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Cleves D, Vargas P, Acuña-Cordero R, Aguilera-Otalvaro P, Camargo B, Aristizábal-Duque R, Rodríguez-Martínez CE. Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric asthma patients. Pediatr Pulmonol 2024; 59:121-128. [PMID: 37818776 DOI: 10.1002/ppul.26723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.
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Affiliation(s)
- Daniela Cleves
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Pedro Vargas
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | | | | | - Bethy Camargo
- Department of Pediatrics, Hospital Militar Central, Bogotá, Colombia
| | | | - Carlos E Rodríguez-Martínez
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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2
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Taheri F, Nasiri A, Namdari S, Salmani F. Effect of motivational interviewing on treatment adherence and self-efficacy of adolescents with asthma: A randomized controlled trial. Nurs Open 2023. [PMID: 36929146 DOI: 10.1002/nop2.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
AIMS This study examined the short-term effect of motivational interviewing on treatment adherence and self-efficacy of adolescents with asthma. DESIGN The randomized controlled trial. METHOD In this study, 72 adolescents with asthma were recruited and assigned to experimental and control groups randomly. In the experimental group, the motivational interviewing was performed for five weekly sessions lasting 80-90 min. The treatment adherence and self-efficacy questionnaires were completed before the intervention, 2 weeks and 3 months after the intervention in both groups. Data were analysed by Chi-Square test, independent samples T-test, repeated measures of Wilcoxon and generalized estimating equation. RESULTS The treatment adherence was found to be significantly higher 2 weeks (p = 0.006) and 3 months after the intervention (p = 0.04) in the experimental group than the control group. In addition, the degree of self-efficacy was significantly more in the experimental group 2 weeks (p < 0.001) and 3 months later (p < 0.001) than the control group. The result of generalized estimating equation showed that the intervention group had an average of 14.44 more self-efficacy points than the control group (p < 0.001). Also, treatment adherence in the intervention group was significantly higher than the control group (β = 6.14, p = 0.05(. CONCLUSION This study adds to the evidence for the effectiveness of motivational interviewing in treatment of adolescents with asthma.
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Affiliation(s)
- Fatemeh Taheri
- Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Nasiri
- Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Somayeh Namdari
- Department of Nursing, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Fatemeh Salmani
- Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
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Nakamuta JS, Puglia ALP, Meireles P, Blanco DC, Lima MA, Birck MG, Braga MC, Oliveira RWD, Julian GS, Forestiero FJ. Asthma control in Brazil: a systematic review. J Asthma 2022; 60:868-880. [PMID: 35896311 DOI: 10.1080/02770903.2022.2107537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: To explore asthma control in patients undergoing pharmacotherapy on studies in the last 20 years in Brazil. Asthma is a chronic airway inflammation disease with a high prevalence worldwide. Even with a variety of drug treatment improvements, attaining asthma control is challenging, since it should have a personalized approach. In Brazil, studies on the prevalence of asthma control are scarce and usually from a small sample size.Data Sources: A systematic review was performed to assess asthma control in Brazilian population. Terms related to "asthma", "asthma control" and "Brazil" were used in the search strategies in PubMed, BVSalud, Embase and Cochrane Library, including Brazilian Journal of Allergy and Immunology as data sources. A narrative synthesis was performed to report key outcome.Study Selections: In total, 23 studies were included. Most of them were conducted in the Southeastern and Northeast regions, in a short duration.Results: Pediatric and non-pediatric population were assessed, with a higher proportion of female. In pediatric population, those with poorly controlled asthma usually had severe or persistent disease. In elderly, an increased asthma severity was found, although proper treatment might be effective. Most studies (70%) also described exacerbations, hospitalizations (48%), quality of life (39%), and emergency visits (30%). Despite heterogeneity of outcomes and population, studies show an important prevalence of uncontrolled asthma even in patients being treated, with better disease control with treatment improvements.Conclusions: Studies in Brazil have shown that asthma control remains a challenge and there is still a need for improvement on disease management.
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Affiliation(s)
| | | | | | | | - Marina Andrade Lima
- Departamento de Pesquisas Clínicas, Hospital Dia do Pulmão, Blumenau, Brazil
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Zaeh SE, Ramsey R, Bender B, Hommel K, Mosnaim G, Rand C. The Impact of Adherence and Health Literacy on Difficult-to-Control Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:386-394. [PMID: 34788658 DOI: 10.1016/j.jaip.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailored interventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.
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Affiliation(s)
- Sandra E Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Conn.
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Cynthia Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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Sánchez-Nieto JM, Bernabeu-Mora R, Fernández-Muñoz I, Carrillo-Alcaraz A, Alcántara-Fructuoso J, Fernández-Alvarez J, Vera-Olmos JC, Martínez-Ferre MJ, Olea MGV, Valenciano MJC, Martínez DS. Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. NPJ Prim Care Respir Med 2022; 32:1. [PMID: 35013343 PMCID: PMC8748930 DOI: 10.1038/s41533-021-00262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.
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Affiliation(s)
- Juan Miguel Sánchez-Nieto
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain.,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain
| | - Roberto Bernabeu-Mora
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain. .,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain. .,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain.
| | - Irene Fernández-Muñoz
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | - Andrés Carrillo-Alcaraz
- Division of Intensive Care Unit, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | - Juan Carlos Vera-Olmos
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | | | - Diego Salmerón Martínez
- Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Health and Social Sciences, Murcia University, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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6
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Takkinsatian P, Chantaratin S, Sirisakpanit S, Srisuwatchari W, Pacharn P, Jirapongsananuruk O, Visitsunthorn N. Psychosocial factors and lack of asthma knowledge undermine child and adolescent adherence to inhaled corticosteroid. J Asthma 2021; 59:2234-2245. [PMID: 34752204 DOI: 10.1080/02770903.2021.1999468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with non-adherence in pediatric asthma patients. A total of 134 patients aged 8-18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (<75%). "Intentional" and "hectic lifestyle and forgetfulness" were the main reasons for missing ICS doses in mid-late adolescents and children, respectively. Asthma knowledge generally improved with age. Overall, 89% and 67.7% of patients could define symptoms and triggers of asthma, respectively; however, less than 25% understood how asthma affected their body and the chronic nature of asthma. Patients with ICS adherence <75% had unfavorable expectations from asthma treatment (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.10), and a higher proportion of inhaled short-acting beta-agonist use before exercise (OR: 4.12, 95% CI: 1.27-13.36). Depression and anxiety were frequently found (27.5%) and 23.3%, respectively; p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.
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Affiliation(s)
- P Takkinsatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Chantaratin
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Sirisakpanit
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Pacharn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - O Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Visitsunthorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Al-Nawayseh MK, Al-Iede M, Elayeh E, Hijazeen R, Oweidat KA, Aleidi SM. The impact of using a mobile application to improve asthma patients' adherence to medication in Jordan. Health Informatics J 2021; 27:14604582211042926. [PMID: 34587767 DOI: 10.1177/14604582211042926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control (p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.
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Affiliation(s)
- Mohammad K Al-Nawayseh
- Department of Management Information Technology, School of Business, The University of Jordan, Amman, Jordan
| | - Montaha Al-Iede
- Department of Pediatrics, Respiratory and Sleep Medicine Section, Jordan University Hospital, Amman, JordanSchool of Medicine, The University of Jordan, Amman, Jordan
| | - Eman Elayeh
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rima Hijazeen
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Khaled Al Oweidat
- School of Medicine, The University of Jordan, Amman, JordanDepartment of Respiratory and Internal Medicine, Jordan University Hospital, Amman, Jordan
| | - Shereen M Aleidi
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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8
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Lee JR, Leo S, Liao S, Ng WR, Tay TYN, Wang Y, Ang WHD, Lau Y. Electronic adherence monitoring devices for children with asthma: A systematic review and meta-analysis of randomised controlled trials. Int J Nurs Stud 2021; 122:104037. [PMID: 34391027 DOI: 10.1016/j.ijnurstu.2021.104037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a common chronic condition amongst children. Poor adherence to asthma medications can increase asthma exacerbations, absence from school, healthcare utilisation and costs and decrease quality of life. Emerging evidence suggests the use of electronic adherence monitoring devices in improving children's adherence to medications. OBJECTIVES This study aimed to evaluate the effectiveness of electronic adherence monitoring devices in improving inhaler adherence amongst children with asthma. DESIGN This study is a systematic review and meta-analysis. DATA SOURCES A systematic search using Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus and ProQuest Dissertations and Theses from inception up to April 6, 2021, was conducted. REVIEW METHODS Randomised controlled trials evaluating the use of electronic adherence monitoring devices amongst children and published in English were included. The outcomes were inhaler adherence, asthma exacerbation, lung function, asthma control and accessibility. The overall effect was measured using Hedges' g and determined using Z-statistics at a significance level of p < 0.05. Heterogeneity was assessed using χ2 and I² statistics. The individual and overall quality of evidence was assessed. Sensitivity and subgroup analyses were conducted. Narrative synthesis of outcomes was performed when meta-analysis could not be conducted on the data. RESULTS A total of 13,429 records were identified, and 10 randomised controlled trials in 11 articles amongst 1123 participants were included in the meta-analysis. Meta-analysis revealed that the electronic adherence monitoring device group was 1.50 times more likely to adhere to inhalers compared with the control group with medium-to-large effect size (g = 0.64). A series of subgroup analyses showed that no significant subgroup differences for inhaler adherence were found amongst different populations, comparator, setting, duration of the monitoring period, reminder, and feedback functions of the electronic adherence monitoring devices. Children found the devices as user friendly with high accessibility scores. However, no significant differences were observed between the intervention and control groups for asthma exacerbations, lung function and asthma control. CONCLUSIONS The findings from this study suggested that electronic adherence monitoring devices could improve inhaler adherence. Future devices should contain actuation and inhalation functions that can help to confirm actual inhalation amongst children with asthma. The overall evidence of outcomes ranged from very low to high. Furthermore, future large-scale trials were recommended before clinical implementations.
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Affiliation(s)
- Jing Ru Lee
- Nursing Department, Dover Park Hospice, Singapore
| | - Siyan Leo
- Nursing Department, National Neuroscience Institute, Singapore
| | - Suyue Liao
- Nursing Department, Changi General Hospital, Singapore.
| | - Wan Ring Ng
- Nursing Department, Tan Tock Seng Hospital, Singapore
| | | | - Yutao Wang
- Nursing Department, Changi General Hospital, Singapore.
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Level 2, Clinical Research Centre, National University of Singapore, Block MD11, 10 Medical Drive 117597, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Level 2, Clinical Research Centre, National University of Singapore, Block MD11, 10 Medical Drive 117597, Singapore.
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AlOlayan AM, Alhammad MA, Almutairi AA, Alshammari MT, Albuhairi S. Adherence to Asthma Controller Therapy Among Children in Majmaah City, Saudi Arabia. Cureus 2021; 13:e14633. [PMID: 34046270 PMCID: PMC8140659 DOI: 10.7759/cureus.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background and objective Improving adherence to asthma medications may prevent asthma exacerbation, which is associated with a decline in lung function. The purpose of this study was to assess the adherence to asthma controller therapy and the factors that might influence the level of adherence among asthmatic children. Materials and methods We conducted a prospective observational study at the King Khalid Hospital in Majmaah, Saudi Arabia between January and April 2020; the study was conducted among children aged 1-14 years with a diagnosis of asthma. The data collected when available included age and gender by using a pre-tested questionnaire that contained four validated items, and the respondents were the parents of the affected children. Due to the coronavirus disease 2019 (COVID-19) pandemic, the data collection was performed via phone calls to ensure safety. Informed consent was obtained from the parents. Results We analyzed 152 asthmatic children to evaluate their adherence to asthma controller therapy. The majority of the children were males (60%). Asthma was most prevalent in the age group of 6-10 years (40.1%), followed by the age group of two to five years (32.9%). We found that the majority of the patients had poor adherence to asthma medication (83.6%) while the remaining had good adherence (16.4%). The total mean score for adherence to medication therapy was 5.16 (SD: 2.3). Conclusions The present study showed that the overall adherence level to the asthma controller therapy was poor among children. Larger, nationwide studies are needed to assess the adherence to asthma medications and implement interventions that can improve the same.
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Affiliation(s)
- Abdullah M AlOlayan
- Department of Pediatrics, College of Medicine, Majmaah University, Majmaah, SAU
| | | | | | | | - Sultan Albuhairi
- Department of Pediatrics - Allergy and Immunology Section, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
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10
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Nduaguba S, Barner JC, Makhinova T, Roberson K. Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study. J Pharm Pract 2021; 35:528-535. [PMID: 33648367 DOI: 10.1177/0897190021997032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD). METHODS This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate. RESULTS Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%). CONCLUSION Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.
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Affiliation(s)
- Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Jamie C Barner
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Roberson
- Former Director of Professional Affairs, Texas Pharmacy Association, Austin, TX, USA
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11
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Chhatar S, Lal G. Role of adrenergic receptor signalling in neuroimmune communication. CURRENT RESEARCH IN IMMUNOLOGY 2021; 2:202-217. [PMID: 35492402 PMCID: PMC9040148 DOI: 10.1016/j.crimmu.2021.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Neuroimmune communication plays a crucial role in maintaining homeostasis and promptly responding to any foreign insults. Sympathetic nerve fibres are innervated into all the lymphoid organs (bone marrow, thymus, spleen, and lymph nodes) and provide a communication link between the central nervous system (CNS) and ongoing immune response in the tissue microenvironment. Neurotransmitters such as catecholamines (epinephrine and norepinephrine) bind to adrenergic receptors present on most immune and non-immune cells, establish a local neuroimmune-communication system, and help regulate the ongoing immune response. The activation of these receptors varies with the type of receptor-activated, target cell, the activation status of the cells, and timing of activation. Activating adrenergic receptors, specifically β-adrenergic signalling in immune cells leads to activation of the cAMP-PKA pathway or other non-canonical pathways. It predominantly leads to immune suppression such as inhibition of IL-2 secretion and a decrease in macrophages phagocytosis. This review discusses the expression of different adrenergic receptors in various immune cells, signalling, and how it modulates immune cell function and contributes to health and diseases. Understanding the neuroimmune communication through adrenergic receptor signalling in immune cells could help to design better strategies to control inflammation and autoimmunity. Primary and secondary lymphoid organs are innervated with sympathetic nerve fibres. Adrenergic receptor expression on immune and non-immune cells establishes a local neuroimmune communication system. Adrenergic receptor signalling in immune cells controls the differentiation and function of various immune cells. Modulating adrenergic receptor signalling with a specific agonist or antagonist also affect the immune response.
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Affiliation(s)
| | - Girdhari Lal
- Corresponding author. National Centre for Cell Science, NCCS Complex, Ganeshkhind, Pune, MH-411007, India.
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Potential normalization of an asthma mHealth intervention in community pharmacies: Applying a theory-based framework. Res Social Adm Pharm 2019; 16:195-201. [PMID: 31109820 DOI: 10.1016/j.sapharm.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/11/2019] [Accepted: 05/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as 'the process of getting a new intervention into routine practice'. OBJECTIVE The aim of this study was to assess the normalization potential of a complex mHealth intervention for adolescents with asthma (ADolescent Adherence Patient Tool; ADAPT) in community pharmacy practice. METHODS The Normalization Process Theory (NPT), a sociological action theory, was retrospectively applied to study the normalization potential of ADAPT. NPT explains factors that promote or hinder implementation, embedding, and integration of new interventions in clinical practice. Evaluation data (structured interviews and questionnaires) of 23 pharmacists who used the ADAPT intervention were used for this study. RESULTS Pharmacists understood the purpose of the ADAPT intervention and were prepared to undertake the necessary work of implementation. However changes at different levels are needed to support full normalization, such as changes in the intervention itself and changes in the pharmacist's work flow. The potential for normalization could also be enhanced by the use of product champions and appropriate reimbursement guidelines, to ensure uptake of the intervention by other pharmacists. Support from professional bodies for the use of mHealth could also promote normalization. CONCLUSIONS Normalization of mHealth is a complex continuous process. The ADAPT intervention has the potential to be normalized in community pharmacy practice, but full normalization would require changes in both daily pharmacy practice and reimbursement models.
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Kosse RC, Bouvy ML, de Vries TW, Koster ES. Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial. Respir Med 2019; 149:45-51. [PMID: 30803885 DOI: 10.1016/j.rmed.2019.02.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Adherence rates among asthma patients are generally low and decrease during adolescence, resulting in poorly controlled asthma. The aim of our study was to evaluate the effectiveness of the ADolescent Adherence Patient Tool (ADAPT), an interactive mobile health (mHealth) intervention, in supporting self-management and improving inhaled corticosteroid adherence in adolescents with asthma. METHODS We conducted a cluster randomized controlled trial in 66 Dutch community pharmacies. Asthma patients aged 12-18 years were invited to participate, based on pharmacy medication refill records. The main study outcome was self-reported medication adherence, measured with the Medication Adherence Report Scale (MARS). Secondary outcomes were asthma control and quality of life. Outcomes were measured at start (t = 0 months) and at the end of follow-up (t = 6 months). Mixed-effects models were used to analyze the effect. RESULTS In total, 234 adolescents (147 in the control group and 87 in the intervention group) completed the study; mean age 15.1 ± 1.9 years and 52.6% females. Adherence rates of patients with low baseline adherence (MARS scores ≤19; n = 76) increased with 1.42 points in the intervention group (n = 26). Adherence rates of patients in the control group (n = 50) decreased with 0.70 points. Thus there was a positive effect of the intervention on medication adherence (MARS +2.12, p = 0.04). This effect was stronger (MARS +2.52, p = 0.02) in poor adherent adolescents with uncontrolled asthma (n = 74). No effect of the intervention was observed on asthma control or quality of life. CONCLUSIONS The ADAPT intervention increases medication adherence in adolescents with asthma having poor adherence rates at baseline. Healthcare providers should consider a tailored mHealth approach to improve the asthma treatment.
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Affiliation(s)
- Richelle C Kosse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
| | - Tjalling W de Vries
- Department of Pediatrics, Medical Centre Leeuwarden (MCL), Leeuwarden, the Netherlands.
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
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George M, Bender B. New insights to improve treatment adherence in asthma and COPD. Patient Prefer Adherence 2019; 13:1325-1334. [PMID: 31534319 PMCID: PMC6681064 DOI: 10.2147/ppa.s209532] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient's adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with better health outcomes, such as improved disease control and a reduction in severe and potentially costly exacerbations. Adherence is a multifaceted concept that includes medication-related, intentional, and unintentional reasons that patients may or may not take their medication as directed. The purpose of this integrative review is to present the individual patient factors that contribute to suboptimal adherence to inhaled therapies and the associated effects on health outcomes, while also highlighting evidence-based strategies for health care providers to improve adherence to such therapies in patients with asthma or COPD. Working closely with patients to establish a model of shared decision-making, which takes patient beliefs and preferences into account when choosing treatment options, has the potential to improve adherence and overall patient outcomes in the management of asthma and COPD.
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Affiliation(s)
- Maureen George
- School of Nursing, Columbia University, New York, NY, USA
| | - Bruce Bender
- Division of Pediatric Behavioral Health, National Jewish Health, Denver, CO, USA
- Correspondence: Bruce BenderDivision of Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO80206, USATel +1 303 398 1697Fax +1 303 270 2141Email
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Baiardini I, Novakova S, Mihaicuta S, Oguzulgen IK, Canonica GW. Adherence to treatment in allergic respiratory diseases. Expert Rev Respir Med 2018; 13:53-62. [PMID: 30518277 DOI: 10.1080/17476348.2019.1554438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent literature on adherence in asthma and AR, focused on the following areas: adherence extent, barriers and consequences, effects of educational interventions and use of new technologies to improve the level of adherence. Expert commentary: Despite the extent, reasons and effects of this problem being well known, non-adherence in asthma and allergic AR remains worryingly high. Poor adherence leads to unsatisfactory health outcomes, with a negative impact on patients and society. Recent literature suggests that successful programs to improve adherence should include a combination of strategies. The new technologies represent a promising tool to improve adherence.
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Affiliation(s)
- Ilaria Baiardini
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy
| | - Silviya Novakova
- b Allergy Unit of Internal Consulting Department , University Hospital "St. George" , Plovdiv , Bulgaria
| | - Stefan Mihaicuta
- c Pulmonology Department, CardioPrevent Foundation , University of Medicine and Pharmacy "Dr Victor Babes" , Timisoara , Romania
| | | | - Giorgio Walter Canonica
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy.,e Personalized Medicine, Asthma and Allergy Clinic , Humanitas Research Hospital, Milano, Italy
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