in improving children's perception of airflow limitation, pulmonary function, and medication adherence. Clinical trial registered with www.clinicaltrials.gov (NCT02702687).

Beneficial effects of pleuran on asthma control and respiratory tract-infection frequency in children with perennial asthma

The aim of this study was to evaluate the effects of pleuran (β-glucan isolated from Pleurotus ostreatus) on asthma control and respiratory morbidity in children on conventional GINA-based asthma treatment who had partially controlled perennial asthma. A double-blind, placebo-controlled multicentre clinical trial with a 2-arm, parallel design was conducted across three countries; 230 children aged 7 to 17 years were randomised (1:1) into an active group (receiving a pleuran/vitamin C combination) or a placebo group (receiving vitamin C only). This study consisted of 24 weeks of treatment (2 capsules a day) and then 24 weeks of follow-up. The primary endpoints included the effects of active treatment versus placebo on asthma control and respiratory tract infections (RTIs). Secondary endpoints included changes in the following measures: number of asthma exacerbations, with or without respiratory infection; quality of life of both asthmatic children and their caregivers; spirometric indices; fractional exhaled nitric oxide (FeNO) levels; safety after 24 weeks of treatment and also after the full 48-week study period. Overall, 206 children completed this study; 113 of these children were in the active group and received a pleuran/vitamin C combination for 24 weeks. After the 24-week treatment period, children below 12 years of age who were in the active group achieved significant improvements in asthma control compared to those in the placebo group (21.8 ± 3.5 vs. 20.3 ± 4.0; P = 0.02); while children at least 12 years old who were in the active group reported lower numbers of RTIs (0.7 ± 1.0 vs. 1.9 ± 1.7; P = 0.002) compared to children of this age in the placebo group. In addition, children below 12 years of age in the active group showed a significant decrease in asthma exacerbations compared to those in the placebo group (2.5 ± 1.6 vs. 3.3 ± 1.9; P = 0.05). At the end of the 48-week trial, a statistically significant improvement in asthma control was observed in 84.7% of children who received pleuran/vitamin C treatment compared to 67.0% of children who received vitamin C only (P = 0.01). The pleuran/vitamin C combined treatment was safe and well-tolerated, and no related serious adverse events were reported. This study highlights the favourable safety profile of pleuran/vitamin C supplementation and demonstrates positive effects of this treatment on asthma control and RTI incidence in children with allergic perennial asthma that was partially controlled by conventional therapy.

Impact of asthma control on quality of life among palestinian children

Asthma is a chronic respiratory disease that significantly affects children, impacting their health-related quality of life. This study aimed to explore the relationship between asthma control and quality of life among pediatric asthma patients in the West Bank, Palestine. A descriptive, cross-sectional study was conducted among 220 pediatric patients with asthma and their mothers, recruited from four governmental hospitals. Data were collected using self-administered questionnaires that included demographic information, an asthma control test, and the Pediatric Asthma Quality of Life questionnaire. The final analysis included 182 children with a mean age of 8 years. The results showed that 71.9% of the children had uncontrolled asthma, with poor health-related quality of life reported by approximately 70% of this group. In contrast, only 2.7% of children with controlled asthma reported reduced quality of life. The findings indicate a strong association between asthma control and health-related quality of life. Healthcare policies should prioritize educational programs for children and their parents to improve asthma management and overall well-being.

Effectiveness of paediatric asthma hubs: a clinical pilot study

BACKGROUND

Children and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub for CYP, to investigate the feasibility and effectiveness of hubs, in providing postattack reviews along with providing asthma education, the opportunity to carry out diagnostic lung function tests and optimise treatment.

METHODS

Clinical pilot study including CYP aged 4-17 years referred to the hub with uncontrolled asthma or postattack from November 2021 to April 2022. CYP received a structured clinical assessment including National Institute for Health and Care Excellence (NICE) first-line diagnostic investigations for asthma including spirometry, bronchodilator reversibility (BDR) and fraction of exhaled nitric oxide (FeNO).

RESULTS

Of 312 CYP referred (mean age 8.6±3.2 years; 42% women), 266 (85.3%) attended their appointment. Median time from referral to review was 2 days (IQR 1-3). Three CYP (1.1%) were severely unwell at review and required further hospital treatment. In the 231 CYP who completed first-line tests, asthma was confirmed for 73 (31.6%) based on NICE diagnostic criteria for CYP. Twenty-two per cent of children with normal baseline spirometry had ≥12% BDR.

CONCLUSION

Paediatric asthma hubs are a feasible model of care to deliver CYP postasthma attack reviews and identify high-risk patients requiring further treatment. Spirometry, BDR and FeNO testing allowed diagnostic confirmation in a significant proportion of CYP.

Control of Asthma and its Influencing Factors in Children Followed in Pneumo-pediatrics Consultation at the Mother-child Hospital in the City of Marrakech, Morocco

Introduction

Evaluate asthma control and determine its influencing factors to ensure adequate management and improve the quality of life for asthmatic children.

Method

A prospective cross-sectional study was conducted over a two-month period, from 02/11/2022 to 01/01/2023, at the pneumo-pediatric consultation at the MCH. The target population was asthmatic children aged 4 to 11 and their parents. The Arabic version of the C-ACT and PMAQ-3W were used to assess asthma control and medication compliance, respectively.Statistical analysis was performed with SPSS, using descriptive and correlational analysis (bivariate and multivariate).

Results

203 asthmatic children were included in the study, out of which 60.6% were male, with a mean age of 6 years. Asthma was uncontrolled in 53% of children. Factors associated with uncontrolled asthma were rural residence, low parental education, low monthly family income, lack of awareness of triggers, presence of conjunctivitis or allergic rhinitis, occurrence of respiratory infections, parental history of asthma, exposure to smoking, and non-compliance with treatment.

Conclusion

53% of children had uncontrolled asthma. A range of predictive factors were significantly associated with suboptimal asthma control. Recommended actions to improve childhood asthma control include education on trigger prevention and medication compliance, treatment of comorbidities, and accessibility of care for all socio-economic classes.

Outcomes and Recommendations From Telehealth Asthma Clinics in Underserved Schools

BACKGROUND AND OBJECTIVE

Individuals from historically marginalized populations face structural and social determinants of health that create barriers to receiving specialty asthma care. School-based specialist care delivered via telehealth offers a potential solution for children with uncontrolled asthma. This study evaluated the reach, implementation, and effectiveness of school-based telehealth asthma clinics led by pediatric pulmonologists in historically marginalized neighborhoods.

METHODS

Patients completed at least one visit with an asthma specialist via telehealth, including assessments of asthma control, lung function, exacerbations, and healthcare utilization. Descriptive analyses and means comparison tests of electronic health record data were conducted to examine outcomes.

RESULTS

Asthma specialists provided telehealth care for 54 patients (Mage = 12.23, SD = 3.71) between May 2019 and May 2023. The clinics reached a high percentage of individuals from historically marginalized populations (90.7% Black or African American, 92.6% public insurance) who had not previously received specialty asthma care (51.9%). Twenty-three patients (42.6%) were seen more than once in the school-based telehealth asthma clinics (M = 3.43 visits, SD = 1.53). Asthma control significantly improved for those patients, t(19) = 2.61, p = 0.017, Cohen's d = 0.58, with 30% improving from poorly controlled to well-controlled. Exacerbations and healthcare utilization decreased.

CONCLUSIONS

Specialist-delivered, school-based telehealth asthma clinics effectively reached patients from historically marginalized backgrounds and improved clinical outcomes. This school-based telehealth model can be applied across settings to reach patients who might not otherwise have access to specialty care.

Pediatric Asthma Impairment and Risk Questionnaire: Rationale and development of a composite control tool

BACKGROUND

Asthma in children is a leading cause of missed school days, emergency department visits, and hospitalizations. Approximately 40% of children with asthma experience uncontrolled disease and annual exacerbations. There is a need for a validated composite tool for children, such as the Asthma Impairment and Risk Questionnaire (AIRQ), which was developed to assess current control and predict exacerbations in adolescents and adults with asthma.

OBJECTIVE

To obtain feedback from children with asthma and their parents/caregivers to inform development of a version of the AIRQ for pediatric use (Peds-AIRQ).

METHODS

Children with asthma aged 5 to 11 years and their parents/caregivers participated in cognitive interviews to elicit language describing asthma symptoms and exacerbations and to assess understanding and relevance of draft Peds-AIRQ questions. Physicians and parents/caregivers provided clinical information and performed assessments relative to the children's asthma morbidity.

RESULTS

There were 60 dyads that participated: children's mean (SD) age = 7.9 (1.9) years; 68% male, 45% non-White, 32% Hispanic, and 40% with public health insurance. Overall, 53% had well-controlled, 30% partly controlled, and 17% uncontrolled asthma, based on the Global Initiative for Asthma symptom control questions. Oral or injected corticosteroids were used for asthma by 53% of the children in the previous year. Participants found draft Peds-AIRQ items understandable and relevant. Seven impairment and 3 risk questions were retained for validation, along with 5 additional items containing wording or control threshold variations.

CONCLUSION

This study supports the need for developing a composite (impairment and risk) control tool to assess children aged 5 to 11 years with asthma and identified suitable questions for the validation of a Peds-AIRQ.

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.

Comparative analysis of ambient, in-home, and personal exposures reveals associations between breathing zone pollutant levels and asthma exacerbations in high-risk children

BACKGROUND

Air pollution is associated with poor asthma outcomes in children. However, most studies focus on ambient or indoor monitor pollution levels. Few studies evaluate breathing zone exposures, which may be more consequential for asthma outcomes.

METHODS

We measured personal exposures to NO2, O3, PM10 and PM10 constituents, including black carbon (BC), brown carbon (BrC), environmental tobacco smoke (ETS), endotoxins, and 𝛽-glucan, in a cohort of children with exacerbation-prone asthma for 72 h using wearable monitors. Personal exposures were compared to concentrations from in-home monitors in the child's bedroom and ambient EPA air quality monitoring using correlation analyses. Personal exposures were tested for association with lung function and compared between participants with and without well-controlled asthma and signs of exacerbation in the prior 60 days using censored regression with robust standard errors.

RESULTS

81 children completed 219 monitoring sessions. Personal NO2, O3, and PM10 exposures ranged from < 2 to 99.1 parts per billion (ppb), < 1.5 to 23.3 ppb, and < 1 to 141.9 𝜇g/m3, respectively. Personal endotoxin ranged from 0.04 to 101.3 EU/m3, 𝛽-glucan from 18.5 to 1,162 pg/m3, BC from < 0.3 to 46.9 𝜇g/m3, BrC from < 0.3 to 6.1 𝜇g/m3, and ETS from < 0.3 to 56.6 𝜇g/m3. Correlations between personal and ambient PM10, NO2, and O3 concentrations were poor, whereas personal PM10 and NO2 correlated with in-home concentrations. In-home monitoring less frequently detected BrC (Personal:79% > lower limit of detection, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) than personal exposures, and detected BC in participants without personal exposure (Personal: 26.5%, Home: 96%). Personal exposures were not significantly associated with lung function or daily asthma control. Children requiring corticosteroid treatment for asthma exacerbation within 60 days of exposure monitoring had 1.98, 2.21 and 2.04 times higher personal exposures to BrC (p < 0.001; 95% CI: 1.43-2.37), ETS (p = 0.007; 95% CI: 1.25-3.91), and endotoxin (p = 0.012; 95% CI: 1.14-3.68), respectively.

CONCLUSIONS

Although in-home monitoring was correlated with personal exposure to PM10 and NO2, in-home detection of ETS and BrC was not associated with personal exposures. Personal PM10 exposures in general, as well as BrC, ETS, and endotoxin levels were associated with recent childhood asthma exacerbations.

CLINICAL TRIAL NUMBER

Not applicable.

Factors influencing health-related quality of life in children with asthma: insights from Addis Ababa public hospitals

Background

Bronchial asthma is a global health problem in particular a respiratory condition characterized by broncho spasms that negatively affect the quality of life (QOL) of children. However, there is a paucity of data regarding the health-related quality of life of asthma in children in Ethiopia, and the study area.

Objective

The objective of this study was to assess the health-related quality of life among asthmatic children aged 7-17 in selected hospitals in Addis Ababa, Ethiopia.

Methods

An institutional-based analytical cross-sectional study involving 136 asthmatic children aged 7-17 years was conducted in the selected hospital in Addis Ababa, from February to April 2024. Respondents were chosen using a systematic random sampling method. Structured, interviewer-administered, and pretested questionnaires, were used to collect data. The data were coded and entered into Epi-Data 3.1 before being exported to SPSS version 25 for analysis. Logistic regression was employed to identify factors influencing health-related quality of life Statistical significance was set at p < 0.05 with a 95% confidence interval.

Results

The study found that 46% [95% CI: 37.6-54.4%] of the study participants had a poor quality of life. Factors associated with an increased likelihood of poor quality of life included caregivers' lack of formal education (Adjusted Odds Ratio [AOR]: 1.39 [1.80-10.69]), a family history of asthma (AOR: 2.51 [1.46-4.299]), longer asthma duration (AOR: 3.47 [1.89-6.39]), uncontrolled asthma (AOR: 3.47 [1.89-6.39]), moderate persistent asthma (AOR: 2.4 [1.40-4.20]), and comorbidities (AOR: 2.4 [1.40-4.20]).

Conclusion

The study highlights almost half of asthmatic children had a poor quality of life in Addis Ababa. Factors such as caregivers' lack of formal education, a family history of asthma, longer duration and increased severity of asthma, uncontrolled asthma, and comorbidities were significantly associated with poor quality of life. Therefore, implementing targeted education programs, encouraging family history assessments, and strengthening comorbidity screening and management for children and their families in Addis Ababa are recommended.

Association of Corticosteroid Inhaler Type with Saliva Microbiome in Moderate-to-Severe Pediatric Asthma

Background/Objectives: Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) are common inhaled corticosteroid (ICS) inhaler devices. The difference in formulation and administration technique of these devices may influence oral cavity microbiota composition. We aimed to compare the saliva microbiome in children with moderate-to-severe asthma using ICS via MDIs versus DPIs. Methods: Saliva samples collected from 143 children (6-17 yrs) with moderate-to-severe asthma across four European countries (The Netherlands, Germany, Spain, and Slovenia) as part of the SysPharmPediA cohort were subjected to 16S rRNA sequencing. The microbiome was compared using global diversity (α and β) between two groups of participants based on inhaler devices (MDI (n = 77) and DPI (n = 65)), and differential abundance was compared using the Analysis of Compositions of Microbiomes with the Bias Correction (ANCOM-BC) method. Results: No significant difference was observed in α-diversity between the two groups. However, β-diversity analysis revealed significant differences between groups using both Bray-Curtis and weighted UniFrac methods (adjusted p-value = 0.015 and 0.044, respectively). Significant differential abundance between groups, with higher relative abundance in the MDI group compared to the DPI group, was detected at the family level [Carnobacteriaceae (adjusted p = 0.033)] and at the genus level [Granulicatella (adjusted p = 0.021) and Aggregatibacter (adjusted p = 0.011)]. Conclusions: Types of ICS devices are associated with different saliva microbiome compositions in moderate-to-severe pediatric asthma. The causal relation between inhaler types and changes in saliva microbiota composition needs to be further evaluated, as well as whether this leads to different potential adverse effects in terms of occurrence and level of severity.

Cohort multiple randomized controlled trial in pediatric asthma to assess the long- and short-term effects of eHealth interventions: protocol of the CIRCUS study

BACKGROUND

Asthma is one of childhood's most prevalent chronic conditions significantly impacting the quality of life. Current asthma management lacks real-time, objective, and longitudinal monitoring reflected by a high prevalence of uncontrolled asthma. Long-term home monitoring promises to establish new clinical endpoints for timely anticipation. In addition, integrating eHealth interventions holds promise for timely and appropriate medical anticipation for controlling symptoms and preventing asthma exacerbations.

OBJECTIVES

This study aims to provide a pragmatic study design for gaining insight into longitudinal monitoring, assessing, and comparing eHealth interventions' short- and long-term effects on improving pediatric asthma care.

DESIGN

The CIRCUS study design is a cohort multiple randomized controlled trial (cmRCT) with a dynamic cohort of 300 pediatric asthma patients.

METHODS

The study gathers observational and patient-reported measurements at set moments including patient characteristics, healthcare utilization, and asthma, clinical, and environmental outcomes. Participants are randomly appointed to the intervention or control group. The effects of the eHealth interventions are assessed and compared to the control group, deploying the CIRCUS outcomes. The participants continue in the CIRCUS cohort after completing the intervention and its follow-up.

RESULTS

This study was ethically approved by the Medical Research Ethics Committee (NL85668.100.23) on February 15th, 2024.

DISCUSSION

The CIRCUS study can provide a rich and unique dataset that can improve insight into risk factors of asthma exacerbations and yield new clinical endpoints. Furthermore, the effects of eHealth interventions can be assessed and compared with each other both short- and long-term. In addition, patient groups within the patient population can be discerned to tailor eHealth interventions to personalized needs on improving asthma management.

CONCLUSION

In conclusion, CIRCUS can provide valuable clinical data to discern risk factors for asthma exacerbations, identify and compare effective scalable eHealth solutions, and improve pediatric asthma care.Trial registration: The protocol is registered at ClinicalTrials.gov (NCT06278662).

Viral Determinants of Childhood Asthma Exacerbation Severity and Treatment Response

BACKGROUND

Although respiratory viruses are common triggers of asthma exacerbations, the influence of viral infection characteristics on exacerbation presentation and treatment response in the pediatric emergency department (ED) is unclear.

OBJECTIVE

To assess viral infection characteristics of children experiencing ED asthma exacerbations and to test their associations with severity and treatment response.

METHODS

This is a prospective study of children, aged 4 to 18 years, who received standard ED asthma exacerbation treatment with inhaled bronchodilators and systemic corticosteroids. Nasal swabs collected for viral metagenomic analyses determined virus presence, load, and species. Outcomes included exacerbation severity (Pediatric Asthma Severity [PAS] score, clinician impression, and vital signs) and treatment response (discharge home without needing additional asthma therapies).

RESULTS

Of 107 children, 47% had moderate/severe exacerbations by PAS and 64% demonstrated treatment response. Viral metagenomic analysis on nasal swabs from 73 children detected virus in 86%, with 10 different species identified, primarily rhinovirus A (RV-A), RV-C, and enterovirus D68. Exacerbations involving RV-A were milder (odds ratio [OR] = 0.25; 95% confidence interval [CI] = 0.07-0.83) and tended to be more responsive to treatment than non-RV-A infections, whereas exacerbations involving enterovirus D68 were more severe (OR = 8.3; 95% CI = 1.3-164.7) and had no treatment response association. Viral load was not associated with treatment response but exhibited a strong linear relationship with heart rate (rpartial = 0.48), respiratory rate (rpartial = 0.25), and oxygen saturation (rpartial = -0.25), indicative of severity.

CONCLUSIONS

The majority of ED asthma exacerbations are triggered by respiratory viruses. Viral species are associated with severity and treatment response, suggesting that early pathogen detection could inform ED treatment decisions. Additional studies are needed to identify differences in pathobiology underlying exacerbations triggered by different viral species, and how to effectively treat these heterogeneous exacerbations.

Difference in the Perceptions of Asthma Control Between Children With Asthma and Their Parents

INTRODUCTION

Asthma is the most prevalent chronic condition in children in primary care. Asthma control can be quantified using the Childhood Asthma Control Test (C-ACT), which includes questions for both children and their parents. However, there can be discrepancies between children and parents in their perceptions of asthma control.

OBJECTIVE

This longitudinal study determines the difference in the perceptions of asthma control between children in primary care and their parents using the C-ACT, measured at five points in time.

METHOD

Children aged 6-12 with asthma who are being treated in primary care were eligible. Data was obtained using electronic questionnaires from the Rotterdam Asthma Trial from baseline to 18 months follow-up. The primary outcome was a difference in C-ACT scores between parents and their children. The data was analyzed using Spearman's correlation and intraclass correlation coefficient (ICC).

RESULTS

We included 90 children and their parents. The mean age of the children was 9.6 years (SD 1.7). At baseline, the children gave a median C-ACT score of 9/12 (IQR 2.5) and the parents gave a median score of 14/15 (IQR 3.0). Children's median C-ACT scores were significantly lower throughout the study period (p < 0.001). The Spearman test showed moderate to strong correlation (0.659-0.775, and the ICC showed good agreement (0.750-0.813).

CONCLUSION

This study showed that parents gave significantly higher scores for the individual items of the C-ACT than their children. Considering the child's perspective on their symptoms is crucial when deciding on additional asthma treatment measures.

The Correlation Between Airborne Pollen and Sensitization in Children with Respiratory Allergic Diseases: A Cross-Sectional Study

Background

Pollen is a significant contributor to respiratory allergies worldwide, underscoring the importance of understanding its association with childhood sensitization to enhance clinical management.

Objective

This study focuses on investigating the prevalence of various airborne pollens and their correlation with clinical characteristics of childhood respiratory allergic diseases in southeastern China.

Methods

From November 2020 to October 2021, this research employed Durham monitoring samplers to collect airborne pollen. Simultaneously, skin prick tests (SPTs) were performed on children with respiratory allergic conditions at the Children's Hospital of Soochow University and standardised questionnaires are also administered to assess children's symptoms.

Results

Over the course of November 2020 to October 2021, the study identified more than 36 pollen species. Notably, the spring season (March to May) exhibited the highest pollen concentrations, with Broussonetia accounting for 30.04% and Pinus for 26.38%. Similarly, the autumn months (September to October) saw prominent taxa like Humulus scandens (47.55%) and Gramineae (35.93%). Among the patients, a significant 92.7% exhibited positive reactions, with 81.7% showing sensitization to house dust mites (HMD), 17.8% to pollen, and 3.7% to Cockroach. Noteworthy the five most common pollens were observed for Bermuda (6.0%), Elm pollen (6.0%), Birch pollen (4.6%), and Mugwort (4.6%). The study indicated a substantial multisensitized ratio among pollen-sensitized patients in comparison to non-pollen-sensitized ones (97.4% vs 1.6%, P <0.001). Moreover, weekly total airborne pollen concentrations showed positive correlations with weekly admissions due to allergic rhinitis(AR)(r=0.642, P <0.001), bronchial asthma (BA) (r= 0.472, P<0.001), and the coexistence of AR and BA (r=0.485, P <0.001).

Conclusion

The findings found that there were two peaks of pollen count in a year during March-May and September-October. The findings emphasize the critical role of specific airborne pollens in driving sensitization and exacerbating respiratory allergic diseases in children.

Effectiveness of psychosocial interventions for improving asthma symptoms and parental stress in families of school-age children with asthma: A systematic review and meta-analysis

BACKGROUND

Asthma is a prevalent chronic disease affecting school-age children, with substantial psychosocial implications for children and their parents.

OBJECTIVES

This review aimed to synthesise current evidence on the effects of psychosocial interventions for families of school-age children with asthma and investigate the optimal features of effective interventions.

METHODS

Embase, MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Google Scholar, CNKI, and Wanfang Data were searched from inception to November 2023. Randomised controlled trials (RCTs) examining psychosocial interventions in children aged six to twelve with asthma on asthma symptoms and parental stress were included. Emergency department visits, hospitalisations, lung function, psychological symptoms and health-related quality of life in both children and parents were secondary outcomes. Data were pooled for short-term (≤ three months), medium-term (> three months and ≤ six months), and long-term (> six months) follow-ups. Risk of bias was appraised using version 2 of the Cochrane risk of bias tool for randomised trials. Meta-analysis was performed using RevMan 5.4.1.

RESULTS

Seven RCTs with 884 parent-child dyads from two countries were included. Meta-analyses found that psychosocial interventions improved asthma control (k = 2, n = 301, standardised mean difference [SMD] 0.35, 95 % confidence interval [CI] 0.12 to 0.58, P = 0.003), sleep problem (k = 2, n = 149, SMD -0.47, 95 % CI -0.79 to -0.14, P = 0.005), cough (k = 2, n = 149, SMD -0.97, 95 % CI -1.59 to -0.35, P = 0.002), wheezing (k = 2, n = 149, SMD -0.76, 95 % CI -1.09 to -0.42, P < 0.0001), and parental stress (k = 6, n = 813, SMD -0.32, 95 % CI -0.61 to -0.02, P = 0.03), compared to controls in the short term. Subgroup analysis revealed significant effects of psychoeducation, family empowerment interventions, and acceptance and commitment therapy-based interventions on reducing parental stress. No significant intervention effects were observed on parental symptoms of depression at any follow-up. Narrative synthesis indicated that psychosocial interventions may provide benefits in children's health-related quality of life in the short term, parental symptoms of anxiety in the medium term, and activity limitation, cough, and wheezing in the long term. The intervention effects for other reviewed outcomes were inconsistent.

CONCLUSIONS

Psychosocial interventions demonstrate possible benefits for families of school-aged children with asthma in asthma symptoms, parental stress, and children's health-related quality of life within three months post-intervention and parental symptoms of anxiety at six months post-intervention. Future research with rigorous design should investigate the optimal duration, frequency, and intervention approaches of psychosocial interventions.

TWEETABLE ABSTRACT

Psychosocial interventions improve asthma symptoms and parental stress within three months post-intervention for families of school-age children with asthma @ConnieChong1.

Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma

AIMS

Spirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the variability of forced expiratory volume in 1 s (FEV1) in children with symptomatically well-controlled asthma by applying three different methods of expressing change in FEV1 over 3-month intervals.

METHODS

Data from five longitudinal studies of children with asthma which measured FEV1 at 3-month intervals over 6 or 12 months were used. We analysed paired FEV1 measurements when asthma symptoms were controlled. The variability of FEV1% predicted (FEV1%), FEV1 z-score (FEV1z) and conditional z score for change (Zc) in FEV1 was expressed as limits of agreement.

RESULTS

A total of 881 children had 3338 FEV1 measurements on occasions when asthma was controlled; 5184 pairs of FEV1 measurements made at 3-month intervals were available. Each unit change in FEV1 z score was equivalent to a Zc 1.45 and an absolute change in FEV1% of 11.6%. The limits of agreement for change in FEV1% were -20 and +21, absolute change in FEV1 z were -1.7 and +1.7 and Zc were -2.6 and +2.1. Regression to the mean and increased variability in younger children were present for change in FEV1% and FEV1z comparisons, but not Zc.

CONCLUSION

Given the wide limits of agreement of paired FEV1 measurements in symptomatically well-controlled children, asthma treatment should primarily be guided by symptoms and not by a change in spirometry.

Exhaled Volatile Organic Compounds for Asthma Control Classification in Children with Moderate to Severe Asthma: Results from the SysPharmPediA Study

Rationale: The early identification of children with poorly controlled asthma is imperative for optimizing treatment strategies. The analysis of exhaled volatile organic compounds (VOCs) is an emerging approach to identify prognostic and diagnostic biomarkers in pediatric asthma. Objectives: To assess the accuracy of gas chromatography-mass spectrometry-based exhaled metabolite analysis to differentiate between controlled and uncontrolled pediatric asthma. Methods: This study encompassed discovery (SysPharmPediA [Systems Pharmacology Approach to Uncontrolled Paediatric Asthma]) and validation (U-BIOPRED [Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes] and PANDA [Paediatric-Asthma-Non-Invasive-Diagnostic-Approaches]) phases. First, exhaled VOCs that discriminated degrees of asthma control were identified. Subsequently, outcomes were validated in two independent cohorts. Patients were classified as controlled or uncontrolled on the basis of asthma control test scores and the number of severe attacks in the past year. In addition, the potential of VOCs to predict two or more future severe asthma attacks in SysPharmPediA was evaluated. Measurements and Main Results: Complete data were available for 196 children (SysPharmPediA, n = 100; U-BIOPRED, n = 49; PANDA, n = 47). In SysPharmPediA, after randomly splitting the population into training (n = 51) and test (n = 49) sets, three compounds (acetophenone, ethylbenzene, and styrene) distinguished between patients with uncontrolled and controlled asthma. The areas under the receiver operating characteristic curves (AUROCCs) for training and test sets were, respectively, 0.83 (95% confidence interval [CI], 0.65-1.00) and 0.77 (95% CI, 0.58-0.96). Combinations of these VOCs resulted in AUROCCs of 0.74 ± 0.06 (U-BIOPRED) and 0.68 ± 0.05 (PANDA). Attack prediction tests resulted in AUROCCs of 0.71 (95% CI, 0.51-0.91) and 0.71 (95% CI, 0.52-0.90) for the training and test sets. Conclusions: Exhaled metabolite analysis might enable asthma control classification in children. This should stimulate the further development of exhaled metabolite-based point-of-care tests in asthma.

Detailed characterization and impact of small airway dysfunction in school-age asthma

BACKGROUND

Small airway dysfunction (SAD) is increasingly recognized as an important feature of pediatric asthma yet typically relies on spirometry-derived FEF25-75 to detect its presence. Multiple breath washout (MBW) and oscillometry potentially offer improved sensitivity for SAD detection, but their utility in comparison to FEF25-75, and correlations with clinical outcomes remains unclear for school-age asthma. We investigated SAD occurrence using these techniques, between-test correlation and links to clinical outcomes in 57 asthmatic children aged 8-18 years.

METHODS

MBW and spirometry abnormality were defined as z-scores above/below ± 1.96, generating MBW reference equations from contemporaneous controls (n = 69). Abnormal oscillometry was defined as > 97.5th percentile, also from contemporaneous controls (n = 146). Individuals with abnormal FEF25-75, MBW, or oscillometry were considered to have SAD.

RESULTS

Using these limits of normal, SAD was present on oscillometry in 63% (resistance at 5-20 Hz; R5-R20; >97.5th percentile), on MBW in 54% (Scond; z-scores> +1.96) and in spirometry FEF25-75 in 44% of participants (z-scores< -1.96). SAD, defined by oscillometry and/or MBW abnormality, occurred in 77%. Among those with abnormal R5-R20, Scond was abnormal in 71%. Correlations indicated both R5-R20 and Scond were linked to asthma medication burden, baseline FEV1 and reversibility. Additionally, Scond correlated with FENO and magnitude of bronchial hyper-responsiveness. SAD, detected by oscillometry and/or MBW, occurred in almost 80% of school-aged asthmatic children, surpassing FEF25-75 detection rates.

CONCLUSIONS

Discordant oscillometry and MBW abnormality suggests they reflect different aspects of SAD, serving as complementary tools. Key asthma clinical features, like reversibility, had stronger correlation with MBW-derived Scond than oscillometry-derived R5-R20.

Association of blood inflammatory phenotypes and asthma burden in children with moderate-to-severe asthma

Background

Underlying immunological mechanisms in children with moderate-to-severe asthma are complex and unclear. We aimed to investigate the association between blood inflammatory parameters and asthma burden in children with moderate-to-severe asthma.

Methods

Blood inflammatory parameters (eosinophil and neutrophil counts and inflammatory mediators using multiplex immunoassay technology) were measured in children (6-17 years) with moderate-to-severe asthma from the SysPharmPediA cohort across four European countries. Based upon low/high blood eosinophil (LBE/HBE) counts of

Results

Among 126 included children (41% girls and mean (sd) age of 11.94 (2.76)), 22%, 44%, 11% and 23% were classified as mixed, eosinophilic, neutrophilic and paucigranulocytic phenotypes, respectively. Neutrophilic children had the lowest lung function (forced expiratory volume in 1 s % predicted pre-salbutamol) compared with other groups. Children with mixed asthma were most often uncontrolled and had the highest asthma-related school absence in the past year. Interleukin (IL)-6 and matrix metalloproteinase-9 levels were significantly higher in patients with mixed or neutrophilic asthma, whereas tissue inhibitor of metalloproteinase-2 was lower in patients with neutrophilic asthma compared with eosinophilic or paucigranulocytic asthma. IL-5 was increased in eosinophilic group compared with the neutrophilic and paucigranulocytic groups, irrespective of the chosen cut-off for eosinophilia.

Conclusion

Differences in asthma burden-related clinical expression and distinct blood inflammatory mediator profiles were found between phenotypes, highlighting implications for optimising personalised treatment and management strategies in children with moderate-to-severe asthma.

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Grants

• Ministry of Education, Science, and Sport of the Republic of Slovenia
• German Ministry of Education and Research
• ZonMw
• ERACoSysMed

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Affiliation(s)

Amir Hossein Alizadeh Bahmani Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
Susanne J.H. Vijverberg Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
Simone Hashimoto Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Christine Wolff Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
Catarina Almqvist Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Lizan D. Bloemsma Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Susanne Brandstetter KUNO, University of Regensburg, Regensburg, Germany
Paula Corcuera-Elosegui Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain
Mario Gorenjak Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
Susanne Harner Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
Anna M. Hedman Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Michael Kabesch Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
Leyre López-Fernández Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain
Aletta D. Kraneveld Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
Anne H. Neerincx Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Maria Pino-Yanes Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, Santa Cruz de Tenerife, Spain CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain Instituto de Tecnologías Biomédicas, Universidad de La Laguna, La Laguna, Spain
Uroš Potočnik Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
Olaia Sardón-Prado Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain Department of Pediatrics, School of Medicine and Nursery, University of the Basque Country, San Sebastián, Spain
Barbara S. Dierdorp Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Tamara Dekker Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Nariman K.A. Metwally Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Jan Willem Duitman Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
René Lutter Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
Paul Brinkman Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
Mahmoud I. Abdel-Aziz Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
Anke H. Maitland-van der Zee Department of Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands

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Factors influencing the initiation of biologic therapy in children with severe asthma: Results of the pediatric asthma noninvasive diagnostic approaches (PANDA) study

BACKGROUND & OBJECTIVES

Despite the availability of biologics for severe pediatric asthma, real-life studies reporting on drivers behind initiating biologics and their alignment with the Global Initiative for Asthma (GINA) recommendations are lacking.

METHODS

We performed analysis within the pediatric asthma noninvasive diagnostic approaches study, a prospective cohort of 6- to 17-year-old children with severe asthma. Information was collected on demographic factors, symptom control, treatment, comorbidities, and diagnostic tests from medical records and questionnaires. We divided patients into "starters" or "nonstarters" based on the clinical decision to initiate biologics and performed multivariate logistic regression analysis to identify drivers behind initiating therapy. Additionally, we assessed patient suitability for biologics according to key factors in the GINA recommendations: Type 2 inflammation, frequency of exacerbations, and optimization of treatment adherence.

RESULTS

In total, 72 children (mean age 11.5 ± 3.0 years, 65.3% male) were included (13 starters). Initiation of biologics was associated with a higher GINA treatment step (adjusted odds ratio's [aOR] = 5.0, 95%CI 1.33-18.76), steroid toxicity (aOR = 21.1, 95%CI 3.73-119.91), frequency of exacerbations (aOR = 1.6, 95%CI 1.10-2.39), improved therapy adherence (aOR = 1.7, 95%CI 1.10-2.46), Caucasian ethnicity (aOR = 0.20, 95%CI 0.05-0.80), ≥1 allergic sensitization (aOR = 0.06, 95%CI 0.004-0.97), and allergic rhinitis (aOR = 0.13, 95%CI 0.03-0.65). Furthermore, steroid toxicity was identified as an important factor for deviation from the current recommendations on biologic prescription.

CONCLUSIONS

We identified multiple drivers and inhibitors for initiating biologics, and showed the clinical need for biologics in severe pediatric asthmatics suffering from steroid toxicity. These findings may help refine asthma management guidelines.

Effectiveness of specialist nurse-led WeChat mini program management for disease control in asthma: A randomized controlled study

BACKGROUND

Asthma is a common chronic respiratory disease in childhood, requiring effective management strategies.

PURPOSE

This study aims to evaluate the effectiveness of a nurse-led WeChat Mini Program in managing asthma among children aged 6 to 11 years.

METHODS

This randomized controlled trial adhered to the CONSORT checklist and was conducted at a tertiary hospital in China from January 2023 to August 2023. One hundred and eight children with asthma were randomly assigned to two groups, and 81 children completed the 6-month follow-up. All participants received asthma management from specialist nurses, including routine treatments such as inhaled corticosteroids. The experimental group also utilized the WeChat Mini Program for asthma management. Both groups underwent follow-up assessments at 3 and 6 months post-enrollment, which included the Childhood Asthma Control Test (C-ACT), asthma control levels, frequency of exacerbations, and lung function.

RESULTS

At 3 and 6 months, the experimental group showed significantly higher C-ACT scores and a lower exacerbation frequency compared to the control group (p < 0.05). While Peak Expiratory Flow improved, Forced Expiratory Volume in 1 Second Percentage Predicted (FEV1%) and FEV1/FVC did not change significantly.

CONCLUSIONS

The WeChat Mini Program significantly improved asthma control and reduced exacerbations but did not substantially enhance all lung function parameters. Further research is required to confirm its long-term effects.

APPLICATION TO PRACTICE

Incorporating a specialist nurse-led digital management tool, such as the WeChat Mini Program, into standard pediatric asthma care may offer an effective management strategy.

Roles of Psychological Flexibility, Parenting Competence, and Asthma Management Self-Efficacy in the Functioning Outcomes of Parents of Children with Asthma Co-Occurring with Attention-Deficit/Hyperactivity Disorder

Asthma and ADHD represent prevalent pediatric conditions, with the former being a physical disorder and the latter being a neurodevelopmental disorder. This study examined the influence of parental psychological flexibility (PF)-the ability to adapt to evolving situational demands, shift perspectives, and balance competing priorities-alongside parenting competence and asthma management self-efficacy on family functioning and parental psychological adjustment in families with children exhibiting concurrent asthma and ADHD symptoms. Baseline data were analyzed from 130 parents (mean age = 40.3 years, SD = 5.5; 88.9% mothers) of children diagnosed with both asthma and ADHD (mean age = 8.0 years, SD = 2.2; 74.6% boys), who were participating in a randomized controlled trial evaluating an Acceptance and Commitment Therapy (ACT)-based parenting intervention. An adjusted structural equation model revealed that greater parental psychological inflexibility was significantly associated with poorer family functioning (β = -0.61, 95% CI [-0.74, -0.33], p < 0.001) and increased psychological maladjustment (β = 0.48, 95% CI [0.32, 0.63], p < 0.001), accounting for intercorrelations with parenting competence and parental asthma management self-efficacy. Additionally, parental psychological flexibility was found to mediate the relationship between parenting competence and both family functioning and psychological adjustment. These findings underscore the importance of targeting parental psychological inflexibility and enhancing parenting competence in interventions to improve family dynamics and parental mental health and thereby suggest a shift from the traditional focus on self-efficacy in symptom management for pediatric asthma and ADHD.

A smartphone app for preschool wheezing and reliability of medical history collection

BACKGROUND

The use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews.

METHODS

Children with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app.

RESULTS

We enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ''simple and intuitive'' at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21-25) for the control group (42 patients) and 23 (21-24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24-25) and 24 (24-25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable.

CONCLUSIONS

The smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.

Association of Mite Molecular Sensitization Profiles with Respiratory Allergies and Asthma Control in Children from East China

Background

Allergic conditions, identified as a significant global health challenge, are profoundly influenced by indoor allergens, especially house dust mites (HDM). Yet the relationship between mite sensitized components and respiratory allergies and asthma control remains poorly understood.

Methods

A cohort of 96 children, either with allergic rhinitis (AR) or rhinitis with asthma syndrome (ARAS), was assessed. Protein microarray technology was deployed to quantify sIgE responses to the allergenic components of Der p and Der f.

Results

The study cohort comprised 18 AR and 78 ARAS patients; with 43 mild and 53 moderate-to-severe AR; with 28 uncontrolled, 21 partially controlled, and 29 well-controlled asthma. Sensitization prevalence for HDM components was highest with Der p (97.9%), Der f 2 (97.9%), Der p 2 (94.8%), Der f 1(94.8%), Der p 1 (93.8%), Der p 23 (57.3%). Notably, sIgE concentrations for Der f and Der f 2 were significantly greater in the ARAS compared to AR (P < 0.05). While sIgE levels varied between mild and moderate-to-severe AR, the differences were not statistically significant (P > 0.05). However, Der p 23 sIgE levels demonstrated a significant fluctuation across the asthma control strata (P < 0.05), with the well-controlled group exhibiting the lowest readings.

Conclusion

The sIgE levels to HDM allergens were higher in ARAS group compared to AR group, especially Der f and Der f 2, indicating an association between sIgE reactivity and the diagnosis of asthma. Reduced Der p 23 sIgE levels were indicative of enhanced asthma control.

Results of the RVA Breathes randomized controlled trial

OBJECTIVE

This study tested a randomized controlled trial of RVA Breathes, a community asthma program, in reducing asthma-related healthcare utilization among children living in an area with a high poverty rate.

METHODS

Participants included 250 caregivers (78% African American/Black; 73.3% household income<$25,000/year) and their children with asthma (5-11 years). Inclusion criteria included an asthma-related emergency department (ED) visit, hospitalization, unscheduled doctor's visit, or systemic steroids in the past 2 years. Families were randomized to a full active intervention (asthma education with community health workers [CHWs], home remediation with home assessors, and a school nurse component; n = 118), partial active intervention (asthma education and home remediation; n = 69), or a control group (n = 63) for 9 months. Measures on healthcare utilization and asthma-related factors were collected. Follow-up assessments occurred across a 9-month period.

RESULTS

Although we did not find any significant effects, there was a trend toward significance for a group by time effect with objective healthcare utilization as the outcome (F4,365 = 2.28, p = .061). The full intervention group experienced a significant decrease from baseline to 9-month follow-up compared with the other groups (p < .001). Only the full intervention group experienced a significant increase in reported asthma action plans across time (no significant group effect).

CONCLUSIONS

In the context of the unprecedented COVID-19 pandemic, which led to a substantial global decrease in healthcare utilization, the study's main hypotheses were not supported. Nevertheless, findings support the benefit of community asthma programs that integrate care across multiple settings and connect families with CHWs.

Patient-Reported Outcomes in Asthma

Food and Drug Administration's Center for Drug Evaluation and Research defines patient-reported outcomes as "any report of the status of a patient's health condition, health behavior, or experience with healthcare that comes directly form the patient, without interpretation of the patient's response by a clinician or anyone else." Validated patient-reported outcome measures are used extensively in pediatric and adult asthma across clinical and research settings to assess the impact of treatments on patient outcomes over time. This work aims to review some of the most commonly used asthma patient-reported outcomes across the following criteria: validity, reliability, responsiveness, time to complete, ease of administration, target population, recall period, scoring method, availability in different languages, use in clinical practice or research settings, licensing requirements, and cost of use.

Fatigue in severe pediatric asthma patients: Results of the PANDA study

BACKGROUND

Fatigue is a commonly reported clinical symptom, yet research on fatigue in children with severe asthma is missing. We aimed to explore the extent of fatigue in severe pediatric asthma and identify associated factors.

METHOD

This study was conducted within the Pediatric Asthma Non-Invasive Diagnostic Approaches (PANDA), an observational cohort of 6- to 17-year-old Dutch children with severe asthma. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™-MFS) was used to measure self-reported fatigue. Fatigue levels were compared with a general pediatric Dutch population using linear regression, and quantifying the prevalence of "fatigued" (-2 < Standard deviations [SD] ≤ -1) and "severely fatigued" (SD ≤ -2) children. Secondly, we performed linear regression analyses to explore whether fatigue levels were independently associated with asthma attacks, comorbidities, medication, pulmonary function, symptom control, and asthma-related quality of life (QoL).

RESULTS

Severe pediatric asthma patients (n = 78, mean age 11.8 ± 3.1 years) reported significantly more fatigue than Dutch peers (n = 328, mean age 11.8 ± 3.2 years) mean difference in z-score: -0.68; 95%CI -0.96, -0.40. In the severe asthma group, 28.2% scored as "fatigued" and 15.4% as "severely fatigued," compared with 14.0% and 3.4% in the general population. In pediatric asthma patients, asthma-related QoL (β = 0.77, p < .01, ΔR2 = .43), symptom control (β = 0.56, p < .01, ΔR2 = .24) and a dysfunctional breathing pattern (β = -0.36, p < .01, ΔR2 = .12) were most strongly associated with fatigue scores.

CONCLUSION

Fatigue is a common symptom in children with severe asthma and is associated with multiple clinical factors and patient-reported outcomes. It should be considered as an important treatment target.

Telemonitoring of pediatric asthma in outpatient settings: A systematic review

Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.

Contribution of caregiver and child anxiety and depressive symptoms to child asthma-related quality of life

BACKGROUND

Depression and anxiety negatively affect asthma-related quality of life (QoL). Yet, little is known regarding mood and asthma-related factors that best uniquely explain asthma-related QoL in children.

OBJECTIVE

This cross-sectional study evaluated the unique variance explained by caregiver and child depressive and anxiety symptom severity in child asthma-related QoL, apart from that explained by demographics and asthma control.

METHODS

Children aged 7 to 17 years with asthma (n = 205) and their caregivers with major depressive disorder were included. A 3-stage hierarchical linear regression analysis was conducted with the Pediatric Asthma Quality of Life Questionnaire total scores considered as the outcome. Predictors included demographic characteristics (stage 1); asthma control assessed by the Asthma Control Test (stage 2); and caregiver depression and anxiety (Hamilton Rating Scale for Depression and the Spielberger State/Trait Anxiety Scale) and child depression and anxiety (Children's Depression Inventory and the Screen for Child Anxiety-Related Disorders) (stage 3).

RESULTS

Demographic characteristics accounted for only 5.5% of the Pediatric Asthma Quality of Life Questionnaire scores. Asthma control significantly increased variance explained in QoL to 32.6%, whereas caregiver and child depression and anxiety symptoms significantly increased variance explained to 42.6%. Child anxiety was found to uniquely explain the largest proportion of variance in QoL (rs2 = 0.584).

CONCLUSION

After adjusting variance in QoL for demographic characteristics and asthma control, caregiver and child depression and anxiety measures significantly increased the proportion of variance explained in a child's asthma-related QoL. In addition to better asthma control, child and caregiver depression and anxiety should be addressed to increase child asthma-related QoL.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02809677.

The effect of motivational interviewing techniques on the knowledge level of asthma control among mothers of children with allergic asthma

PURPOSE

This study aims to evaluate the effect of education given with motivational interviewing techniques on mothers of children with allergic asthma aged 4-11 years on asthma control and knowledge level.

METHODS

The research was designed according to the CONSORT checklist with a randomized controlled design. 76 participants were randomly assigned to either an intervention (n = 38) or control group (n = 38). The intervention group received asthma education utilizing motivational interviewing techniques from a pediatric nurse. The control group received no further education. The Childhood Asthma Control Test and Asthma Knowledge Level Questionnaire were used to collect data. The control group received only education at the time of discharge.

RESULTS

The mothers' asthma control and asthma knowledge scores in the experimental group were significantly higher than in the control group (p < 0.001). In the experimental group, asthma control scores increased from 14.29 ± 4.27 to 21.37 ± 1.57 after education. The mean score of the asthma knowledge score increased from 54.74 ± 10.89 to 73.47 ± 7.17 after intervention.

CONCLUSIONS

The study showed that education using motivational interviewing techniques for mothers of children with allergic asthma increased their knowledge and positively affected asthma control.

IMPLICATIONS TO PRACTICE

Education is important in improving mothers' knowledge about allergic asthma. Asthma education using motivational interviewing techniques should be provided when their children are newly diagnosed. Education practices should be implemented as a policy in hospitals and pediatric clinics, and nurses should be supported in ensuring the implementation of education practices.

Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms

BACKGROUND

Colder temperature exposure is a known trigger for pediatric asthma exacerbation. The induction of oxidative stress is a known pathophysiologic pathway for asthma exacerbation. However, the role of oxidative stress in linking colder temperature exposure and worsened pediatric asthma symptoms is poorly understood.

METHODS

In a panel study involving 43 children with asthma, aged 5-13 years old, each child was visited 4 times with a 2-week interval. At each visit, nasal fluid, urine, and saliva samples were obtained and measured for biomarkers of oxidative stress in the nasal cavity (nasal malondialdehyde [MDA]), the circulatory system (urinary MDA), and the oral cavity (salivary MDA). Childhood Asthma-Control Test (CACT) was used to assess asthma symptoms.

RESULTS

When ambient daily-average temperature ranged from 7 to 18 °C, a 2 °C decrement in personal temperature exposures were significantly associated with higher nasal MDA and urinary MDA concentrations by 47-77% and 6-14%, respectively. We estimated that, of the decrease in child-reported CACT scores (indicating worsened asthma symptoms and asthma control) associated with colder temperature exposure, 14-57% were mediated by nasal MDA.

CONCLUSION

These results suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing nasal oxidative stress.

IMPACT

The role of oxidative stress in linking colder temperature exposure and worsened asthma symptoms is still poorly understood. Lower temperature exposure in a colder season was associated with higher nasal and systemic oxidative stress in children with asthma. Nasal MDA, a biomarker of nasal oxidative stress, mediated the associations between colder temperature exposures and pediatric asthma symptoms. The results firstly suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing oxidative stress in the nasal cavity.