1
|
Martinez A, Ye M, Hessler D, de la Rosa R, Benson M, Gilgoff R, Koita K, Bucci M, Harris NB, Long D, Thakur N. Adverse Childhood Experiences and Related Events are Associated with Asthma Symptoms in Children. Acad Pediatr 2024; 24:669-676. [PMID: 38246348 DOI: 10.1016/j.acap.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To examine the association between adverse childhood experiences (ACEs) and related events and asthma symptom burden in children. METHODS This is a cross-sectional study of baseline data from 147 participants with asthma from a cohort of children enrolled in the Pediatric ACEs Screening and Resiliency Study. Participants completed the PEdiatric ACEs and Related Life Events Screener (PEARLS) tool, a 17-item questionnaire, capturing 3 domains of childhood adversity-child maltreatment, household challenges, and social context. Asthma symptom burden was assessed using the International Study of Asthma and Allergies in Childhood core questionnaire, which asks participants to identify the presence and frequency of severe wheezing that limits speech, wheezing with exercise, nocturnal wheezing, and nocturnal cough in the last 12 months. Using multivariable logistical regression models, we examined the relationship between reported PEARLS and asthma symptoms. RESULTS Of children with asthma, 86% reported at least 1 adversity, with 48% reporting 4 or more. The odds of severe wheeze limiting speech increased by 19% with each additional reported adversity captured by the PEARLS tool (95% confidence intervals (CI) 1.01-1.41). Increasing PEARLS scores were also associated with 16% increased odds of reporting wheeze with exercise (95% CI 1.03-1.31). Wheezing with exercise was associated with the household challenges domain (odds ratio (OR) 1.34; 95% CI 1.05-1.72), while severe wheeze limiting speech was associated with the social context domain (OR 1.75; 95%CI 1.02-3.02). CONCLUSIONS Childhood adversities are associated with increased asthma symptom burden, suggesting the tool may be helpful in identifying children at risk for poorly controlled asthma.
Collapse
Affiliation(s)
- Adali Martinez
- University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur)
| | - Morgan Ye
- University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur)
| | - Danielle Hessler
- University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur)
| | - Rosemarie de la Rosa
- University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur)
| | - Mindy Benson
- UCSF Benioff Children's Hospital Oakland (M Benson and D Long), Oakland, Calif
| | - Rachel Gilgoff
- Center for Youth Wellness (R Gilgoff, K Koita, M Bucci, and NB Harris), San Francisco, Calif
| | - Kadiatou Koita
- Center for Youth Wellness (R Gilgoff, K Koita, M Bucci, and NB Harris), San Francisco, Calif
| | - Monica Bucci
- Center for Youth Wellness (R Gilgoff, K Koita, M Bucci, and NB Harris), San Francisco, Calif
| | - Nadine Burke Harris
- Center for Youth Wellness (R Gilgoff, K Koita, M Bucci, and NB Harris), San Francisco, Calif
| | - Dayna Long
- UCSF Benioff Children's Hospital Oakland (M Benson and D Long), Oakland, Calif
| | - Neeta Thakur
- University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur).
| |
Collapse
|
2
|
Schuler CL, Kercsmar C, Mansour M, McDowell KM, Huang G, Hossain MM, Robinette ED, Beck AF. Identifying asthma-related risks during hospitalization using the child asthma risk assessment tool. J Asthma 2023; 60:2189-2197. [PMID: 37345884 DOI: 10.1080/02770903.2023.2228897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
Objective: The Child Asthma Risk Assessment Tool (CARAT) identifies risk factors for asthma morbidity. We hypothesized that CARAT-identified risk factors (using a CARAT adapted for inpatient use) would be associated with future healthcare utilization and would identify areas for intervention.Methods: We reviewed CARAT data collected during pediatric asthma admissions from 2010-2015, assessing for risk factors in environmental, medical, and social domains and providing prompts for inpatient (specialist consultation or social services engagement) and post-discharge interventions (home care visit or home environmental assessment). Confirmatory factor analysis identified groups of CARAT-identified risk factors with similar effects on healthcare utilization (latent factors). Structural equation models then evaluated relationships between latent factors and future utilization.Results: There were 2731 unique patients admitted for asthma exacerbations; 1015 (37%) had complete CARAT assessments and were included in analyses. Those with incomplete CARAT assessments were more often younger and privately-insured. CARAT-identified risk factors across domains were common in children hospitalized for exacerbations. Risks in the environmental domain were most common. Inpatient asthma consults by pulmonologists or allergists and home care referrals were the most frequent interventions indicated (62%, 628/1015, and 50%, 510/1015, respectively). Two latent factors were positively associated with healthcare utilization in the year after index stay - social stressors and known/suspected allergies (both p < 0.05). Stratified analyses analyzing data just from those children with prior healthcare utilization also indicated known/suspected allergies to be positively associated with future utilization.Conclusions: Inpatient interventions to address social stressors and allergic profiles may be warranted to reduce subsequent asthma morbidity.
Collapse
Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carolyn Kercsmar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mona Mansour
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen M McDowell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Guixia Huang
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Md Monir Hossain
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric D Robinette
- Division of Infectious Disease, Akron Children's Hospital, Akron, OH, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
3
|
Ramsey RR, Noser A, McDowell KM, Sherman SN, Hommel KA, Guilbert TW. Children with uncontrolled asthma from economically disadvantaged neighborhoods: Needs assessment and the development of a school-based telehealth and electronic inhaler monitoring system. Pediatr Pulmonol 2023; 58:2249-2259. [PMID: 37194988 PMCID: PMC10524439 DOI: 10.1002/ppul.26457] [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: 11/08/2022] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Children from economically disadvantaged communities often encounter healthcare access barriers, increasing risk for poorly controlled asthma and subsequent healthcare utilization. This highlights the need to identify novel intervention strategies for these families. OBJECTIVE To better understand the needs and treatment preferences for asthma management in children from economically disadvantaged communities and to develop a novel asthma management intervention based on an initial needs assessment and stakeholder feedback. METHODS Semistructured interviews and focus groups were conducted with 19 children (10-17 years old) with uncontrolled asthma and their caregivers, 14 school nurses, 8 primary care physicians, and three school resource coordinators from economically disadvantaged communities. Interviews and focus groups were audio-taped and transcribed verbatim and then analyzed thematically to inform intervention development. Using stakeholder input, an intervention was developed for children with uncontrolled asthma and presented to participants for feedback to fully develop a novel intervention. RESULTS The needs assessment resulted in five themes: (1) barriers to quality asthma care, (2) poor communication across care providers, (3) problems identifying and managing symptoms and triggers among families, (4) difficulties with adherence, and (5) stigma. A proposed video-based telehealth intervention was proposed to stakeholders who provided favorable and informative feedback for the final development of the intervention for children with uncontrolled asthma. CONCLUSIONS Stakeholder input and feedback provided information critical to the development of a multicomponent (medical and behavioral) intervention in a school setting that uses technology to facilitate care, collaboration, and communication among key stakeholders to improve asthma management for children from economically disadvantaged neighborhoods.
Collapse
Affiliation(s)
- Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Amy Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Karen M. McDowell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
| | | | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Theresa W. Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
| |
Collapse
|
4
|
Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
Collapse
Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
5
|
Gent JF, Holford TR, Bracken MB, Plano JM, McKay LA, Sorrentino KM, Koutrakis P, Leaderer BP. Childhood asthma and household exposures to nitrogen dioxide and fine particles: a triple-crossover randomized intervention trial. J Asthma 2023; 60:744-753. [PMID: 35796019 PMCID: PMC10162040 DOI: 10.1080/02770903.2022.2093219] [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: 10/17/2022]
Abstract
OBJECTIVE Triple-crossover randomized controlled intervention trial to test whether reduced exposure to household NO2 or fine particles results in reduced symptoms among children with persistent asthma. METHODS Children (n = 126) aged 5-11 years with persistent asthma living in homes with gas stoves and levels of NO2 15 ppb or greater recruited in Connecticut and Massachusetts (2015-2019) participated in an intervention involving three air cleaners configured for: (1) NO2 reduction: sham particle filtration and real NO2 scrubbing; (2) particle filtration: HEPA filter and sham NO2 scrubbing; (3) control: sham particle filtration and sham NO2 scrubbing. Air cleaners were randomly assigned for 5-week treatment periods using a three-arm crossover design. Outcome was number of asthma symptom-days during final 14 days of treatment. Treatment effects were assessed using repeated measures, linear mixed models. RESULTS Measured NO2 was lower (by 4 ppb, p < .0001) for NO2-reducing compared to control or particle-reducing treatments. NO2-reducing treatment did not reduce asthma morbidity compared to control. In analysis controlling for measured NO2, there were 1.8 (95% CI -0.3 to 3.9, p = .10) fewer symptom days out of 14 in the particle-reducing treatment compared to control. CONCLUSIONS It remains unknown if using an air cleaner alone can achieve levels of NO2 reduction large enough to observe reductions in asthma symptoms. We observed that in small, urban homes with gas stoves, modest reductions in asthma symptoms occurred using air cleaners that remove fine particles. An intervention targeting exposures to both NO2 and fine particles is complicated and further research is warranted. REGISTRATION NUMBER NCT02258893.
Collapse
Affiliation(s)
- Janneane F Gent
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Theodore R Holford
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Michael B Bracken
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Julie M Plano
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Lisa A McKay
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Keli M Sorrentino
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brian P Leaderer
- The Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
6
|
Baptist AP, Apter AJ, Gergen PJ, Jones BL. Reducing Health Disparities in Asthma: How Can Progress Be Made. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:737-745. [PMID: 36693539 PMCID: PMC10640900 DOI: 10.1016/j.jaip.2022.12.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Health disparities (recently defined as a health difference closely linked with social, economic, and/or environmental disadvantage) in asthma continue despite the presence of safe and effective treatment. For example, in the United States, Black individuals have a hospitalization rate that is 6× higher than that for White individuals, and an asthma mortality rate nearly 3× higher. This article will discuss the current state of health disparities in asthma in the United States. Factors involved in the creation of these disparities (including unconscious bias and structural racism) will be examined. The types of asthma interventions (including case workers, technological advances, mobile asthma clinics, and environmental remediation) that have and have not been successful to decrease disparities will be reviewed. Finally, current resources and future actions are summarized in a table and in text, providing information that the allergist can use to make an impact on asthma health disparities in 2023.
Collapse
Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Bridgette L Jones
- Section of Allergy Asthma Immunology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Mo; Children's Mercy, Kansas City, Mo
| |
Collapse
|
7
|
Dreisbach N, Wang H, Campbell S, Correa H, Dickson T, Brown-Dudley L, Escoffery D, Evtimova T, Fonseca A, Myers C, Plasencia S, Manyindo N. Improving childhood asthma outcomes in East Harlem: the East Harlem Asthma Center of Excellence's Asthma Counselor Program. J Asthma 2023; 60:339-347. [PMID: 35293833 DOI: 10.1080/02770903.2022.2051543] [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: 10/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the Asthma Counselor Program, a program of the New York City Department of Health and Mental Hygiene, designed to improve asthma outcomes among children. METHODS We used a pre-post study design among children who enrolled in the program. We included self-reported outcome measures by comparing the previous 12 months (captured at intake) to the 12 months following program enrollment. To calculate the 12 months after enrollment, we added the number of outcome events reported at each follow-up session, which are conducted approximately three months apart, to compute 12-month (or "year-end") post-enrollment outcomes. RESULTS We enrolled 136 children during the study period (2018); 85 children remained in the program for 12 months and 51 became lost-to-follow-up. Among those who remained in the program, at the "year-end" session, there were statistically significant reductions in the mean number of asthma-related unscheduled healthcare appointments or urgent-care visits (73%), uses of prednisone (65%), asthma-related school absences (60%), asthma-related ED visits (57%), and asthma-related hospitalizations (50%). CONCLUSIONS Twelve months after children enrolled in the program, they had significantly improved asthma outcomes. Our findings, along with results from similar studies, support multicomponent interventions, especially those led by masters-level social workers.
Collapse
Affiliation(s)
- Nicole Dreisbach
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Henry Wang
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Safiya Campbell
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Héctor Correa
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Teré Dickson
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - La'Shawn Brown-Dudley
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Dodrie Escoffery
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Teodora Evtimova
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Anthony Fonseca
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Christa Myers
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Stephanie Plasencia
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Noel Manyindo
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| |
Collapse
|
8
|
Hosseini B, Berthon BS, Jensen ME, McLoughlin RF, Wark PAB, Nichol K, Williams EJ, Baines KJ, Collison A, Starkey MR, Mattes J, Wood LG. The Effects of Increasing Fruit and Vegetable Intake in Children with Asthma on the Modulation of Innate Immune Responses. Nutrients 2022; 14:nu14153087. [PMID: 35956264 PMCID: PMC9370535 DOI: 10.3390/nu14153087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
Children with asthma are at risk of acute exacerbations triggered mainly by viral infections. A diet high in fruit and vegetables (F&V), a rich source of carotenoids, may improve innate immune responses in children with asthma. Children with asthma (3−11 years) with a history of exacerbations and low F&V intake (≤3 serves/d) were randomly assigned to a high F&V diet or control (usual diet) for 6 months. Outcomes included respiratory-related adverse events and in-vitro cytokine production in peripheral blood mononuclear cells (PBMCs), treated with rhinovirus-1B (RV1B), house dust mite (HDM) and lipopolysaccharide (LPS). During the trial, there were fewer subjects with ≥2 asthma exacerbations in the high F&V diet group (n = 22) compared to the control group (n = 25) (63.6% vs. 88.0%, p = 0.049). Duration and severity of exacerbations were similar between groups. LPS-induced interferon (IFN)-γ and IFN-λ production showed a small but significant increase in the high F&V group after 3 months compared to baseline (p < 0.05). Additionally, RV1B-induced IFN-λ production in PBMCs was positively associated with the change in plasma lycopene at 6 months (rs = 0.35, p = 0.015). A high F&V diet reduced asthma-related illness and modulated in vitro PBMC cytokine production in young children with asthma. Improving diet quality by increasing F&V intake could be an effective non-pharmacological strategy for preventing asthma-related illness by enhancing children’s innate immune responses.
Collapse
Affiliation(s)
- Banafsheh Hosseini
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Bronwyn S. Berthon
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Megan E. Jensen
- Priority Research Centre Grow Up Well, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (M.E.J.); (J.M.)
| | - Rebecca F. McLoughlin
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Peter A. B. Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Kristy Nichol
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Evan J. Williams
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Katherine J. Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
| | - Adam Collison
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
- Priority Research Centre Grow Up Well, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (M.E.J.); (J.M.)
| | - Malcolm R. Starkey
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
- Priority Research Centre Grow Up Well, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (M.E.J.); (J.M.)
- Department of Immunology and Pathology, Central Clinical School, Sub-Faculty of Translational Medicine and Public Health, Monash University, Melbourne, VIC 3004, Australia
| | - Joerg Mattes
- Priority Research Centre Grow Up Well, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (M.E.J.); (J.M.)
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Lisa G. Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (B.H.); (B.S.B.); (R.F.M.); (P.A.B.W.); (K.N.); (E.J.W.); (K.J.B.); (A.C.); (M.R.S.)
- Priority Research Centre Grow Up Well, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia; (M.E.J.); (J.M.)
- Correspondence:
| |
Collapse
|
9
|
Lee DL, Baptist AP. Understanding the Updates in the Asthma Guidelines. Semin Respir Crit Care Med 2022; 43:595-612. [PMID: 35728605 DOI: 10.1055/s-0042-1745747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Asthma is a chronic inflammatory lung disease that affects millions of Americans, with variable symptoms of bronchospasm and obstruction among individuals over time. The National Heart, Lung, and Blood Institute (NHLBI) published the 2020 Focused Updates to the Asthma Management Guidelines based on the latest research since the 2007 Expert Panel Report-3 (EPR-3). The following article reviews the 21 new recommendations on the six core topics in asthma: use of intermittent inhaled corticosteroids, long-acting muscarinic antagonist therapy, use of the fractional exhaled nitric oxide test in asthma diagnosis and monitoring, indoor allergen mitigation, immunotherapy, and bronchial thermoplasty. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate recommendations as strong or conditional based on the evidence. The recommendations were based on systematic reviews of the literature and focused on patient-centered critical outcomes of asthma exacerbations, asthma control, and asthma-related quality of life. Understanding the recommendations with consideration of individual values through shared decision-making may improve asthma outcomes.
Collapse
Affiliation(s)
- Deborah L Lee
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI
| | - Alan P Baptist
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
10
|
Trivedi M, Pappalardo AA, Udoko M, Garg A, Phipatanakul W, Szefler SJ, Nyenhuis SM. Social Determinants of Health in Asthma Through the Life Course. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:953-961. [PMID: 35033702 DOI: 10.1016/j.jaip.2021.12.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
There is strong evidence supporting the influence of social determinants of health (SDOH) on the development and progression of asthma. SDOH are defined as conditions in which people are born, grow up, live, work, and age, which influence their opportunity to be healthy, risk of illness, and life expectancy. The goal of this article was to describe 2 case-based approaches (pediatric and adult) to assessing and addressing SDOH in asthma across the life course and in community settings. As asthma providers and specialists, the role of SDOH is complex in our clinical care; however, it is critical to address social needs identified through clinical care for our patients with asthma. Clinical-community partnerships, through grant and cost-sharing mechanisms with resource agencies, are necessary to ameliorate social needs for patients and their communities and have the potential to improve asthma outcomes. Although this is a unique and exciting time in health care to promote individual and population health, knowledge gaps remain, including best practices to integrate holistic SDOH care into the care of patients with asthma.
Collapse
Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill; Department of Medicine, University of Illinois at Chicago, Chicago, Ill
| | - Mfonobong Udoko
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Stanley J Szefler
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo; Anschutz Medical Campus, Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Denver, Colo
| | | |
Collapse
|
11
|
Mitchell SJ, Rangel A, Klein EJ, Stout JW, Lowry SJ, Wingfield E, Horn IB, Coker TR. Sociodemographic Differences in Asthma Self-Management Knowledge of Parents Seeking Asthma Care for their Children in Pediatric Emergency Departments. J Health Care Poor Underserved 2021; 32:2191-2201. [PMID: 34803068 DOI: 10.1353/hpu.2021.0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To effectively support asthma self-management among children most at risk for poor outcomes, it is important to examine potential disparities in parents' asthma-related knowledge. This study draws on baseline data collected from a randomized controlled trial to analyze how knowledge of asthma self-management varies by sociodemographic characteristics in a racially and economically diverse sample of Medicaid-insured children seeking emergency asthma care (N=221). Multivariable linear regression revealed that parent race/ethnicity, preferred language, and education were independently associated with scores on the Asthma Self Management Knowledge Questionnaire, and there was a significant interaction between parent race/ethnicity and education. In analyses stratified by parent education level, Latinx race/ethnicity was associated with lower-self-management knowledge among parents with higher education level, but not among those with a lower level of education. Our findings call for further research to understand and address the unique barriers to improving asthma self-management knowledge among Latinx parents and parents with limited English proficiency.
Collapse
|
12
|
Schechter SB, Lakhaney D, Peretz PJ, Matiz LA. Community Health Worker Intervention to Address Social Determinants of Health for Children Hospitalized With Asthma. Hosp Pediatr 2021; 11:1370-1376. [PMID: 34849926 DOI: 10.1542/hpeds.2021-005903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) contribute to racial disparities in asthma outcomes. Community health worker (CHW) programs represent a promising way to screen for SDOH and connect patients to resources, but the impact of CHW programs in the inpatient pediatric setting has been examined in few studies. In this study, we aimed to evaluate a CHW program for children hospitalized with asthma in a predominantly Hispanic community by examining rates of SDOH and social resource navigation. METHODS This pilot study involved a CHW intervention to improve pediatric asthma care. Patients were included if they were hospitalized with asthma over an 18-month period and enrolled in the CHW program during their hospitalization. In an intake interview, CHWs screened caregivers for SDOH and provided tailored social resource navigation. Descriptive statistics were used to assess rates of social risk factors and social resource navigation. RESULTS Eighty patients underwent SDOH screening. The majority of patients were Hispanic (81.3%, n = 65). Half of caregivers reported food or housing insecurity over the past 12 months (50.0%, n = 40), and most reported inadequate housing conditions (63.8%, n = 51). CHWs coordinated social resources for the majority of families (98.8%, n = 79), with the most common being food resources (42.5%, n = 34), housing resources (82.5%, n = 66), and appointment navigation (41.3%, n = 33). CONCLUSIONS CHWs identified a high burden of unmet social needs and provided associated social resource navigation in a largely Hispanic pediatric population hospitalized for asthma. CHW programs have potential to improve asthma outcomes by linking high-risk patients with social resources.
Collapse
Affiliation(s)
- Sarah B Schechter
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Divya Lakhaney
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Patricia J Peretz
- Division of Community and Population Health, New York-Presbyterian Hospital, New York
| | - Luz Adriana Matiz
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
13
|
Abstract
Inner-city children with asthma are known to have high disease mortality and morbidity. Frequently, asthma in this high-risk population is difficult to control and more severe in nature. Several factors, including socioeconomic hardship, ability to access to health care, adherence to medication, exposure to certain allergens, pollution, crowd environment, stress, and infections, play an important role in the pathophysiology of inner-city asthma. Comprehensive control of home allergens and exposure to tobacco smoke, the use of immune based therapies, and school-based asthma programs have shown promising results in asthma control in this population.
Collapse
Affiliation(s)
- Divya Seth
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI 48201, USA.
| | - Shweta Saini
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
14
|
Identification and Remediation of Environmental Exposures in Patients With Interstitial Lung Disease: Evidence Review and Practical Considerations. Chest 2021; 160:219-230. [PMID: 33609518 DOI: 10.1016/j.chest.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/07/2020] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.
Collapse
|
15
|
Cloutier MM, Dixon AE, Krishnan JA, Lemanske RF, Pace W, Schatz M. Managing Asthma in Adolescents and Adults: 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program. JAMA 2020; 324:2301-2317. [PMID: 33270095 DOI: 10.1001/jama.2020.21974] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Asthma is a major public health problem worldwide and is associated with excess morbidity, mortality, and economic costs associated with lost productivity. The National Asthma Education and Prevention Program has released the 2020 Asthma Guideline Update with updated evidence-based recommendations for treatment of patients with asthma. OBJECTIVE To report updated recommendations for 6 topics for clinical management of adolescents and adults with asthma: (1) intermittent inhaled corticosteroids (ICSs); (2) add-on long-acting muscarinic antagonists; (3) fractional exhaled nitric oxide; (4) indoor allergen mitigation; (5) immunotherapy; and (6) bronchial thermoplasty. EVIDENCE REVIEW The National Heart, Lung, and Blood Advisory Council chose 6 topics to update the 2007 asthma guidelines based on results from a 2014 needs assessment. The Agency for Healthcare Research and Quality conducted systematic reviews of these 6 topics based on literature searches up to March-April 2017. Reviews were updated through October 2018 and used by an expert panel (n = 19) that included asthma content experts, primary care clinicians, dissemination and implementation experts, and health policy experts to develop 19 new recommendations using the GRADE method. The 17 recommendations for individuals aged 12 years or older are reported in this Special Communication. FINDINGS From 20 572 identified references, 475 were included in the 6 systematic reviews to form the evidence basis for these recommendations. Compared with the 2007 guideline, there was no recommended change in step 1 (intermittent asthma) therapy (as-needed short-acting β2-agonists [SABAs] for rescue therapy). In step 2 (mild persistent asthma), either daily low-dose ICS plus as-needed SABA therapy or as-needed concomitant ICS and SABA therapy are recommended. Formoterol in combination with an ICS in a single inhaler (single maintenance and reliever therapy) is recommended as the preferred therapy for moderate persistent asthma in step 3 (low-dose ICS-formoterol therapy) and step 4 (medium-dose ICS-formoterol therapy) for both daily and as-needed therapy. A short-term increase in the ICS dose alone for worsening of asthma symptoms is not recommended. Add-on long-acting muscarinic antagonists are recommended in individuals whose asthma is not controlled by ICS-formoterol therapy for step 5 (moderate-severe persistent asthma). Fractional exhaled nitric oxide testing is recommended to assist in diagnosis and monitoring of symptoms, but not alone to diagnose or monitor asthma. Allergen mitigation is recommended only in individuals with exposure and relevant sensitivity or symptoms. When used, allergen mitigation should be allergen specific and include multiple allergen-specific mitigation strategies. Subcutaneous immunotherapy is recommended as an adjunct to standard pharmacotherapy for individuals with symptoms and sensitization to specific allergens. Sublingual immunotherapy is not recommended specifically for asthma. Bronchial thermoplasty is not recommended as part of standard care; if used, it should be part of an ongoing research effort. CONCLUSIONS AND RELEVANCE Asthma is a common disease with substantial human and economic costs globally. Although there is no cure or established means of prevention, effective treatment is available. Use of the recommendations in the 2020 Asthma Guideline Update should improve the health of individuals with asthma.
Collapse
Affiliation(s)
| | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Chicago
| | - Robert F Lemanske
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Wilson Pace
- University of Colorado School of Medicine, Aurora
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, California
| |
Collapse
|
16
|
Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, DiMango E, Dixon AE, Elward KS, Hartert T, Krishnan JA, Lemanske RF, Ouellette DR, Pace WD, Schatz M, Skolnik NS, Stout JW, Teach SJ, Umscheid CA, Walsh CG. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2020; 146:1217-1270. [PMID: 33280709 PMCID: PMC7924476 DOI: 10.1016/j.jaci.2020.10.003] [Citation(s) in RCA: 394] [Impact Index Per Article: 98.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022]
Abstract
The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was coordinated and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. It is designed to improve patient care and support informed decision making about asthma management in the clinical setting. This update addresses six priority topic areas as determined by the state of the science at the time of a needs assessment, and input from multiple stakeholders:A rigorous process was undertaken to develop these evidence-based guidelines. The Agency for Healthcare Research and Quality's (AHRQ) Evidence-Based Practice Centers conducted systematic reviews on these topics, which were used by the Expert Panel Working Group as a basis for developing recommendations and guidance. The Expert Panel used GRADE (Grading of Recommendations, Assessment, Development and Evaluation), an internationally accepted framework, in consultation with an experienced methodology team for determining the certainty of evidence and the direction and strength of recommendations based on the evidence. Practical implementation guidance for each recommendation incorporates findings from NHLBI-led patient, caregiver, and clinician focus groups. To assist clincians in implementing these recommendations into patient care, the new recommendations have been integrated into the existing Expert Panel Report-3 (EPR-3) asthma management step diagram format.
Collapse
Affiliation(s)
- Michelle M Cloutier
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Alan P Baptist
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Kathryn V Blake
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Edward G Brooks
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Tyra Bryant-Stephens
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Emily DiMango
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Anne E Dixon
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Kurtis S Elward
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Tina Hartert
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Jerry A Krishnan
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Robert F Lemanske
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Daniel R Ouellette
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Wilson D Pace
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Michael Schatz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Neil S Skolnik
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - James W Stout
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Stephen J Teach
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Craig A Umscheid
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Colin G Walsh
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| |
Collapse
|
17
|
Jonas JA, Leu CS, Reznik M. A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes. J Asthma 2020; 59:395-406. [PMID: 33148066 DOI: 10.1080/02770903.2020.1846746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of using Community Health Workers (CHWs) to deliver the home-based Wee Wheezers asthma education program on asthma symptoms among children with persistent asthma. METHODS In this randomized controlled trial of 151 children aged 2-9 years with persistent asthma, we assigned 75 to the intervention and 76 to the control. The primary outcome was caregiver-reported asthma symptom days. Secondary outcomes included asthma-related healthcare utilization, caregivers' asthma knowledge, illness perception and management behaviors, MDI-spacer administration technique, and home environmental triggers. Outcomes were collected at baseline, 3, 6, 9 and 12 months. A repeated measurements analytic approach with generalized estimating equations was used. To account for missing data, multiple imputation methods were employed. RESULTS At 3 and 6 months, improvement in symptom days was not significantly different between groups. However, at 9 and 12 months, the reduction in asthma symptom days was 2.15 and 2.31 days more respectively for those in the intervention group compared to the control. Improvements in MDI-spacer technique, knowledge and attitudes were significant throughout follow-up. Improvement in habits regarding MDI use was significant at 3 and 6 months, and asthma routines were improved at 3 months. However, there was no change in asthma-related healthcare utilization or home environmental triggers. CONCLUSION Using CHWs to deliver a home-based asthma education program to caregivers of children with persistent asthma led to improvements in symptom days and several secondary outcomes. Expanding the use of CHWs to provide home-based interventions can help reduce disparities in children's health outcomes.
Collapse
Affiliation(s)
| | - Cheng-Shiun Leu
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marina Reznik
- Albert Einstein College of Medicine, Bronx, NY, USA.,Children's Hospital at Montefiore, Bronx, NY, USA
| |
Collapse
|
18
|
Sleath B, Carpenter DM, Davis SA, Sayner R, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Provider-adolescent discussion and provider education about asthma triggers during pediatric visits: results of a randomized trial. J Asthma 2020; 58:1565-1573. [PMID: 32867560 DOI: 10.1080/02770903.2020.1817936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We examined how an asthma question prompt list with video intervention influenced discussion of and provider education about asthma triggers. METHODS English or Spanish-speaking adolescents ages 11-17 with persistent asthma and their caregivers were enrolled from four pediatric clinics. Adolescents were randomized to the intervention or usual care groups. Adolescents in the intervention group watched the video on an iPad and then completed a one-page asthma question prompt list before their visits. All visits were audio-recorded. Generalized Estimating Equations were used to predict the number of trigger areas discussed and the number of areas providers educated adolescents about during visits. RESULTS Forty providers and 359 patients participated. Triggers were discussed during 89% of intervention group visits and 81% of usual care visits; providers educated adolescents about triggers during 59% of intervention group visits and 46% of usual care visits. More triggers were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents in the intervention group and when adolescents asked one or more questions during visits. More trigger areas were significantly more likely to be discussed if the adolescent was White and male. Providers were significantly more likely to educate adolescents whose family spoke Spanish at home about more trigger areas than adolescents who spoke English at home. CONCLUSIONS More trigger areas were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents who received the intervention and when adolescents asked one or more questions.
Collapse
Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Health Professions at Southern, New Hampshire University, Manchester, NH, USA
| |
Collapse
|
19
|
Everhart RS, Mazzeo SE, Corona R, Holder RL, Thacker LR, Schechter MS. A community-based asthma program: Study design and methods of RVA Breathes. Contemp Clin Trials 2020; 97:106121. [PMID: 32822827 DOI: 10.1016/j.cct.2020.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 11/15/2022]
Abstract
Disparities in pediatric asthma morbidity and healthcare utilization exist on the basis of race, ethnicity, environment, and income; interventions are needed to address these inequities. The following protocol describes an evidence-based intervention, RVA Breathes, designed to coordinate pediatric asthma care across family, home, community, and medical sectors. Community stakeholder feedback was utilized to refine the intervention specifically for the Richmond, Virginia community. The aims of this study are to assess the effect of RVA Breathes on asthma-related healthcare utilization, as well as secondary outcomes of asthma control, asthma symptoms, and quality of life. We will enroll 300 elementary school children from the Richmond City Public School system. Participants will be between the ages of 5-11, have a diagnosis of asthma, and have had an asthma exacerbation (as indicated by an asthma-related ED visit, hospitalization, unscheduled PCP visit, or use of systemic steroids) in the last two years. Participants will be randomized to one of three groups: asthma education + home environment remediation + school intervention, asthma education + home environment remediation, or a comparator condition. Data will be collected across one baseline research visit, four intervention sessions, and four follow-up research visits over the course of 18 months. A General Linear Mixed Model (GLMM) will be used to test primary aims. We expect the findings will provide support for coordination of asthma care across sectors. Further, we hope RVA Breathes will serve as a model of community-based pediatric asthma care.
Collapse
Affiliation(s)
- Robin S Everhart
- Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Suzanne E Mazzeo
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Rosalie Corona
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Rachel L Holder
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Leroy R Thacker
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Michael S Schechter
- Children's Hospital of Richmond at VCU, Richmond, VA, United States of America
| |
Collapse
|
20
|
Villarreal MA, Wildfire JJ, Sorkness CA, Gergen PJ, Visness CM, Mitchell HE. Impact of Past Research Experience on Subsequent Trials: A Caution. Am J Respir Crit Care Med 2020; 201:253-256. [PMID: 31525073 DOI: 10.1164/rccm.201905-0926le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Christine A Sorkness
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsinand
| | | | | | | |
Collapse
|
21
|
Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García-Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
Collapse
Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Iolo J Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Luis García-Marcos
- Department of Paediatrics, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, Murcia, Spain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | | | - Peter D Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Tonya Winders
- Allergy & Asthma Network, Vienna, Virginia.,Global Allergy & Asthma Patient Platform, Vienna, Virginia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical Science, Keele University, Keele, UK
| |
Collapse
|
22
|
Lin NY, Ramsey RR, Miller JL, McDowell KM, Zhang N, Hommel K, Guilbert TW. Telehealth delivery of adherence and medication management system improves outcomes in inner-city children with asthma. Pediatr Pulmonol 2020; 55:858-865. [PMID: 31905264 PMCID: PMC9125769 DOI: 10.1002/ppul.24623] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low-income families in inner-city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high-quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school-based care delivery model that incorporates video-based telehealth (VBT) medical and self-management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6-month period, children from inner-city, low-income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self-management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI ≥ 4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI < 4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school-based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.
Collapse
Affiliation(s)
- Nancy Y Lin
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen M McDowell
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nanhua Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
23
|
Olson C, Leu CS, Alper H, Millican M, Reznik M. A randomized trial of a one-time pest intervention: impact on childhood asthma outcomes. J Asthma 2020; 58:616-624. [PMID: 31920176 DOI: 10.1080/02770903.2019.1709870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation.Study design: In a randomized controlled trial of 384 children aged 5-12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use.Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group.Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.
Collapse
Affiliation(s)
- Carolyn Olson
- Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Howard Alper
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Michael Millican
- Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Marina Reznik
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
24
|
Horwitz D, Kestenbom I, Goldbart A, Chechik T, Dizitzer Y, Golan-Tripto I. The effect of a coaching program on asthma control and health care utilization in children with asthma. J Asthma 2019; 58:240-247. [PMID: 31591919 DOI: 10.1080/02770903.2019.1672721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSRACTObjective: Poor adherence to asthma therapy is a major problem in the management of asthma. We aimed to assess if a designed coaching program in children with asthma, coming from low socioeconomic background, will reduce respiratory morbidity and health care utilization.Methods: A prospective interventional pilot study enrolling children aged 3-18 years, admitted to Soroka University Medical Center (SUMC) between October 2015 and May 2016 due to asthma exacerbation. The intervention group was part of a coaching program, which was conducted by medical and paramedical personnel and included a diagnostic and personal educational office visit and a house visit by a nurse educator for asthma. The control group comprised of demographically matched children with asthma, who were admitted to the SUMC, but did not go through any intervention. Medications purchase and health care utilization were extracted from the participants' HMO databases, during 1-year of follow-up.Results: 41 children were enrolled to the intervention group, with 63 children as a control group. No differences were found in asthma-related drugs purchase, number of clinic visits, ER admissions and hospitalizations during the follow-up year, although the intervention group showed a trend towards having a shorter length of stay (2.3 vs. 4.5 days, Cohen's D = 0.44, p = 0.06). The intervention group demonstrated subjective improvement in asthma control, as reflected in Asthma Control Test questionnaires.Conclusions: In this pilot study of coaching program for children with asthma coming from low income families, no decrease in health care utilization was shown. Larger and longer intervention programs are needed.
Collapse
Affiliation(s)
- Dana Horwitz
- Department of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Kestenbom
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Aviv Goldbart
- Faculty of Health Sciences, Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel.,Pediatric Pulmonology Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Tzila Chechik
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Inbal Golan-Tripto
- Faculty of Health Sciences, Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel.,Pediatric Pulmonology Unit, Soroka University Medical Center, Beer Sheva, Israel
| |
Collapse
|
25
|
Cost-effectiveness of an Evidence-Based Childhood Asthma Intervention in Real-World Primary Care Settings. J Ambul Care Manage 2019; 41:213-224. [PMID: 29847408 DOI: 10.1097/jac.0000000000000231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present an incremental cost-effectiveness analysis of an evidence-based childhood asthma intervention (Community Healthcare for Asthma Management and Prevention of Symptoms [CHAMPS]) to usual management of childhood asthma in community health centers. Data used in the analysis include household surveys, Medicaid insurance claims, and community health center expenditure reports. We combined our incremental cost-effectiveness analysis with a difference-in-differences multivariate regression framework. We found that CHAMPS reduced symptom days by 29.75 days per child-year and was cost-effective (incremental cost-effectiveness ratio: $28.76 per symptom-free days). Most of the benefits were due to reductions in direct medical costs. Indirect benefits from increased household productivity were relatively small.
Collapse
|
26
|
Abstract
Inner-city children with asthma are known to have high disease mortality and morbidity. Frequently, asthma in this high-risk population is difficult to control and more severe in nature. Several factors, including socioeconomic hardship, ability to access to health care, adherence to medication, exposure to certain allergens, pollution, crowd environment, stress, and infections, play an important role in the pathophysiology of inner-city asthma. Comprehensive control of home allergens and exposure to tobacco smoke, the use of immune based therapies, and school-based asthma programs have shown promising results in asthma control in this population.
Collapse
Affiliation(s)
- Divya Seth
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI 48201, USA.
| | - Shweta Saini
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
27
|
Gergen PJ. Rethinking Access to Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:853-854. [PMID: 29747988 DOI: 10.1016/j.jaip.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, Md.
| |
Collapse
|
28
|
Gharibi H, Entwistle MR, Schweizer D, Tavallali P, Thao C, Cisneros R. Methyl-bromide and asthma emergency department visits in California, USA from 2005 to 2011. J Asthma 2019; 57:1227-1236. [PMID: 31311358 DOI: 10.1080/02770903.2019.1645167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Urban monitors of Methyl bromide (MBr), not typically near application sites, are used to investigate the impact of ambient concentrations on asthma Emergency Department (ED) visits.Methods: 4262 ED visits from August to February of 2005 to 2011 in Central and Southern California were selected from California's Office of Statewide Health Planning and Development (OSHPD). A bidirectional-symmetric case-crossover study design using conditional logistic regression model was used to obtain the odds ratio (OR) and 95% confidence interval associated with a 0.01 ppb (interquartile range) increase in MBr.Results: The population sample was comprised of 46.0% male and 53.9% females. Ethnic groups included 32.0% Non-Hispanic White, 23.5% Non-Hispanic Black, and 44.4% Hispanic. Age distribution was between 2 and 5 years old (11.6%), 6 and 18 years old (23.5%), 19 and 40 years old (29.3%), 41 and 64 years old (24.1%), and 65 or older (6.9%). There was a positive association between MBr and asthma ED visits among Non-Hispanic Blacks [OR: 1.065 (95% confidence intervals: 1.019, 1.108)] and Hispanics [OR: 1.107 (95% confidence intervals: 1.043, 1.173)], while Non-Hispanic Whites did not have an association with asthma ED visits. Positive association between MBr and asthma ED visits was found only among 6 to 18 [OR: 1.071 (95% confidence intervals: 1.016, 1.125)] years old.Conclusion: An increase in MBr concentration was found to be associated with an increase of the odds of having asthma ED visits in California among 6 to 18 years old and disproportionately affects Non-Hispanic Blacks and Hispanics over Non-Hispanic Whites.
Collapse
Affiliation(s)
- Hamed Gharibi
- Health Sciences Research Institute, University of California, Merced, Merced, CA, USA
| | - Marcela R Entwistle
- Health Sciences Research Institute, University of California, Merced, Merced, CA, USA
| | - Donald Schweizer
- Health Sciences Research Institute, University of California, Merced, Merced, CA, USA.,USDA Forest Service, Pacific Southwest Region, Clovis, CA, USA
| | - Pooya Tavallali
- Electrical Engineering and Computer Science, University of California, Merced, Merced, CA, USA
| | - Chia Thao
- Health Sciences Research Institute, University of California, Merced, Merced, CA, USA
| | - Ricardo Cisneros
- Health Sciences Research Institute, University of California, Merced, Merced, CA, USA.,Public Health, University of California, Merced, Merced, CA, USA
| |
Collapse
|
29
|
Abstract
Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.
Collapse
|
30
|
Asthma in inner city children: recent insights: United States. Curr Opin Allergy Clin Immunol 2019; 18:139-147. [PMID: 29406360 DOI: 10.1097/aci.0000000000000423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Children living in US inner cities experience disparate burdens of asthma, especially in severity, impairment, exacerbations, and morbidity. Investigations seeking to better understand the factors and mechanisms underlying asthma prevalence, severity, and exacerbation in children living in these communities can lead to interventions that can narrow asthma disparities and potentially benefit all children with asthma. This update will focus on recent (i.e. late 2016-2017) advances in the understanding of asthma in US inner city children. RECENT FINDINGS Studies published in the past year expand understanding of asthma prevalence, severity, exacerbation, and the outcomes of guidelines-based management of these at-risk children, including: asthma phenotypes in US inner city children that are severe and difficult-to-control; key environmental determinants and mechanisms underlying asthma severity and exacerbations (e.g. allergy-mediated exacerbation susceptibility to rhinovirus); the importance of schools as a place for provocative exposures (e.g. mouse allergen, nitrogen dioxide) as well as a place where asthma care and outcomes can be improved; and the development and validation of clinically useful indices for gauging asthma severity and predicting exacerbations. SUMMARY These recent studies provide a trove of actionable findings that can improve asthma care and outcomes for these at-risk children.
Collapse
|
31
|
Baxi SN, Sheehan WJ, Sordillo JE, Muilenberg ML, Rogers CA, Gaffin JM, Permaul P, Lai PS, Louisias M, Petty CR, Fu C, Gold DR, Phipatanakul W. Association between fungal spore exposure in inner-city schools and asthma morbidity. Ann Allergy Asthma Immunol 2019; 122:610-615.e1. [PMID: 30904580 DOI: 10.1016/j.anai.2019.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students. OBJECTIVE To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma. METHODS In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period. RESULTS Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels. CONCLUSION Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01756391.
Collapse
Affiliation(s)
- Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Joanne E Sordillo
- Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael L Muilenberg
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Christine A Rogers
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Division of Respiratory Diseases, Boston, Massachusetts
| | - Perdita Permaul
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, Massachusetts
| | - Peggy S Lai
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, Massachusetts
| | | | - Carter R Petty
- Brigham and Women's Hospital, Boston, Massachusetts; Boston Children's Hospital, Clinical Research Center Boston, Massachusetts
| | - Chunxia Fu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Diane R Gold
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
32
|
Law E, Fisher E, Eccleston C, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2019; 3:CD009660. [PMID: 30883665 PMCID: PMC6450193 DOI: 10.1002/14651858.cd009660.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.
Collapse
Affiliation(s)
- Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | | | | | | |
Collapse
|
33
|
Beck-Sague CM, Arrieta A, Pinzon-Iregui MC, Ortiz B, Dean AG, Cuddihy A, Gasana J. Trends in Racial and Ethnic Disparities in Childhood Asthma in Miami, Florida: 2005-2013. J Immigr Minor Health 2019; 20:1429-1437. [PMID: 29290019 DOI: 10.1007/s10903-017-0686-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nationally, racial and ethnic disparities in childhood asthma plateaued from 2005 to 2013. We assessed trends in childhood asthma in Miami, Florida using Youth Risk Behavior Surveillance System (YRBSS) data and emergency department (ED) utilization and hospitalization rates by zip code population characteristics. Asthma prevalence in Miami did not vary significantly by race/ethnicity in YRBSS respondents in 2005 (16.2-17.2%, all groups), but rose in African-Americans and Hispanics and declined in Whites by 2013 to 27.9, 20.9 and 12.6%, respectively (P = 0.02). Median asthma ED visit rates rose from 106.8 (2006-2008) to 138.2 (2011-2013; P = 0.004) per 10,000 children. High-poverty and majority African-American zip codes were 6.3 and 7.3 times more likely to have asthma ED visit rates > 200 than others (P < 0.001). In high-poverty zip codes, majority African-American population was not associated with significantly higher ED utilization. In low-poverty zip codes, the association became stronger. Greater poverty explains much, but not all of Miami African-Americans' higher asthma risk.
Collapse
Affiliation(s)
- Consuelo M Beck-Sague
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA. .,Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 Street, AHC 5-410, Miami, FL, 33199, USA.
| | - Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - M Claudia Pinzon-Iregui
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Benjamin Ortiz
- Columbia University Medical Center, New York, NY, USA.,Harlem Hospital Center, New York, NY, USA.,Immunology and Inflammation Medical Unit, Sanofi, East Hanover, NJ, USA
| | | | - Andrew Cuddihy
- South Florida Asthma Consortium, Ft. Lauderdale, FL, USA
| | - Janvier Gasana
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,South Florida Asthma Consortium, Ft. Lauderdale, FL, USA.,Department of EOH, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
34
|
Schuers M, Chapron A, Guihard H, Bouchez T, Darmon D. Impact of non-drug therapies on asthma control: A systematic review of the literature. Eur J Gen Pract 2019; 25:65-76. [PMID: 30849253 PMCID: PMC6493294 DOI: 10.1080/13814788.2019.1574742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking. Objectives: To identify non-drug interventions likely to improve asthma control. Methods: A systematic review of the available literature in Medline and the Cochrane Library was conducted in March 2017, without any time limit. Initial searching identified 884 potentially relevant clinical trial reports, literature reviews and meta-analyses, which were screened for inclusion using criteria of quality, relevance, and reporting outcomes based on asthma control. Results: Eighty-two publications met the inclusion criteria. In general, the quality of the studies was low. Patient education programmes (22 studies) significantly improved asthma control. Multifaceted interventions (10 studies), which combined patient education programmes with decreasing exposure to indoor allergens and pollutants, significantly improved asthma control based on clinically relevant outcomes. Renovating homes to reduce exposure to allergens and indoor pollutants improved control (two studies). Air filtration systems (five studies) were effective, especially in children exposed to second-hand smoke. Most measures attempting to reduce exposure to dust mites were ineffective (five studies). Dietary interventions (eight studies) were ineffective. Promoting physical activity (five studies) tended to yield positive results, but the results did not attain significance. Conclusion: Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
Collapse
Affiliation(s)
- Matthieu Schuers
- a Department of General Medicine , Rouen University , Rouen , France
| | - Anthony Chapron
- b Department of General Medicine , Rennes University , Rennes , France
| | - Hugo Guihard
- a Department of General Medicine , Rouen University , Rouen , France
| | - Tiphanie Bouchez
- c Department of General Medicine , Nice University , Nice , France
| | - David Darmon
- c Department of General Medicine , Nice University , Nice , France
| |
Collapse
|
35
|
Bhaumik U, Sommer SJ, Lockridge R, Penzias R, Nethersole S, Woods ER. Community Asthma Initiative: Cost Analyses using Claims Data from a Medicaid Managed Care Organization. J Asthma 2019; 57:286-294. [PMID: 30663906 DOI: 10.1080/02770903.2019.1565825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Use claims data to examine the cost benefit of the Community Asthma Initiative (CAI), a Boston area nurse-supervised community health worker (CHW) asthma home-visiting program. Methods: The reduction in asthma treatment costs was assessed using Massachusetts claims data from one Medicaid Managed Care Organization (MCO) in the north east that included all costs between January 1, 2011 and December 31, 2016. The data was used to determine asthma-related utilization cost reductions between 1 year pre- and 1, 2 and 3 years post-intervention. The cost reductions for 45 CAI patients and 45 cost-matched comparison patients were measured. Return on investment (ROI) was computed as the difference in cost reduction for CAI patients and a cost-matched comparison population divided by CAI program cost. Results: The excess reduction in per patient asthma-related utilization costs among CAI patients compared to the comparison population was $806 (p = 0.047), $1,253 (p = 0.01) and $1,549 (p = 0.005) between 1 year pre- and 1, 2 and 3 years post-intervention. These yielded adjusted ROI's of 0.31, 0.78 and 1.37 after 1, 2 and 3 years post-CAI intervention. Conclusions: The reduction in asthma utilization costs of a home visit program by nurse-supervised CHWs exceeds program costs. The findings support the business case for the provision of secondary prevention of home-based asthma services through reimbursement from payers or integration into Accountable Care Organizations (ACOs).
Collapse
Affiliation(s)
- Urmi Bhaumik
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ryan Lockridge
- Neighborhood Health Plan, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca Penzias
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Shari Nethersole
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
36
|
In-Home Secondhand Smoke Exposure Among Urban Children With Asthma: Contrasting Households With and Without Residential Smokers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:E7-E16. [PMID: 29883368 PMCID: PMC6173659 DOI: 10.1097/phh.0000000000000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Secondhand smoke exposure (SHSe) affects up to half of all children in the United States. Many studies have identified factors associated with in-home SHSe, but few have contrasted these factors between households with and without residential smokers. In the latter case, exposure occurs from only external sources that enter the home, such as visitors or environmental incursion. OBJECTIVE Among children with SHSe at home, to examine demographic and psychosocial differences between households with and without residential smokers. DESIGN Baseline analysis of an observational cohort. SETTING Baltimore City, Maryland. PARTICIPANTS A total of 157 children with asthma, aged 5 to 12 years. MEASURES At-home airborne nicotine, caregiver-reported depression, asthma-related quality of life, functional social support, and demographics. Univariable comparisons were performed between SHS-exposed households with and without residential smokers. Multivariable logistic regression models were fit to examine associations between measured factors and absence of residential smokers. RESULTS Children (78.3%) had at-home SHSe. Of these, 40.7% lived in households without residential smokers. Compared with households with residential smokers, these caregivers endorsed stronger beliefs in SHS harms and also worse functional social support and asthma-related stress, despite no differences in asthma morbidity. In adjusted models, SHS-exposed children with caregivers in the lowest tertile of functional social support (adjusted odds ratio, 3.50; 95% confidence interval, 1.12-10.99), asthma-related quality of life (2.90; 1.06-7.95), and those living alone (5.28; 1.26-22.15) had at least twice higher odds of having exclusively external SHSe than the highest tertile (P trends < .05). CONCLUSIONS In-home SHS exposure remains alarmingly high in urban environments. However, a substantial proportion of this exposure appears to be occurring only from external sources that enter the home. Caregivers in these homes had higher desire but lower agency to avoid SHSe, driven by lack of functional support and physical isolation. Public policies targeting these factors may help remediate exposure in this especially vulnerable population.
Collapse
|
37
|
Kercsmar CM, Sorkness CA, Calatroni A, Gergen PJ, Bloomberg GR, Gruchalla RS, Kattan M, Liu AH, O'Connor GT, Pongracic JA, Szefler SJ, Teach SJ, Wildfire JJ, Wood RA, Zoratti EM, Busse WW. A computerized decision support tool to implement asthma guidelines for children and adolescents. J Allergy Clin Immunol 2018; 143:1760-1768. [PMID: 30529451 DOI: 10.1016/j.jaci.2018.10.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multicenter randomized controlled trials (RCTs) for asthma management that incorporate usual-care regimens could benefit from standardized application of evidence-based guidelines. OBJECTIVE We sought to evaluate performance of a computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual-care regimens for asthma management in RCTs. METHODS Children and adolescents with persistent uncontrolled asthma living in urban census tracts were recruited into 3 multicenter RCTs (each with a usual-care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control-level determinants (symptoms, rescue medication use, pulmonary function measure, and adherence estimates) were collected at visits and entered into the ACET Program. Changes in control levels and treatment steps were examined during the trials. RESULTS At screening, more than half of the participants were rated as having symptoms that were not controlled or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all 3 trials. Between 51% and 70% had symptoms that were well controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last posttreatment visit. Nighttime symptoms were the most common control-level determinant; there were few (<1%) instances of complete overlap of factors. FEV1 was the driver of control-level assignment in 30% of determinations. CONCLUSION The ACET Program decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants.
Collapse
Affiliation(s)
- Carolyn M Kercsmar
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Christine A Sorkness
- Department of Medicine, Division of Allergy and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institutes of Health, Bethesda, Md
| | - Gordon R Bloomberg
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Rebecca S Gruchalla
- Department of Internal Medicine/Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Meyer Kattan
- Department of Pediatrics, Division of Pediatric Pulmonology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew H Liu
- Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital Colorado, Aurora, Colo
| | - George T O'Connor
- Department of Medicine, Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, Mass
| | - Jacqueline A Pongracic
- Department of Pediatrics, Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Stanley J Szefler
- Department of Pediatrics, Division of Pulmonary Medicine, National Jewish Health and University of Colorado, Denver School of Medicine, Denver, Colo
| | - Stephen J Teach
- Department of Pediatrics, Division of Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC
| | | | - Robert A Wood
- Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Edward M Zoratti
- Department of Pediatrics, Division of Allergy and Immunology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Mich
| | - William W Busse
- Department of Medicine, Division of Allergy and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | |
Collapse
|
38
|
Yawn BP, Israel E, Wechsler ME, Pace W, Madison S, Manning B, Doros G, Fuhlbrigge A. The asthma Symptom Free Days Questionnaire: how reliable are patient responses? J Asthma 2018; 56:1222-1230. [PMID: 30365368 DOI: 10.1080/02770903.2018.1531990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Symptom free days are a widely used patient-reported outcome (PRO) in asthma clinical trials. We assessed the internal consistency of one instrument for this PRO, the Symptom Free Days Questionnaire (SFDQ), in a population of Black adults with asthma enrolled in the Blacks and Exacerbations on Long-acting beta agonists and Tiotropium (BELT) trial. Methods: We assessed responses to the SFDQ collected at baseline, 6 and 12 months as part of the BELT trial. The internal consistency of responses, specifically number of patient-reported days with symptoms in 14 days were compared to the number of patient-reported days with no symptoms in the same 14 days. Lin concordance correlation coefficients (Lin ccc) were calculated over time to assess "learning" and by age, sex, geographic location, and annual family income. Results: The internal consistency of the responses of the 1070 enrolled patients was consistently low over the 12 months of the study; varying from 43.8% at baseline to 52.1% at 12 months. This corresponded to Lin cccs of 0.33-0.32 over the study period. Internal consistency and the Lin ccc did not vary by age group, sex, geographic location or percent poverty. Concordance was slightly but not significantly higher at all time points in those with family annual income of ≥$50,000 compared to those with lower annual incomes. Conclusions: The SFDQ did not work well in the BELT population of Black adults with asthma. Further validation is required before the SFDQ is used in other large clinical trials with any population.
Collapse
Affiliation(s)
- Barbara P Yawn
- Department of Family and Community Health, University of Minnesota , Minneapolis , MN , USA
| | - Elliot Israel
- Harvard Medical School and Brigham and Women's Hospital , Boston , MA , USA
| | | | - Wilson Pace
- National Research Network, American Academy of Family Physicians , Leawood , KS , USA
| | | | - Brian Manning
- National Research Network, American Academy of Family Physicians , Leawood , KS , USA
| | - Gheorghe Doros
- Biostatistics Department and Harvard Clinic Research Institute, Boston University , Boston , MA , USA
| | - Anne Fuhlbrigge
- University of Colorado School of Medicine , Denver , CO , USA
| |
Collapse
|
39
|
Lantz PM, Miller G, Rhyan CN, Rosenbaum S, Ku L, Iovan S. "Pay for Success" Financing and Home-Based Multicomponent Childhood Asthma Interventions: Modeling Results From the Detroit Medicaid Population. Milbank Q 2018; 96:272-299. [PMID: 29870111 DOI: 10.1111/1468-0009.12325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points: The Pay for Success (PFS) financing approach has potential for scaling the implementation of evidence-based prevention interventions in Medicaid populations, including a range of multicomponent interventions for childhood asthma that combine home environment risk mitigation with medical case management. Even though this type of intervention is efficacious and cost-saving among high-risk children with asthma, the main challenges for implementation in a PFS context include legal and regulatory barriers to capturing federal Medicaid savings and using them as a source of private investor repayment. Federal-level policy change and guidance are needed to support PFS financing of evidence-based interventions that would reduce expensive acute care among Medicaid enrollees. CONTEXT Pay for Success has emerged as a potential financing mechanism for innovative and cost-effective prevention programs. In the PFS model, interventions that provide value to the public sector are implemented with financing from private investors who receive a payout from the government only if the metrics identified in a performance-based contract are met. In this nascent field, little has been written about the potential for and challenges of PFS initiatives that produce savings and/or value for Medicaid. METHODS In order to elucidate the basic economics of a PFS intervention in a Medicaid population, we modeled the potential impact of an evidence-based multicomponent childhood asthma intervention among low-income children enrolled in Medicaid in Detroit. We modeled outcomes and a comparative benefit-cost analysis in 3 risk-based target groups: (1) all children with an asthma diagnosis; (2) children with an asthma-related emergency department visit in the past year; and (3) children with an asthma-related hospitalization in the past year. Modeling scenarios for each group produced estimates of potential state and federal Medicaid savings for different types or levels of investment, the time frames for savings, and some overarching challenges. FINDINGS The PFS economics of a home-based asthma intervention are most viable if it targets children who have already experienced an expensive episode of asthma-related care. In a 7-year demonstration, the overall (undiscounted) modeled potential savings for Group 2 were $1.4 million for the federal Medicaid and $634,000 for the state Medicaid programs, respectively. Targeting children with at least 1 hospitalization in the past year (Group 3) produced estimated potential savings of $2.8 million to federal Medicaid and $1.3 million to state Medicaid. However, current Medicaid rules and regulations pose significant challenges for capturing federal Medicaid savings for PFS payouts. CONCLUSIONS A multicomponent intervention that provides home remediation and medical case management to high-risk children with asthma has significant potential for PFS financing in urban Medicaid populations. However, there are significant administrative and payment challenges, including the limited ability to capture federal Medicaid savings and to use them as a source of investor repayment. Without some policy reform and clear guidance from the federal government, the financing burden of PFS outcome payments will be on the state Medicaid program or some other state-level funding source.
Collapse
Affiliation(s)
- Paula M Lantz
- Gerald R. Ford School of Public Policy, University of Michigan
| | | | | | - Sara Rosenbaum
- Milken Institute School of Public Health, George Washington University
| | - Leighton Ku
- Milken Institute School of Public Health, George Washington University
| | - Samantha Iovan
- Gerald R. Ford School of Public Policy, University of Michigan
| |
Collapse
|
40
|
Leas BF, D'Anci KE, Apter AJ, Bryant-Stephens T, Lynch MP, Kaczmarek JL, Umscheid CA. Effectiveness of indoor allergen reduction in asthma management: A systematic review. J Allergy Clin Immunol 2018; 141:1854-1869. [DOI: 10.1016/j.jaci.2018.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
|
41
|
Parikh K, Hall M, Kenyon CC, Teufel RJ, Mussman GM, Montalbano A, Gold J, Antoon JW, Subramony A, Mittal V, Morse RB, Wilson KM, Shah SS. Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma. J Pediatr 2018; 195:175-181.e2. [PMID: 29395170 PMCID: PMC8666980 DOI: 10.1016/j.jpeds.2017.11.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/24/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. STUDY DESIGN This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated. RESULTS The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation. CONCLUSIONS Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.
Collapse
Affiliation(s)
- Kavita Parikh
- Children's National Medical Center and George Washington School of Medicine, Washington, DC.
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Chén C Kenyon
- The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Grant M Mussman
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amanda Montalbano
- Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Jessica Gold
- Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Stanford, CA
| | - James W Antoon
- Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Anupama Subramony
- Cohen Children's Medical Center, Northwell Health, Hofstra School of Medicine, New Hyde Park, NY
| | - Vineeta Mittal
- Children's Health, Children's Medical Center, Dallas, TX
| | - Rustin B Morse
- Children's Health, Children's Medical Center, Dallas, TX
| | | | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
42
|
Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities. Ann Am Thorac Soc 2018; 13:1231-8. [PMID: 27249657 DOI: 10.1513/annalsats.201601-054ps] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Socioeconomic and racial disparities in the outcomes of medical management remain common across pulmonary diseases in the United States and worldwide. Acknowledging this, the American Thoracic Society recently put forth recommendations to advance respiratory health equity. Through engagement of vulnerable communities in search of collaborative solutions to improve health disparities, community-based participatory research embodies concepts essential to the American Thoracic Society mission for respiratory health equity. The purpose of this commentary is to provide an overview of the principles of community-based participatory research and the application of this approach to addressing inequity in the outcomes of treatment for lung disease. Community-based participatory research aims to decrease health disparities by recognizing the social and ecological paradigms of health care and by partnering community members with academic researchers in all aspects of the research process. Community partners are uniquely poised to offer insight into local culture, circumstances that guide health behaviors, and other challenges to improve their own community's health. Sustainable interventions, either through strengthening existing community assets or through community empowerment and local capacity building throughout the research process, are essential to the success of community-based participatory research. The National Institutes of Health and other funding agencies offer funding opportunities to support specific interventions aimed at engaging community members in the research process. In pulmonary medicine, community-based initiatives have focused primarily on improving pediatric asthma outcomes. Using a community-based approach in adult asthma and other pulmonary diseases could be an ideal manner in which to decrease pulmonary health disparities.
Collapse
|
43
|
Bee P, Pedley R, Rithalia A, Richardson G, Pryjmachuk S, Kirk S, Bower P. Self-care support for children and adolescents with long-term conditions: the REfOCUS evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BackgroundSelf-care support (e.g. education, training, peer/professional support) is intended to enhance the self-care capacities of children and young people, while simultaneously reducing the financial burden facing health-care systems.ObjectivesTo determine which models of self-care support for long-term conditions (LTCs) are associated with significant reductions in health utilisation and costs without compromising outcomes for children and young people.DesignSystematic review with meta-analysis.PopulationChildren and young people aged 0–18 years with a long-term physical or mental health condition (e.g. asthma, depression).InterventionSelf-care support in health, social care, educational or community settings.ComparatorUsual care.OutcomesGeneric/health-related quality of life (QoL)/subjective health symptoms and health service utilisation/costs.DesignRandomised/non-randomised trials, controlled before-and-after studies, and interrupted time series designs.Data sourcesMEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Science, NHS Economic Evaluation Database, The Cochrane Library, Health Technology Assessment database, Paediatric Economic Database Evaluation, IDEAS, reference scanning, targeted author searches and forward citation searching. All databases were searched from inception to March 2015.MethodsWe conducted meta-analyses, simultaneously plotting QoL and health utilisation effects. We conducted subgroup analyses for evidence quality, age, LTC and intervention (setting, target, delivery format, intensity).ResultsNinety-seven studies reporting 114 interventions were included. Thirty-seven studies reported adequate allocation concealment. Fourteen were UK studies. The vast majority of included studies recruited children and young people with asthma (n = 66, 68%). Four per cent of studies evaluated ‘pure’ self-care support (delivered through health technology without additional contact), 23% evaluated facilitated self-care support (≤ 2 hours’/four sessions’ contact), 65% were intensively facilitated (≥ 2 hours’/four sessions’ contact) and 8% were case management (≥ 2 hours’ support with multidisciplinary input). Self-care support was associated with statistically significant, minimal benefits for QoL [effect size (ES) –0.17, 95% confidence interval (CI) –0.23 to –0.11], but lacked clear benefit for hospital admissions (ES –0.05, 95% CI –0.12 to 0.03). This finding endured across intervention intensities and LTCs. Statistically significant, minimal reductions in emergency use were observed (ES –0.11, 95% CI –0.17 to –0.04). The total cost analysis was limited by the small number of data. Subgroup analyses revealed statistically significant, minimal reductions in emergency use for children aged ≤ 13 years (ES –0.10, 95% CI –0.17 to –0.04), children and young people with asthma (ES –0.12, 95% CI –0.18 to –0.06) and children and young people receiving ≥ 2 hours per four sessions of support (ES –0.10, 95% CI –0.17 to –0.03). Preliminary evidence suggested that interventions that include the child or young person, and deliver some content individually, may optimise QoL effects. Face-to-face delivery may help to maximise emergency department effects. Caution is required in interpreting these findings.LimitationsIdentification of optimal models of self-care support is challenged by the size and nature of evidence available. The emphasis on meta-analysis meant that a minority of studies with incomplete but potentially relevant data were excluded.ConclusionsSelf-care support is associated with positive but minimal effects on children and young people’s QoL, and minimal, but potentially important, reductions in emergency use. On current evidence, we cannot reliably conclude that self-care support significantly reduces health-care costs.Future workResearch is needed to explore the short- and longer-term effects of self-care support across a wider range of LTCs.Study registrationThis study is registered as PROSPERO CRD42014015452.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amber Rithalia
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Steven Pryjmachuk
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Susan Kirk
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
44
|
McCallum GB, Morris PS, Brown N, Chang AB. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev 2017; 8:CD006580. [PMID: 28828760 PMCID: PMC6483708 DOI: 10.1002/14651858.cd006580.pub5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with asthma who come from minority groups often have poorer asthma outcomes, including more acute asthma-related doctor visits for flare-ups. Various programmes used to educate and empower people with asthma have previously been shown to improve certain asthma outcomes (e.g. adherence outcomes, asthma knowledge scores in children and parents, and cost-effectiveness). Models of care for chronic diseases in minority groups usually include a focus of the cultural context of the individual, and not just the symptoms of the disease. Therefore, questions about whether tailoring asthma education programmes that are culturally specific for people from minority groups are effective at improving asthma-related outcomes, that are feasible and cost-effective need to be answered. OBJECTIVES To determine whether culture-specific asthma education programmes, in comparison to generic asthma education programmes or usual care, improve asthma-related outcomes in children and adults with asthma who belong to minority groups. SEARCH METHODS We searched the Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, Embase, review articles and reference lists of relevant articles. The latest search fully incorporated into the review was performed in June 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the use of culture-specific asthma education programmes with generic asthma education programmes, or usual care, in adults or children from minority groups with asthma. DATA COLLECTION AND ANALYSIS Two review authors independently selected, extracted and assessed the data for inclusion. We contacted study authors for further information if required. MAIN RESULTS In this review update, an additional three studies and 220 participants were added. A total of seven RCTs (two in adults, four in children, one in both children and adults) with 837 participants (aged from one to 63 years) with asthma from ethnic minority groups were eligible for inclusion in this review. The methodological quality of studies ranged from very low to low. For our primary outcome (asthma exacerbations during follow-up), the quality of evidence was low for all outcomes. In adults, use of a culture-specific programme, compared to generic programmes or usual care did not significantly reduce the number of participants from two studies with 294 participants for: exacerbations with one or more exacerbations during follow-up (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.50 to 1.26), hospitalisations over 12 months (OR 0.83, 95% CI 0.31 to 2.22) and exacerbations requiring oral corticosteroids (OR 0.97, 95% CI 0.55 to 1.73). However, use of a culture-specific programme, improved asthma quality of life scores in 280 adults from two studies (mean difference (MD) 0.26, 95% CI 0.17 to 0.36) (although the MD was less then the minimal important difference for the score). In children, use of a culture-specific programme was superior to generic programmes or usual care in reducing severe asthma exacerbations requiring hospitalisation in two studies with 305 children (rate ratio 0.48, 95% CI 0.24 to 0.95), asthma control in one study with 62 children and QoL in three studies with 213 children, but not for the number of exacerbations during follow-up (OR 1.55, 95% CI 0.66 to 3.66) or the number of exacerbations (MD 0.18, 95% CI -0.25 to 0.62) among 100 children from two studies. AUTHORS' CONCLUSIONS The available evidence showed that culture-specific education programmes for adults and children from minority groups are likely effective in improving asthma-related outcomes. This review was limited by few studies and evidence of very low to low quality. Not all asthma-related outcomes improved with culture-specific programs for both adults and children. Nevertheless, while modified culture-specific education programs are usually more time intensive, the findings of this review suggest using culture-specific asthma education programmes for children and adults from minority groups. However, more robust RCTs are needed to further strengthen the quality of evidence and determine the cost-effectiveness of culture-specific programs.
Collapse
Affiliation(s)
- Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
| | - Ngiare Brown
- Ngaoara ‐ Child and Adolescent WellbeingAustinmerAustralia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
| | | |
Collapse
|
45
|
Gleason M, Cicutto L, Haas-Howard C, Raleigh BM, Szefler SJ. Leveraging Partnerships: Families, Schools, and Providers Working Together to Improve Asthma Management. Curr Allergy Asthma Rep 2017; 16:74. [PMID: 27709456 DOI: 10.1007/s11882-016-0655-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Asthma is one of the most common illnesses of school-aged children and can lead to both health and educational disparities. Children from low socioeconomic backgrounds and racial/ethnic minorities suffer the greatest impact. They often lack the asthma self-management skills to successfully monitor, navigate, and negotiate appropriate asthma care. School settings are a strategic point of contact for this additional support. School nurses can monitor for signs of asthma worsening, manage symptoms, provide care coordination, and reinforce self-management skills. Likewise, school-based asthma programs have the potential to reduce health and educational disparities, but it is the strong linkage to the asthma care provider that is critical to successful school-based asthma management. Healthcare providers are encouraged to establish partnerships with families through patient-centered care and schools through clear communication and care coordination to ensure asthma is well controlled so the child is in school and ready to learn.
Collapse
Affiliation(s)
- Melanie Gleason
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA. .,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Lisa Cicutto
- Clinical Science Program, University of Colorado Denver AMC, Denver, CO, USA.,National Jewish Health, Denver, CO, USA
| | | | - Bridget M Raleigh
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA.,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| | - Stanley J Szefler
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA.,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| |
Collapse
|
46
|
Wood PR, Kampschmidt JC, Dube PH, Cagle MP, Chaparro P, Ketchum NS, Kannan TR, Singh H, Peters JI, Baseman JB, Brooks EG. Mycoplasma pneumoniae and health outcomes in children with asthma. Ann Allergy Asthma Immunol 2017. [PMID: 28634021 DOI: 10.1016/j.anai.2017.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acute infections with Mycoplasma pneumoniae (Mp) have been associated with worsening asthma in children. Mp can be present in the respiratory tract for extended periods; it is unknown whether the long-term persistence of Mp in the respiratory tract affects long-term asthma control. OBJECTIVE To determine the effect of Mp on asthma control. METHODS We enrolled 31 pediatric subjects 3 to 10 years of age with persistent asthma who completed up to 8 visits over a 24-month period. We detected Mp by antigen capture and polymerase chain reaction. Primary outcome measurements included symptom scores, quality of life, medication scores, oral corticosteroid use, health care usage, school absences, and exhaled breath condensate pH. RESULTS Low levels of Mp community-acquired respiratory distress syndrome toxin were detected in 20 subjects (64.5%) at enrollment. Subjects with Mp positivity at a given visit had a .579 probability of remaining Mp positive at the subsequent visit, whereas those with Mp negativity had a .348 probability of becoming Mp positive at the following visit. The incidence of Mp overall was higher in the spring and summer months. Overall, we found no significant relation between the detection of Mp and worse outcome measurements at the same visit or at subsequent visits. CONCLUSION The long-term persistence of Mp in the respiratory tract is common in children with asthma. However, the detection of Mp was not associated significantly with worse asthma symptoms, quality of life, health care usage, school absences, or exhaled breath condensate pH in this pediatric asthma cohort.
Collapse
Affiliation(s)
- Pamela R Wood
- Department of Pediatrics, UT Health San Antonio, San Antonio, Texas.
| | | | - Peter H Dube
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Marianna P Cagle
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Paola Chaparro
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Norma S Ketchum
- Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, Texas
| | - Thirumalai R Kannan
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Harjinder Singh
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Jay I Peters
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Joel B Baseman
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Edward G Brooks
- Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
| |
Collapse
|
47
|
Phipatanakul W, Koutrakis P, Coull BA, Kang CM, Wolfson JM, Ferguson ST, Petty CR, Samnaliev M, Cunningham A, Sheehan WJ, Gaffin JM, Baxi SN, Lai PS, Permaul P, Liang L, Thorne PS, Adamkiewicz G, Brennan KJ, Baccarelli AA, Gold DR. The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2017; 60:14-23. [PMID: 28619649 DOI: 10.1016/j.cct.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.
Collapse
Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Petros Koutrakis
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Choong-Min Kang
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Jack M Wolfson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Stephen T Ferguson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Carter R Petty
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Mihail Samnaliev
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan M Gaffin
- Boston Children's Hospital, Division of Respiratory Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peggy S Lai
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States
| | - Perdita Permaul
- Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, MA, United States
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Peter S Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, United States
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Kasey J Brennan
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Andrea A Baccarelli
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Diane R Gold
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, United States
| |
Collapse
|
48
|
Kennedy S, Bailey R, Jaffee K, Markus A, Gerstein M, Stevens DM, Lesch JK, Malveaux FJ, Mitchell H. Effectiveness of Evidence-Based Asthma Interventions. Pediatrics 2017; 139:peds.2016-4221. [PMID: 28562279 DOI: 10.1542/peds.2016-4221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. METHODS Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. RESULTS A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P < .001), and this result was consistent with changes found in the rigorous evidence-based interventions. CONCLUSIONS Evidence-based interventions can be successfully adapted into primary care settings that serve impoverished, high-risk populations, reducing the morbidity of asthma in these high-need populations.
Collapse
Affiliation(s)
| | | | | | - Anne Markus
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
| | - Maya Gerstein
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
| | - David M Stevens
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
| | | | | | | |
Collapse
|
49
|
Eggleston PA. Cockroach allergy and urban asthma. J Allergy Clin Immunol 2017; 140:389-390. [PMID: 28528788 DOI: 10.1016/j.jaci.2017.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Peyton A Eggleston
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| |
Collapse
|
50
|
Hallit S, Assi TB, Hallit R, Salameh P. Allergic diseases, smoking, and environmental exposure among university students in Lebanon. J Asthma 2017; 55:35-42. [PMID: 28296532 DOI: 10.1080/02770903.2017.1306075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Smoking habits among university students in Lebanon are not clearly identified, and studies correlating these habits to asthma and allergic diseases are lacking. The primary objective of this study is to assess asthma and allergic diseases' predictors, particularly cigarette and/or waterpipe smoking and other environmental exposures, among university students. A second objective is to evaluate the potential role of these predictors as correlates of health-related self-assessment. METHODS A cross-sectional study, using a proportionate cluster sample of 3000 Lebanese students in both public and private universities, was conducted between January 2015 and December 2015. RESULTS The number of smokers at home, living close to an electricity generator and exposure to sand and dust significantly increased the odds of having asthma or allergic diseases (p = 0.015; OR = 1.183; p = 0.01; OR = 2.062; p = 0.001; OR = 3.558 respectively). Having tried cigarette smoking and having an air conditioner inside the means of transportation would decrease the odds of having asthma or allergic diseases by around 68% and 56.1% respectively (p = 0.009; ORa = 0.320; p = 0.01; ORa = 0.439 respectively). CONCLUSION Although students with asthma or allergic diseases tended to avoid all identifiable atopic risk factors, lesser known environmental factors such as living close to an electricity generator, exposure to sand and dust, and exposure to car exhaust fumes were associated with a higher risk of asthma and a decrease in health related self-assessment. Students with asthma and allergic diseases smoked cigarettes and waterpipe at similar percentages, but cigarette smokers had a lower health related self-assessment.
Collapse
Affiliation(s)
- Souheil Hallit
- a Faculty of Pharmacy , Lebanese University , Hadath , Lebanon.,b School of Pharmacy , Saint Joseph University , Beirut , Lebanon.,c Faculty of Medicine , Universite Saint Esprit Kaslik , Kaslik , Lebanon.,d Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,e Occupational Health Environment Research Team , U1219 BPH Bordeaux Population Health Research Center Inserm-Université de Bordeaux
| | - Tarek Bou Assi
- d Psychiatric Hospital of the Cross , Jal Eddib , Lebanon
| | - Rabih Hallit
- c Faculty of Medicine , Universite Saint Esprit Kaslik , Kaslik , Lebanon
| | - Pascale Salameh
- a Faculty of Pharmacy , Lebanese University , Hadath , Lebanon.,f Faculty of Medicine , Lebanese University , Beirut , Lebanon
| |
Collapse
|