Child and caregiver experiences and perceptions of asthma self-management

Relationship of prenatal ambient air pollutants exposure with childhood asthma risk and underlying mechanism: Ma'anshan Birth Cohort study

INTRODUCTION

Association between prenatal exposure to particulate matter speciation and childhood asthma was limited, and study of sensitive exposure window was needed.

METHODS

Among 1807 children from Ma'anshan Birth Cohort, childhood asthma information was obtained by standardized questionnaire. Family address was collected at birth and in 7 years old and used to assess trimester-specific ambient air pollutants (AAPs) exposure. Restricted cubic spline and mixed effects logistic regression were applied to assess association of AAPs with childhood asthma, stratified by sex. Moreover, potential mechanism of AAPs-childhood asthma association was revealed by constructing adverse outcome pathway.

RESULTS

There were significant correlations between AAPs. During the third trimester, exposure to PM2.5 exhibited a nearly J-shaped association with childhood asthma risk. When compared to the lowest tertile, childhood asthma risk increased by 59% (95% CI: 1.00-2.52) among children within the highest tertile of PM2.5 exposure (>76.65 μg/m3); and each unit increase in log2-transformed PM2.5 was associated with 102% (95% CI: 1.24-3.27) increase in childhood asthma risk. For chemical compositions of PM2.5, exposure to Cl-, NO3-, NH4+, and NO3- was also significantly associated with increased childhood asthma risk in the third trimester, especially in boys. Up-expression of IL-4 is molecular initiation event in the AAPs-asthma association, followed by decreased fibrinolysis, activated bradykinin, increased proinflammatory mediators, and recruitment of inflammatory cells, ultimately causing hyperinflammation.

CONCLUSIONS

Association of AAPs with asthma risk varied by trimester and sex, particularly PM2.5. Our findings enhance the public awareness of air pollution, heighten the importance of monitoring and control of AAPs.

Understanding Caregiver Burden in Severe Pediatric Asthma - A Qualitative Study

Objective

This study aimed to clarify the emotional and practical burden on primary caregivers of children with severe asthma and identify the support needs of those caring for individuals with severe asthma.

Methods

A phenomenological research approach in qualitative research was used. Semi-structured interviews with caregivers of children with asthma waiting in the outpatient clinic of Shanghai Children's Hospital were conducted from January to August 2024 through purposive sampling. The researcher transcribed audio-recorded interview data verbatim into text and thematically analyzed the data using the Colaizzi 7-step analysis method and then obtained the final results.

Results

There were a total of 12 participants. Through these 12 in-depth one-on-one interviews, all necessary study data were obtained. The study identified the following four main burdens for caregivers of children with severe asthma: 1) Multiple barriers to the care-giving process. (Incomplete knowledge of disease management; lack of competence in care as well as poor child compliance making care more difficult; lack of support for asthma in schools). 2) Excessive consumption of time and energy. (Disturbed sleep rhythms and lack of physical energy). 3) Family dysfunction. (Conflicts among family members; disruption of normal life; increased financial burden). 4) Negative emotions. (fear; nervousness, worry).

Conclusion

This study focuses on caregivers of children with severe asthma who face multiple stressors. Caregivers are critical to disease management: healthcare professionals and the community should provide support; family members should share tasks; and children's poor self-management skills place a burden on caregivers, and professionals should teach children to better care for themselves. These findings have important implications for healthcare providers to develop targeted support programs and improve overall care for children with severe asthma.

Individual and system-level determinants of caregivers' quality of life among inner-city preschool children with asthma

OBJECTIVE

Caregivers of children with asthma can become overwhelmed by the burden of care provision. Guided by the socioecological framework, we examined individual and system-level factors associated with caregiver health-related quality of life (HRQoL) among preschool children (aged two to six years) enrolled in a multilevel home- and school-based asthma educational intervention in Baltimore, Maryland.

METHODS

The primary outcome was caregiver HRQoL measured at baseline and six months. Independent variables were baseline individual-level factors (caregiver's health literacy, self-efficacy to manage asthma, and depressive symptoms) and system-level factors (barriers to asthma care measured in five subdomains-pragmatics, health knowledge and beliefs, expectations, skills, and marginalization-and neighborhood social cohesion). Multiple regression models were used to assess the association between baseline individual and system-level factors and caregiver HRQoL at baseline and six-month follow-up adjusting for the child's asthma control, caregiver's age, household income, and study arm assignment/intervention.

RESULTS

398 caregivers completed the baseline survey and 328 (82%) completed the six-month follow-up survey. In the adjusted multiple regression model, lower caregiver's health literacy and higher barriers to asthma care related to pragmatics were significantly associated with lower caregiver HRQoL at baseline (b = 0.38, 95% CI, 0.15-0.61, p = .002; and b = 0.01, 95% CI, 0.004-0.02, p < .001, respectively). The results were similar at the six-month follow-up.

CONCLUSION

Caregiver health literacy and barriers to asthma care related to pragmatics and skills were found to be important determinants of asthma caregiver HRQoL. Addressing these factors may improve the quality of life among caregivers of preschool children with asthma.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of environmental, demographic and clinical parameters with physical activity in children with asthma

Personal characteristics, unfavorable weather conditions and air pollution have been linked with reduced physical activity in children. However, among children with asthma the effects of these parameters remain unclear. This study objectively quantified the physical activity of children with asthma and evaluated its association with environmental, personal, and clinical parameters. Participants of the prospective LIFE-MEDEA asthma study wore the EMRACE™ smartwatch daily for continuous monitoring of physical activity and acquisition of global positioning system data. Daily physical activity, personal and clinical data were combined with daily temperature, precipitation, and air pollution levels in adjusted mixed effect regression models to examine the relationship between physical activity and the examined parameters. For a follow-up period of 4 months, 186 children with asthma demonstrated a decrease of 796 steps (95% CI: -1080, -512) on days with precipitation compared to non-precipitation days and a decrease of 96 steps (95% CI: -182, -9) for every 10 µg/m3 increase in PM10. The relationship between temperature and daily steps was characterized by an inverted U-shape. There was also evidence that gender and age-adjusted BMI z-score were negatively associated with daily steps. These results can further inform the design of physical activity interventions targeting children with asthma.

Pediatric asthma inhaler technique: quality and content analysis of YouTube videos

BACKGROUND

Proper technique for using inhalers is crucial in treating pediatric asthma. YouTube offers a wide range of videos on pediatric inhaler technique, but there is a need to analyze the quality, reliability, and content of these resources.

AIMS

This study aims to analyze the quality, reliability, and content of YouTube videos on pediatric asthma inhaler techniques.

METHODS

The study has a descriptive, retrospective, and cross-sectional design. The research was conducted by searching YouTube using the "Pediatric Metered Dose Inhaler," "Pediatric Accuhaler," and "Pediatric Diskus." The video's popularity was measured using the Video Power Index. The quality and reliability of the videos were evaluated using the modified DISCERN and Global Quality Scale (GQS).

RESULTS

This study analyzed 55 YouTube videos on the pediatric inhaler technique. 19 of the videos were related to the pMDI inhaler with a spacer for tidal breathing, 14 pMDI inhaler with a spacer for single breath, and 22 diskus device. Findings show that videos demonstrating the use of pMDI devices for single breath have more reliable modified DISCERN scores. However, videos related to tidal breathing are more popular than those showing the use of diskus devices and single breath. Based on the checklist for videos on diskus devices, the steps with the highest error rates are 'Check dose counter' at 72.7% and 'Breathe out gently, away from the inhaler' at 63.6%. A moderate correlation was observed between the modified DISCERN score and the GQS.

CONCLUSIONS

While YouTube videos on the pMDI single-breath technique may be useful for pediatric patients and caregivers, it is crucial for them to receive inhaler technique education from their healthcare provider. This study's findings hold great significance for pediatric patients and caregivers, particularly those who rely on YouTube for health-related information.

Improving asthma care in children: revealing needs and bottlenecks through in-depth interviews

Asthma affects 7% of Dutch children and poses an increasing challenge, highlighting the need for effective paediatric asthma care. Achieving optimal asthma control is crucial given the potentially negative long-term effects of bad asthma control on lung development and quality of life in young children. The aim was to understand the challenges and requirements of existing asthma management practices in children. In a qualitative explorative study design, semi-structured, in-depth interviews were held among 37 Dutch stakeholders. A total of 15 patients/parents, 10 general practitioners (GPs), 5 paediatricians/paediatric pulmonologists and 7 nursing specialist/pulmonary nurses participated. Analysis was based on a thematic inductive analysis, using open and axial coding. GPs tended to emphasise the treatment of patients/parents with acute symptoms and underestimate the diagnosis and management of chronic symptoms, leading to possible over- and undertreatment. Asthma care between primary and secondary healthcare is fragmented and worsens these challenges. Moreover, the absence of well-established follow-up structures in primary care contributes to insufficient self-management skills among patients. Shared Decision-Making in children lacks a tailored approach, with variable engagement levels among healthcare providers. Limited focus on preventive strategies leads to little attention to, for example, promoting healthy lifestyles. Moreover, children are often not actively involved in decision-making. The study provides valuable insights to improve the quality and continuity of care for children with asthma and their parents. It underlines the need for a comprehensive and integrated care pathway to minimise the long-term negative effects of uncontrolled asthma.

Effect of high-efficiency particulate air filter on children with asthma: a systematic review protocol of RCTs

INTRODUCTION

Asthma has been classified as a major non-communicable disease by the WHO. With the worsening air quality index worldwide, the burden of asthma has increased specifically in children. The focus of the management strategy of asthma has shifted from traditional pharmacological treatments towards non-pharmacological preventive and control therapy in recent decades. The use of high-efficiency particulate air (HEPA) filters is one of the methods to achieve that, despite extensive research, the efficacy of HEPA filters in this context of effectiveness and usage guidelines remains unclear. Our study aims to examine the effect of HEPA filters in (1) reducing clinical visits or hospital admissions or the number of exacerbation events, (2) reducing asthma symptoms, (3) increasing asthma symptom-free days, (4) reducing indoor particulate matter 2.5 levels for children with asthma aged 5-17 years and (5) improving quality of life.

METHODS

We will conduct a systematic review using MEDLINE, Google Scholar and Scopus as databases, article selection is planned to be restricted to randomised controlled trials only (2002-2025). We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines developed specifically for the protocol(s). Two reviewers will screen the studies independently and assess study quality using the Cochrane Risk of Bias Tool for Randomised Trials, V.2. The results of outcome measure(s) will be summarised in tables. If the studies are sufficient, we will also perform a quantitative analysis by creating forest plots and subgroup analysis will be performed if required. Lastly, publication bias will be assessed using a funnel plot and Egger's test and reported accordingly.

ETHICS AND DISSEMINATION

We will conduct a systematic review, therefore there is no need for a formal ethical review. After successful completion, our results will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CR42024494949.

Children and young people's self-reported experiences of asthma and self-management nursing strategies: An integrative review

AIM

To explore children and young people's (CYP) (5-24 years of age) self-reported experiences of asthma self-management strategies (ASMS) with nursing involvement across various settings.

BACKGROUND

Childhood asthma is an increasingly significant health issue, highlighting the importance of acquiring self-management skills to optimise future health outcomes. Registered nurses play a pivotal role in delivering appropriate, personalized self-management support.

METHODS

This integrative review searched four electronic databases: Cumulated Index to Nursing and Allied Health Literature via Elton B. Stephens Company, Medical Literature Analysis and Retrieval System Online (MEDLINE), Object, View and Interactive Design (OVID), and PubMed, that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart. Included studies were critically appraised using the Joanna Briggs Institute critical appraisal tools. Braun and Clarks thematic analysis was used to generate themes, and sub-themes.

FINDINGS

Fifteen studies were included for review. Thematic analysis generated three themes being healthy literacy; health and wellbeing; and tools and working together.

CONCLUSIONS

Asthma continues to have negative physical, psychological, and social implications among CYP. CYP are both willing and capable of engaging in ASMS and learning self-management skills, however, continue to have unmet self-management needs.

IMPLICATIONS TO PRACTICE

Strategies must bolster health literacy, improve physical and psychological health, and harness interactive, youth-centric, and informative tools to facilitate communication and decrease the burden of self-management. Applications pose a promising avenue for self-management support. This age group remains under-explored and future research should enable meaningful engagement with CYP to better understand their perspectives and improve strategy success.

The effect of mobile game training designed for asthmatic children on asthma management and quality of life

PURPOSE

This study aimed to examine the effect of mobile game training designed for children with asthma on inhaler use skills, asthma symptoms and treatment needs, and quality of life.

DESIGN AND METHODS

This randomized controlled study was conducted between April and October 2023 at "Pediatric Asthma and Allergy Clinic" in Turkey. The sample of the study consists of a total of 74 children diagnosed with asthma, including the Mobile game (n: 37) and the Control group (n: 37). In the study, a mobile game was developed for children with asthma between the ages of 8-12. In collecting research data; Child and Parent Information Form, Inhaler Use Skill Evaluation Form, Asthma Symptom and Treatment Need Scoring (Asthma Symptom Score [ASS], Rhinitis Symptom Score [RSS] and Total Symptom Score [TSS]), DISABKIDS Asthma Scale were used.

RESULTS

There was no significant difference between the groups in terms of the demographic status of the children (p > 0.05). It was determined that the average inhaler use skill score and DISABKIDS asthma scale Child/Parent score average of the children in the mobile game group were higher than the control group (p < 0.05). When the children's final follow-up ASS, RSS and TSS total scores were examined; It was determined that there was a statistically significant difference between the children in the mobile game and control groups (p < 0.05).

CONCLUSIONS

As a result of this study, it was determined that mobile game training designed for children is an effective method in increasing children's ability to use inhaler medications, reducing asthma symptoms and treatment needs, and improving quality of life.

PRACTICE IMPLICATION

Nurses can improve children's quality of life by using mobile game training programs that attract children's attention.

Correlation between parents and child’s version of the child health survey for asthma questionnaire

Background

The American Academy of Pediatrics Children's Health Survey for Asthma (CHSA) is a widely used instrument to assess various aspects of health and well-being in relation to asthma. There is a parent and a child version of this questionnaire and little is known about the concordance between these versions.

Method

In a cross-sectional study conducted in 13 facilities, hospitals and outpatient clinics covering all areas of Kosovo, children with asthma aged 7-16 years were enrolled. Information about asthma diagnosis was obtained from the treating physician. Children and parents answered the CHSA, parent or child version (CHSA-C) as well as a number of questions about environmental conditions, health insurance and socio-demographic characteristics.

Results

The survey included 161 Kosovar children with asthma and their caregivers. Although there were significant differences between parents and child versions regarding physical health, child activity and emotional health, with parents rating physical and emotional health higher and child activity lower, there were significant correlations (R > 0.7) for physical and child activity scales but only a low one (R = 0.25) for emotional health. Inspection of concordance for single items revealed very high correlations (>0.9) for all disease events, but a significant underestimation of the number of wheezing episodes by parents. Good agreement was found for statements about disease severity.

Conclusions

The high correlation between information about children's health obtained from parents and children underlines the usefulness of parents as source of information on child's asthma. Impact of the disease on emotional health is, however, underestimated by parents.

Parenting style and child asthma control in families of school-age children with asthma: The mediating effects of children's general self-efficacy and medication adherence

PURPOSE

Parenting style plays a pivotal role in children's chronic disease control. However, the relationship and underlying mechanism between parenting style and asthma control remain unclear. This study investigated the effects of parenting style on children's general self-efficacy, medication adherence and asthma control and the mediating effects of general self-efficacy and medication adherence among school-age children with asthma.

DESIGN AND METHODS

A cross-sectional study with a convenience sampling approach was conducted. This study followed the STROBE guidelines. School-age children with asthma and their parents (N = 211) from pediatric respiratory clinics in China completed the General Questionnaire, Short-Egna Minnen av. Barndoms Uppfostran-Chinese, General Self-Efficacy Scale, Medication Adherence Questionnaire and Childhood Asthma Control Test. Structural equation modeling was used to examine the mediation models.

RESULTS

Positive parenting style was positively correlated with child general self-efficacy, medication adherence and asthma control (r = 0.602, 0.572, 0.613, p < 0.001). Negative parenting style was negatively correlated with child general self-efficacy, medication adherence and asthma control (r = -0.535, -0.598, -0.586, p < 0.001). Structure Equation Modle (SEM) results indicated that the relationships between positive parenting style, negative parenting style and child asthma control were mediated by general self-efficacy (Effect Size [ES]: 0.209, 95%CI [0.075, 0.372]; and ES: -0.229, 95%CI [-0.387, -0.103], respectively) and medication adherence (ES: 0.128, 95%CI [0.032, 0.322]; and ES: -0.190, 95%CI [-0.432, -0.071], respectively) and together in serial (ES: 0.177, 95%CI [0.076, 0.295]; and ES: -0.118, 95%CI [-0.235, -0.020], respectively).

CONCLUSIONS

Parenting style may impact child asthma through both child general self-efficacy and medication adherence. The study may provide useful intervention targets for improving asthma control.

PRACTICE IMPLICATIONS

Nurses should encourage parents to increase positive parenting style while decreasing negative parenting style. Family interventions focusing on general self-efficacy and medication adherence may be advantageous to improve asthma control.

Assessing asthma self-management education among US children with current asthma, Asthma Call-back Survey (ACBS) 2015-2017

OBJECTIVE

Asthma self-management education (AS-ME) is an effective strategy to help children with asthma achieve better asthma control and outcome. The objective of this study is to assess the association between the prevalence of receiving AS-ME curriculum components and sociodemographic characteristics among children with current asthma.

METHODS

Behavioral Risk Factor Surveillance System, child Asthma Call-back Survey 2015-2017 aggregated data were used. Multivariable logistic regression models were used to assess associations of each AS-ME component question and sociodemographic characteristic, adjusting for sample weighting.

RESULTS

Among 3,213 children with current asthma, 52% of children reported ever being given an asthma action plan by a doctor or other healthcare professional. After adjusting for other variables, boys and Non-Hispanic Black children were more likely to report being given an action plan (APR= 1.15[95% CI 1.00-1.32] and APR= 1.28[95% CI 1.07-1.54] respectively). Non-Hispanic Black (APR = 2.15 [95% CI 1.30-3.55]), non-Hispanic, other race (APR = 1.95 [95% CI1.04-3.66]), and Hispanic children (APR = 1.84 [95% CI 1.18-2.89]) were more likely to report taking a course to learn how to manage asthma than non-Hispanic White children. Hispanic children (40.8%) were more likely to report being advised to change home environment compared to non-Hispanic Whites (31.5%) (APR =1.28 [95% CI 1.01-1.63).

CONCLUSION

The prevalence of some elements of asthma-self management education was relatively low and there were differences observed in the prevalence of receiving AS-ME by race/ethnicity, parental education, and income. Targeted implementation of asthma self-management components and interventions may improve asthma control and reduce asthma morbidity.

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers

OBJECTIVES

This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.

DESIGN

One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control.

SETTING

Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe).

PARTICIPANTS

Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey.

RESULTS

There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma.

CONCLUSIONS

In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa.

TRIAL REGISTRATION NUMBER

269211.

Caregivers' Self-Rated General Health, Physical and Mental Health Status, Disease Morbidity and Association with Uncontrolled Asthma in Children

This study examined the association between caregivers' self-rated general health, poor physical/mental health days, disease morbidity and asthma control in children from the United States with current asthma. The data analyzed for this study were obtained from 7522 children aged 0-17 years who participated in the 2012-2014, 2015-2017, 2018, and 2019 cycles of the Behavioral Risk Factor Surveillance System Asthma Call-back Survey (ACBS). We employed univariate analysis to describe the study population and weighted binary logistic regression to examine the association of predictors with asthma control. Approximately 50% of the children had uncontrolled asthma. The results show that caregivers who reported fair general health had a 61% higher likelihood of reporting uncontrolled asthma in their children compared to those who reported good/very good/excellent health (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.14-2.26). Poor caregiver general health did not reach statistical significance in predicting uncontrolled asthma (aOR = 1.05, 95% CI, 0.62-1.75). Furthermore, having 1 to 14 poor physical/mental health days ([aOR] = 1.70; 95% CI, 1.28-2.227) and ≥15 poor physical/mental health days (aOR = 1.82, 95% CI, 1.31-2.53) was predictive of uncontrolled asthma in children. Additionally, endorsing one reported disease (aOR = 1.49, 95% CI, 1.15-1.93) and ≥2 diseases (aOR = 1.38, 95% CI, 1.08-1.78) was associated with uncontrolled child asthma. These findings underscore the association between caregivers' self-reported general health, poor mental/physical health days, disease morbidity and uncontrolled asthma among children from the U.S. with asthma. Pediatricians and child health practitioners should recall the importance of this relationship. To facilitate the identification of caregivers at risk and provide more comprehensive and effective care for children with asthma, healthcare practitioners should utilize every child asthma care encounter to inquire about the overall health of caregivers.

Adherence, reliability, and variability of home spirometry telemonitoring in cystic fibrosis

Introduction

Forced spirometry is the gold standard to assess lung function, but its accessibility may be limited. By contrast, home spirometry telemonitoring allows a multi-weekly lung function follow-up but its real-life adherence, reliability, and variability according to age have been poorly studied in patients with CF (PwCF). We aimed to compare real-life adherence, reliability and variability of home spirometry between children, teenagers and adults with CF.

Methods

This real-life observational study included PwCF followed for six months in whom lung function (i.e, forced expiratory volume maximum in 1 s (FEV1), forced vital capacity (FVC), forced mid-expiratory flow (FEF) and FEV1/FVC ratio) was monitored by both conventional and home spirometry between July 2015 and December 2021. The adherence, reliability and variability of home spirometry was assessed in all PwCF and compared between children (<12years old), teenagers (12-18 years old) and adults.

Results

174 PwCF were included (74 children, 43 teenagers and 57 adults). Home spirometry was used at least one time per week by 64.1 ± 4.9% PwCF, more frequently in children and teenagers than in adults (79.4 ± 2.9%, 69.2 ± 5.5% and 40.4 ± 11.5% respectively). The reliability to conventional lung function testing was good for all assessed parameters (e.g., FEV1: r = 0.91, p < 0.01) and the variability over the 6 months of observation was low (FEV1 coefficient of variation = 11.5%). For each parameter, reliability was better, and the variability was lower in adults than in teenagers than in children.

Conclusion

Home spirometry telemonitoring appears to be a reliable tool for multi-weekly lung function follow-up of PwCF.

Caregiver Perceptions of Change in Pediatric Asthma Control During the COVID-19 Pandemic

Purpose

Although several indicators suggest that pediatric asthma control in the United States improved early in the pandemic, other indicators suggest not. Missing are reports from caregivers of the experiences of their children with asthma early in the pandemic.

Methods

Using the PP-ACT and other measures that we specifically constructed for our research, we conducted a cross-sectional national survey of US caregivers of children with asthma (N=595) to examine perceived change in their child's asthma control and changes in reports of ED visits and use of emergency relief medicine and controller medicine pre-pandemic (January to March 2020) versus early-pandemic (June to September 2020).

Results

Caregivers fell into three groups: most caregivers perceived that their child's asthma control was improved (50.3%) or unchanged (41.2%), and few reported worse control (8.5%). Surprisingly, all three groups of caregivers reported similar frequencies of early-pandemic and pre-pandemic ED visits and use of emergency relief medicine. Also surprising, caregivers who perceived their child's asthma as more controlled (compared with the other two groups) reported more frequent ED visits and use of emergency relief medicine, yet also more use of controller medicine at both early-pandemic and pre-pandemic.

Conclusion

The mismatch between caregivers' perceptions of their child's early-pandemic asthma control and their reports of ED visits and use of emergency relief medicine suggests that caregivers may rely on a gist (a global evaluation that can include nonbiomedical evidence) when estimating their child's asthma control. Caregivers and their families could benefit from help from clinicians in understanding the discrepancy between subjective asthma control and asthma control indicators and in understanding what well-controlled asthma looks and feels like.