1
|
Ciprandi G, Silvestri M, Tosca MA. Visual analog scale for assessing the perception of short-acting β2-agonist use in clinical practice. Lung India 2019; 36:82-83. [PMID: 30604716 PMCID: PMC6330800 DOI: 10.4103/lungindia.lungindia_370_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, Respiratory Allergy, Ospedale Policlinico San Martino, Genoa, Italy
| | - Michela Silvestri
- Department of Pediatrics, Pediatric Pulmonology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Angela Tosca
- Department of Pediatrics, Pediatric Pulmonology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
2
|
Assessment of genetic factor and depression interactions for asthma symptom severity in cohorts of childhood and elderly asthmatics. Exp Mol Med 2018; 50:1-7. [PMID: 29973587 PMCID: PMC6031659 DOI: 10.1038/s12276-018-0110-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
It is well known that depression is associated with asthma symptoms. We assessed the combined effects of genetic factors and depression on asthma symptom severity using Bayesian network (BN) analysis. The common 100 top-ranked single-nucleotide polymorphisms (SNPs) were obtained from two genome-wide association studies of symptom severity in two childhood asthmatics trials (CAMP (Childhood Asthma Management Program) and CARE (Childhood Asthma Research and Education)). Using SNPs plus five discretized variables (depression, anxiety, age, sex, and race), we performed BN analysis in 529 CAMP subjects. We identified two nodes (depression and rs4672619 mapping to ERBB4 (Erb-B2 receptor tyrosine kinase 4)) that were within the Markov neighborhood of the symptom node in the network and then evaluated the interactive effects of depressive status and rs4672619 genotypes on asthma symptom severity. In childhood asthmatics with homozygous reference alleles, severe depression was related to less severe symptoms. However, in childhood asthmatics with heterozygous alleles and homozygous variant alleles, depression and symptom severity showed a positive correlation (interaction permutation P value = 0.019). We then tried to evaluate whether the interactive effects that we found were sustained in another independent cohort of elderly asthmatics. Contrary to the findings from childhood asthmatics, elderly asthmatics with homozygous reference alleles showed a positive correlation between depression and symptom severity, and elderly asthmatics with heterozygous alleles and homozygous variant alleles showed a negative correlation (interaction permutation P value = 0.003). In conclusion, we have identified a novel SNP, rs4672619, that shows interactive effects with depression on asthma symptom severity in childhood and elderly asthmatics in opposite directions.
Collapse
|
3
|
Butz AM, Bellin M, Tsoukleris M, Mudd SS, Kub J, Ogborn J, Morphew T, Lewis-Land C, Bollinger ME. Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:844-852. [PMID: 28958744 PMCID: PMC5862725 DOI: 10.1016/j.jaip.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/20/2017] [Accepted: 08/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied. OBJECTIVE To examine the risk factors associated with VPC asthma in urban minority children. METHODS This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months. RESULTS At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14). CONCLUSIONS Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.
Collapse
Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Melissa Bellin
- School of Social Work, The University of Maryland, Baltimore, Md
| | - Mona Tsoukleris
- The School of Pharmacy, The University of Maryland, Baltimore, Md
| | - Shawna S Mudd
- The Johns Hopkins University School of Nursing, Baltimore, Md
| | - Joan Kub
- The Johns Hopkins University School of Nursing, Baltimore, Md
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Cassia Lewis-Land
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
| | | |
Collapse
|
4
|
Choi YJ, Suh DI, Sohn MH, Koh YY. Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:131-136. [PMID: 29411553 PMCID: PMC5809761 DOI: 10.4168/aair.2018.10.2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 11/23/2022]
Abstract
Purpose Dyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR). Methods We retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade). Results Subjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (P=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (P<0.001) and BHR grade (P<0.001). The mBorg score was affected by the dose-step (P<0.001) and BHR grade (P=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ2 [1]=21.06, P<0.001) and 0.327 (χ2 [1]=47.45, P<0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ2 [1]=16.20, P<0.001). Conclusions In asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.
Collapse
Affiliation(s)
- Yun Jung Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Severance Children's Hospital, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
5
|
Wong E, Wong TW, Chung M, Lau CC. Knowledge and Beliefs of Parents of Asthmatic Children Presenting to an Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790100800403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is a survey on the knowledge and beliefs of 100 parents or guardians of asthmatic children presenting to the emergency department with an asthmatic attack and staying in the observation ward for treatment. The parents were asked to fill in a questionnaire on their knowledge and beliefs about asthma. Demographic data and data related to routine asthma care were also collected. The mean age of the children was 6.2± 3.2. The mean duration of asthma was 3.4 year (±2.6). In the preceding 6 months the mean attendance frequency at our accident and Energency department was 1.5±1.4. The majority of respondent (79%) agreed that asthma is caused by bronchoconstriction but only 42% understood that mucosal oedema is involved during an acute attack. Many people (82%) believed that asthma is just sensitive bronchus. Less than half (40%) believes asthma is a hereditary disease. It was a common belief that asthmatic attack can be precipitated by a change of weather (89%) and cold food/drink (77%). Over 75% agreed that carpet in the house is undesirable for an asthmatic child. The majority of parents (69%) disagreed that an asthmatic child should avoid physical exercise and only 13 would not allow the child to attend physical exercise class. Over half (54%) of the respondents believed that asthma could be cured. Only a minority (17%) believed that antibiotics are useful in shortening the attack. Thirty (30%) respondents also used alternative means of therapy for example crocodile meat. Parents' knowledge of preventive medication was inadequate. Understanding common beliefs among parents is beneficial in patient and parental education.
Collapse
|
6
|
Rhee H, Belyea M, Mammen J. Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: a prospective study. Allergy Asthma Clin Immunol 2017; 13:24. [PMID: 28465694 PMCID: PMC5410071 DOI: 10.1186/s13223-017-0196-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022] Open
Abstract
Background Success in asthma management hinges on patients’ competency to detect and respond to ever-changing symptom severity. Thus, it is crucial to have reliable, simple, and sustainable methods of symptom monitoring that can be readily incorporated into daily life. Although visual analogue scale (VAS) has been considered as a simple symptom assessment method, its utility as a daily symptom monitoring tool in adolescents is unknown. This study was to determine the concurrent validity of VAS in capturing diurnal changes in symptoms and to examine the relationships between VAS and asthma control and pulmonary function. Methods Forty-two adolescents (12–17 years old) with asthma completed daily assessment of symptoms twice per day, morning and bedtime, for a week using VAS and 6-item symptom diary concurrently. Asthma control was measured at enrollment and 6 month later, and spirometry was conducted at enrollment. Pearson correlations, multilevel modeling and regression were conducted to assess the relationships between VAS and symptom diary, asthma control and FEV1. Results Morning and evening VAS was positively associated with symptom diary items of each corresponding time frame of the day (r = 0.41–0.58, p < 0.0001). Morning VAS was significantly predicted by morning diary data reflecting nocturnal wakening (β = 2.13, p = 0.033) and morning symptoms (β = 4.09, p = 0.002), accounting for 57% of the total variance of morning VAS. Similarly, changes in four evening diary items, particularly shortness of breath (β = 2.60, p = 0.028), significantly predicted changes in evening VAS, accounting for 55% of the total variance. Average VAS scores correlated with asthma control (r = 0.65, p < 0.001) and FEV1 (r = −0.38, p = 0.029), and were predictive of asthma control 6 months later (β = 0.085, p = 0.006). Conclusions VAS is a valid tool capturing diurnal changes in symptoms reflected in a multi-item symptom diary. Moreover, VAS is a valid measure predicting concurrent and future asthma control. The findings suggest VAS can be a simple alternative to daily dairies for daily symptom monitoring, which can provide invaluable information about current and future asthma control without substantially increasing self-monitoring burdens for adolescent patients. Clinical Trial Registration NCT01696357. Registered 18 September 2012
Collapse
Affiliation(s)
- Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
| | - Michael Belyea
- Arizona State University, College of Nursing and Health Innovation, 500 N. 3rd Street, Phoenix, AZ 85004 USA
| | - Jennifer Mammen
- University of Rochester, School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
| |
Collapse
|
7
|
Yin HS, Gupta RS, Mendelsohn AL, Dreyer B, van Schaick L, Brown CR, Encalada K, Sanchez DC, Warren CM, Tomopoulos S. Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study. J Asthma 2017; 54:919-929. [PMID: 28045551 DOI: 10.1080/02770903.2016.1277542] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. METHODS A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. RESULTS 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). CONCLUSIONS Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
Collapse
Affiliation(s)
- Hsiang Shonna Yin
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Ruchi S Gupta
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Alan L Mendelsohn
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Benard Dreyer
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Linda van Schaick
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christina R Brown
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Karen Encalada
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Dayana C Sanchez
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christopher M Warren
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Suzy Tomopoulos
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| |
Collapse
|
8
|
Yin HS, Gupta RS, Tomopoulos S, Mendelsohn AL, Egan M, van Schaick L, Wolf MS, Sanchez DC, Warren C, Encalada K, Dreyer BP. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Pediatrics 2016; 137:peds.2015-0468. [PMID: 26634774 DOI: 10.1542/peds.2015-0468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
Collapse
Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York;
| | - Ruchi S Gupta
- Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Maureen Egan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda van Schaick
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Michael S Wolf
- Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dayana C Sanchez
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | | | - Karen Encalada
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Benard P Dreyer
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| |
Collapse
|
9
|
Ciprandi G, Schiavetti I, Rindone E, Ricciardolo FLM. The impact of anxiety and depression on outpatients with asthma. Ann Allergy Asthma Immunol 2015; 115:408-14. [PMID: 26392047 DOI: 10.1016/j.anai.2015.08.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/03/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anxiety and depression may frequently affect patients with asthma. However, the findings of several studies are partially conflicting and conducted in selected cohorts. OBJECTIVE To investigate the effect of anxiety and depression in a group of outpatients with asthma. METHODS This cross-sectional, real-life study included 263 patients (109 males; mean age, 39.2 years) with asthma. Clinical examination, lung function, fractional exhaled nitric oxide measurement, Asthma Control Test (ACT) score, asthma control grade, perception of symptoms by visual analog scale, and Hospital Anxiety and Depression Scale (HADS) questionnaires were evaluated. RESULTS Globally, 97 patients (36.9%) had anxiety, and 29 (11%) had depression. Of these patients, 71 had combined anxiety and depression. Anxiety and depression were associated with poor asthma control (P =.007 and .02, respectively). Patients with depression had higher body mass indexes (P =.002). Anxiety and depression were associated with lower ACT scores (P < .001 for both). The scores on the anxiety and depression subscales of HADS were moderately related (r = 0.57). CONCLUSIONS The present real-life study indicates that anxiety and depression are common and relevant comorbidities in asthmatic outpatients and are associated with uncontrolled asthma and lower ACT scores. Thus, assessment of comorbid mental disorders should be performed in common practice.
Collapse
Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
| | | | - Elena Rindone
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Fabio L M Ricciardolo
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| |
Collapse
|
10
|
Abstract
OBJECTIVES Asthma control is the goal of asthma management. The perception of asthma symptoms represents a cornerstone aspect in this issue. The visual analogue scale (VAS) has been proposed as a useful tool for assessing respiratory symptoms perception. The present cross-sectional real-life study investigated whether VAS assessment of asthma symptoms perception could predict asthma control level. METHODS This cross-sectional study included a total of 370 (153 males, mean age 39.9 years) patients with asthma. Perception of asthma symptoms was assessed by VAS; clinical examination, lung function, fraction of exhaled nitric oxide (FeNO) measurement, Asthma Control Test (ACT) and Hospital Anxiety Depression Scale questionnaires were also evaluated. RESULTS Asthma was well controlled in 47% of patients. Considering most of the evaluated parameters, there were significant differences among patients with well-controlled, partly controlled and uncontrolled asthma. VAS values were significantly (p < 0.001) different considering the asthma control level. VAS score were significantly related with ACT scores (p < 0.001). A VAS <6 was able to reliably predict uncontrolled asthma (area under the curve: 0.74; odds ratio: 5.16). CONCLUSION The present real-life study demonstrates that asthma symptoms assessment by VAS might be useful for approximately predicting uncontrolled asthma in particular conditions, such as at home or at the general practitioner's office.
Collapse
Affiliation(s)
- Giorgio Ciprandi
- a 1 Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino , Viale Benedetto XV 6, 16132 Genoa, Italy
| | | | | |
Collapse
|
11
|
Park HW, Dahlin A, Tse S, Duan QL, Schuemann B, Martinez FD, Peters SP, Szefler SJ, Lima JJ, Kubo M, Tamari M, Tantisira KG. Genetic predictors associated with improvement of asthma symptoms in response to inhaled corticosteroids. J Allergy Clin Immunol 2014; 133:664-9.e5. [PMID: 24486069 DOI: 10.1016/j.jaci.2013.12.1042] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND To date, genome-wide association studies (GWASs) of inhaled corticosteroid (ICS) response in asthmatic patients have focused primarily on lung function and exacerbations. OBJECTIVE We hypothesized that GWAS analysis could identify novel genetic markers predicting a symptomatic response to ICSs. METHODS We analyzed differences in asthma symptoms in response to ICSs in 124 white children from the Childhood Asthma Management Program (CAMP) trial using scores from diary cards. Of the 440,862 single nucleotide polymorphisms (SNPs) analyzed, the top 100 ranked SNPs were pursued for replication initially in subjects from the pediatric Childhood Asthma Research and Education trials (77 white children) and then in subjects from the adult Asthma Clinical Research Network (110 white adults) and Leukotriene Modifier or Corticosteroid or Corticosteroid-Salmeterol trials (110 white adults). RESULTS The lowest P value for GWAS analysis in the CAMP trial was 8.94 × 10(-8) (rs2388639). Of the 60 SNPs available in the Childhood Asthma Research and Education Network trials, rs1558726 (combined P = 1.02 × 10(-5)), rs2388639 (combined P = 8.56 × 10(-9)), and rs10044254 (combined P = 9.16 × 10(-8)) independently replicated. However, these 3 SNPs were not additionally replicated in the adult asthmatic patients of the remaining trials. rs10044254 lies in the intronic region of F-box and leucine-rich repeat protein 7 (FBXL7) and is associated with decreased expression in immortalized B cells derived from CAMP participants. CONCLUSIONS We have identified a novel SNP, rs10044254, associated with both decreased expression of FBXL7 and improved symptomatic response to ICSs in 2 independent pediatric cohorts. Our results suggest that there might be a specific genetic mechanism regulating symptomatic response to ICSs in children that does not carry over to adults.
Collapse
Affiliation(s)
- Heung-Woo Park
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Amber Dahlin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Szeman Tse
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Qing Ling Duan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Brooke Schuemann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Fernando D Martinez
- Arizona Respiratory Center, University of Arizona, College of Medicine, Tucson, Ariz
| | - Stephen P Peters
- Center for Genomics and Personalized Medicine Research and the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stanley J Szefler
- Department of Pediatric and Pharmacology, National Jewish Health and University of Colorado, Denver School of Medicine, Denver, Colo
| | - John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Clinic, Jacksonville, Fla
| | - Michiaki Kubo
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | - Mayumi Tamari
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
| |
Collapse
|
12
|
Ciprandi G, Tosca MA, Silvestri M. Measuring the perception of symptom, drug use and allergen immunotherapy efficacy using the Visual Analogue Scale. Expert Rev Clin Immunol 2013; 10:179-82. [PMID: 24345288 DOI: 10.1586/1744666x.2014.872034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The availability of a simple and reliable tool for quantitatively measuring symptom perception is surely very important in the daily practice. Especially, this concept appears to be fundamental in doctor's office and at home, where there are no adequate resources. The Visual Analogue Scale is a very simple and popular tool that could be used by anyone anywhere. The advantage given by the Visual Analogue Scale consists in the translation of a subjective sensation in an objective measure provided by numbers.
Collapse
Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy
| | | | | |
Collapse
|
13
|
Tosca MA, Silvestri M, Rossi GA, Ciprandi G. Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma. Allergol Immunopathol (Madr) 2013; 41:359-63. [PMID: 23141750 DOI: 10.1016/j.aller.2012.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/17/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Visual Analogue Scale (VAS) has been proposed as a useful tool for assessing the perception of asthma symptoms, a cornerstone in disease management. While airway flow limitation and its reversibility are thought to be a useful marker of disease severity, there are very few studies that evaluated the response to bronchodilation (BD) testing perception by VAS. To investigate whether VAS assessment of breathlessness perception could provide a useful tool to assess the response to BD testing in asthmatic children. METHODS This cross-sectional study included a total of 150 children (96 males, mean age 11.05 years) with asthma, 50 had bronchial obstruction (i.e. FEV1 <80% of predicted). Perception of breathlessness was assessed by VAS; lung function was measured by spirometry. BD testing was performed in all children. RESULTS In children with bronchial obstruction, VAS at baseline was 4.7 and significantly increased to 6.9 (p<0.001) after BD. In children without bronchial obstruction, VAS at baseline was 7.4, but further significantly increased to 8.4 after BD testing (p<0.01). There was a significant difference in Δ VAS between children with bronchial reversibility and children without it (p<0.0001). CONCLUSIONS The present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma, mainly with overt bronchial obstruction.
Collapse
Affiliation(s)
- Maria Angela Tosca
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | |
Collapse
|
14
|
Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: a real-life study. Pediatr Allergy Immunol 2012; 23:537-42. [PMID: 22625869 DOI: 10.1111/j.1399-3038.2012.01316.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In children with asthma, discrepancies between objective indicators of airway obstruction and symptom perception are often observed. Although visual analogue scale (VAS) has been proposed as a useful tool for assessing accurate symptom perception, previous studies conducted in children with asthma included only small cohorts. A study was therefore designed to investigate the usefulness of VAS in establishing a reliable relationship between breathlessness perception and lung function in a large cohort of children with clinical diagnosis of asthma. METHODS A total of 703 children [470 boys and 233 girls, median age 10.29 (8.33-12.58) yr] with asthma were included in this cross-sectional, real-life study. Perception of breathlessness was assessed by using VAS, and lung volumes and expiratory flows were measured by spirometry. RESULTS Most children had intermittent or mild persistent asthma (93.3%), and only 46 children had a significant bronchial obstruction defined by FEV(1) values <80% of predicted. Globally, VAS was significantly, even though weakly, related to lung function. Analyzing children with bronchial obstruction, a moderate relationship between both FEV(1) (r = 0.47) and FEF(25-75) (r = 0.42) and VAS was detected. A VAS value of 6 was found to be a reliable cutoff for discriminating children with bronchial obstruction (AUC 0.83 at ROC curve; OR 9.4). CONCLUSION The present study demonstrates that VAS might be considered a useful tool to assess symptom perception, mainly in children with airflow limitation.
Collapse
Affiliation(s)
- Maria A Tosca
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | | | | | |
Collapse
|
15
|
Rhee H, Belyea MJ, Halterman JS. Adolescents' perception of asthma symptoms and health care utilization. J Pediatr Health Care 2011; 25:105-13. [PMID: 21320682 PMCID: PMC3060703 DOI: 10.1016/j.pedhc.2009.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 09/28/2009] [Accepted: 10/05/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services. METHODS This exploratory study included 126 adolescents with asthma who were between 13 and 20 years of age. Subjects were classified as having inaccurate symptom perception (IG); well-controlled accurate symptom perception (WCA); and poorly controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization, including emergency department (ED) visits, hospitalization, and office visits and school absenteeism in the past 3 months. RESULTS More adolescents in the IG group had at least one hospitalization compared with adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6%, respectively). A similar trend was seen for ED visits. Compared with the WCA group, adolescents in the IG group were nearly nine times more likely to have been hospitalized, 3.4 times more likely to have visited an ED, and four times more likely to have missed school days. DISCUSSION Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school compared with those who have accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to ensure appropriate care.
Collapse
Affiliation(s)
- Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642, USA.
| | | | | |
Collapse
|
16
|
Hafkamp-de Groen E, Mohangoo AD, de Jongste JC, van der Wouden JC, Moll HA, Jaddoe VW, Hofman A, de Koning HJ, Raat H. Early detection and counselling intervention of asthma symptoms in preschool children: study design of a cluster randomised controlled trial. BMC Public Health 2010; 10:555. [PMID: 20843313 PMCID: PMC2944378 DOI: 10.1186/1471-2458-10-555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 09/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of childhood asthma is an important public health objective. This study evaluates the effectiveness of early detection of preschool children with asthma symptoms, followed by a counselling intervention at preventive child health centres. Early detection and counselling is expected to reduce the prevalence of asthma symptoms and improve health-related quality of life at age 6 years. METHODS/DESIGN This cluster randomised controlled trial was embedded within the Rotterdam population-based prospective cohort study Generation R in which 7893 children (born between April 2002 and January 2006) participated in the postnatal phase. Sixteen child health centres are involved, randomised into 8 intervention and 8 control centres. Since June 2005, an early detection tool has been applied at age 14, 24, 36 and 45 months at the intervention centres. Children who met the intervention criteria received counselling intervention (personal advice to parents to prevent smoke exposure of the child, and/or referral to the general practitioner or asthma nurse). The primary outcome was asthma diagnosis at age 6 years. Secondary outcomes included frequency and severity of asthma symptoms, health-related quality of life, fractional exhaled nitric oxide and airway resistance at age 6 years. Analysis was according to the intention-to-treat principle. Data collection will be completed end 2011. DISCUSSION This study among preschool children provides insight into the effectiveness of early detection of asthma symptoms followed by a counselling intervention at preventive child health centres. TRIAL REGISTRATION Current Controlled Trials ISRCTN15790308.
Collapse
|
17
|
Butz A, Kub J, Donithan M, James NT, Thompson RE, Bellin M, Tsoukleris M, Bollinger ME. Influence of caregiver and provider communication on symptom days and medication use for inner-city children with asthma. J Asthma 2010; 47:478-85. [PMID: 20528605 DOI: 10.3109/02770901003692793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Effective pediatric guideline-based asthma care requires the caregiver to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the child's primary care clinician. OBJECTIVE This study evaluated the longitudinal effects of a caregiver-clinician asthma communication education intervention (ACE) relative to an asthma education control group (CON) on symptom days and controller medication use in inner-city children with asthma. PARTICIPANTS AND METHODS 231 inner-city children with asthma, recruited from urban pediatric emergency departments (EDs) and community practices, were followed for 12 months. Data included number of symptom days and nights, ED visits, hospitalizations, presence of limited activity, and controller medication use over 12 months. Pharmacy records were used to calculate controller to total asthma medication ratios as a proxy of appropriate controller medication use. Multivariate logistic regression models were used to identify factors associated with number of symptom days and nights over the past 30 days at the 12-month follow-up. RESULTS Most caregivers rated the communication with their child's clinician as high. Unadjusted and adjusted rates of symptom days and nights did not differ by group at follow-up. ACE children tended towards a higher controller to total medication ratio at 12 months as compared to CON children (mean ratio: ACE: 0.54, SD 0.3; CON, 0.45, SD 0.4; p = .07). Activity limitation due to asthma and persistent asthma severity were the only factors significantly associated with reporting any symptom day within the past 30 days, adjusting for treatment group, number of oral corticosteroid courses and number of clinician visits in the last 6 months, seasonality, insurance type, and controller to total asthma medication ratio covariates. CONCLUSION A home-based caregiver asthma communication educational intervention was not associated with decreased symptom days. However, a trend was noted in higher controller to total medication ratios in the intervention group. Inner-city caregivers of children with asthma may require a health systems approach to help convey the child's asthma health information to their clinician.
Collapse
Affiliation(s)
- Arlene Butz
- School of Medicine, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Mohangoo AD, de Koning HJ, Hafkamp-de Groen E, van der Wouden JC, Jaddoe VWV, Moll HA, Hofman A, Mackenbach JP, de Jongste JC, Raat H. A comparison of parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview: The Generation R study. Pediatr Pulmonol 2010; 45:500-7. [PMID: 20425859 DOI: 10.1002/ppul.21208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The prevalence of asthma symptoms among preschool children is difficult to determine with accuracy because no gold standard is available for diagnosis. The aim of this study was to compare parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview. METHODS We studied 1,202 children participating in the Generation R study. Their parents completed a written questionnaire at home when the infant was 12 months old, including items on wheezing or shortness of breath. During the regular free-of-charge youth healthcare visit at age 14 months, the physician interviewed the parents to assess the presence of wheezing or shortness of breath. RESULTS The prevalence of wheezing or shortness of breath estimated from questionnaire was significantly higher than from physician-interview (36% vs. 20%; P < 0.001): observed agreement 73% (kappa 0.36). Only 41% of questionnaire-reported symptoms were assessed through the physician-interview, while 73% of physician-interviewed symptoms were reported in the questionnaire. Compared with infants in the subgroup with agreement on the presence of wheezing or shortness of breath, the infants in the subgroups without agreement significantly less often received anti-asthma medication and significantly less often had abnormal respiratory sounds or bronchiolitis or croup, and their mothers were significantly less often working. The proportion of infants receiving anti-asthma medication was higher in interview-data compared with questionnaire-data (22.7% vs. 3.9%; P < 0.001). CONCLUSIONS Questionnaire yielded higher prevalence rates for wheezing or shortness of breath than physician-interview. Physician-reported symptoms are associated with a higher proportion of infants receiving anti-asthma medication. Parent-reported asthma symptoms should be confirmed by pediatricians whenever possible.
Collapse
Affiliation(s)
- Ashna D Mohangoo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3000 CA, the Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Garbutt J, Highstein G, Nelson KA, Rivera-Spoljaric K, Strunk R. Detection and home management of worsening asthma symptoms. Ann Allergy Asthma Immunol 2010; 103:469-73. [PMID: 20084839 DOI: 10.1016/s1081-1206(10)60262-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma guidelines recommend early home treatment of exacerbations. However, home treatment is often suboptimal and delayed. OBJECTIVES To describe antecedent symptoms and signs of asthma exacerbations noticed by parents and to learn when and how parents intensify asthma treatment. METHODS Parents of children 2 to 12 years old with asthma exacerbations that required urgent care in the past 12 months completed telephone questionnaires. Where multiple responses were possible, percentages may sum to more than 100%. RESULTS One hundred one parents were enrolled and interviewed; 94% were the children's mothers. Seventy percent of the children were black, and 64% had Medicaid insurance. Parents reported multiple antecedent symptoms and signs (median number per child, 3; range, 1-6), including respiratory symptoms (79%), allergy or cold symptoms (43%), behavioral changes (24%), and other nonspecific symptoms (29%). Twenty-three parents reported late respiratory symptoms, such as gasping for breath and using accessory muscles to breath, as the earliest antecedent signs. Treatment was most often intensified when the parent noticed cough (55%), shortness of breath (54%), and wheeze (25%) and included adding albuterol (92%), an oral corticosteroid (17%), an inhaled corticosteroid (8%), or other nonasthma medications (16%). CONCLUSIONS Although parents described antecedent symptoms and signs of impending asthma exacerbations that they consistently noticed in their children, many waited for lower respiratory signs to be present before intensifying treatment. Oral corticosteroids were used infrequently. Interventions to improve the ability of parents and children to accurately recognize worsening symptoms and initiate timely, effective treatment are needed.
Collapse
Affiliation(s)
- Jane Garbutt
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA.
| | | | | | | | | |
Collapse
|
20
|
Abstract
PURPOSE To examine how two groups (parents and healthcare providers) perceive asthma in Southeast (SE) Asian children in the United States, and to address issues of access to asthma care. STUDY DESIGN AND METHODS Using Kleinman's Explanatory Models (EM) approach, semistructured interviews were used with 12 families and 26 providers. Families were interviewed in a clinic setting. Providers read a case example of a SE Asian child with asthma and were asked to anticipate the case family's EM of asthma. Data were analyzed using template analytic technique in which segments were clustered into etiology, causation, treatments, asthma impact, and access to asthma care. RESULTS Families predominately followed current asthma practice guidelines, whereas providers believed that SE Asian families primarily followed cultural practices. Families described the severity and impact of asthma as more intense than the providers described the same items. While families identified barriers to care as difficulty getting appointments and unavailable providers, providers viewed family barriers to be predominately culturally based. Both groups noted the need for education and frequent healthcare visits as facilitators to care. CLINICAL IMPLICATIONS This study suggests that important differences may exist between the way providers and SE Asian families perceive childhood asthma. Nurses are encouraged to ask the families in their care how they explain their children's asthma, thus facilitating more culturally competent care and increased ability to meet the family's needs. Implications for policy change relative to improving access to care to immigrant groups are also suggested.
Collapse
|
21
|
Abstract
BACKGROUND To reduce symptoms and emergency department (ED) visits, the National Asthma Education and Prevention Program (NAEPP) guidelines recommend early treatment of acute asthma symptoms with albuterol and oral corticosteroids. Yet, ED visits for asthma are frequent and often occur several days after onset of increased symptoms, particularly for children from low-income, urban neighborhoods. OBJECTIVES To describe home use of albuterol and identify factors associated with appropriate albuterol use. METHODS A total of 114 caregivers in the intervention group of a randomized trial to reduce emergent care for low-income, urban children completed a structured telephone interview with an asthma nurse to evaluate home management of their child's acute asthma symptoms. Interviews lasted approximately 20 minutes and were conducted from November 5, 2003, through September 30, 2005. Albuterol use as reported by caregivers was categorized as appropriate or inappropriate based on NAEPP recommendations. RESULTS Albuterol use for worsening asthma symptoms was categorized as appropriate for only 68% of caregivers and was more likely if the children had an ED visit or hospitalization for asthma in the prior year. The remaining 32% of caregivers used albuterol inappropriately (overtreatment or undertreatment). Appropriate albuterol use was not associated with caregiver report of having an asthma action plan (AAP) or a recent primary care physician visit to discuss asthma maintenance care. CONCLUSIONS Caregivers reported that they would use albuterol to treat their child's worsening asthma symptoms, but many described inappropriate use. Detailed evaluation of proper albuterol use at home may provide insight into how health care professionals can better educate and support parents in their management of acute exacerbations and more effective use of AAPs.
Collapse
|
22
|
Butz A, Sellers MD, Land C, Walker J, Tsoukleris M, Bollinger ME. Factors affecting primary care provider and caregiver concordance for pediatric asthma medications. J Asthma 2009; 46:308-13. [PMID: 19373641 DOI: 10.1080/02770900902718845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lack of discussion regarding actual asthma medication use by physicians with caregivers of children with asthma may result in low caregiver and physician concordance about prescribed asthma medications. OBJECTIVE The primary objective was to examine the concordance between primary care providers (PCP) and caregivers regarding child asthma medication use. METHODS Current asthma medications in the home with verification from each child's PCP were obtained for 231 underserved children with persistent asthma. Kappas and chi-square statistics were calculated to measure the strength of the concordance. Caregiver and PCP dyads were categorized as concordant or discordant based on asthma medication use. RESULTS For all asthma prescriptions N = 479, two thirds of caregiver-PCP dyads (67.8) were categorized as concordant with at least one asthma medication. Concordance for asthma medications varied by type of medication ranging from 84% agreement for albuterol and 77% agreement for Flovent. In the final regression model predicting caregiver and PCP concordance, the number of PCP visits within the past 6 months and caregiver report of no limitation of child's activity due to asthma were significantly higher in caregivers who were considered concordant with their child's PCP while controlling for child age and frequency of symptom nights and number of ED visits in prior 6 months. In a model predicting the number of PCP visits, the number of ED visits was the only significant variable associated with the number of PCP visits while controlling for caregiver and PCP concordance. CONCLUSION Caregiver and PCP concordance was significantly associated with increased number of PCP visits suggesting that increased exposure to a health care provider may increase agreement between a child's PCP and caregiver regarding prescribed asthma medications. However, there may be other important factors including increased emergency department visits that may also be associated with subsequent pediatric primary care visits for asthma.
Collapse
Affiliation(s)
- Arlene Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Hammer SC, Robroeks CMHHT, van Rij C, Heynens J, Droog R, Jöbsis Q, Hendriks HJE, Dompeling E. Actual asthma control in a paediatric outpatient clinic population: do patients perceive their actual level of control? Pediatr Allergy Immunol 2008; 19:626-33. [PMID: 18221469 DOI: 10.1111/j.1399-3038.2007.00705.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several epidemiological studies described poor asthma control in children. However, the diagnosis of childhood asthma in these studies is uncertain, and asthma control in children of an outpatient clinic population during treatment by a paediatrician is unknown. (1) to investigate the hypothesis that asthma control in a paediatric outpatient clinic population is better than epidemiological surveys suggest; (2) to find possible explanations for suboptimal asthma control. Asthmatic children aged 6-16 years, known for at least 6 months by a paediatrician at the outpatient clinic, were selected. During a normal visit, both the responsible physicians and parent/children completed a standardised questionnaire about asthma symptoms, limitation of daily activities, treatment, asthma attacks and emergency visits. Overall, excellent asthma control of 8.0% in this study was not significantly better than of 5.8% in the European AIR study (Chi-square, p = 0.24). Separate GINA goals like minimal chronic symptoms and no limitation of activities were better met in our study. Good to excellent controlled asthma was perceived by most children/parents (83%), but was less frequently indicated by the paediatrician (73%), or by objective criteria of control (45%) (chi-square, p = 0.0001). The agreement between patient-perceived and doctor assessed control was low, but improved in poorly controlled children. Patients were not able to perceive the difference between 'excellent asthma control' and 'good control' (p = 0.881).Too little children with uncontrolled disease got step-up of their asthma treatment. Although separate GINA goals like 'minimal chronic symptoms' and 'no limitation of activities' were significantly better in our study, overall, asthma control in this outpatient clinic population, treated by a paediatrician, was not significantly better than in the European AIR study. Poorly controlled disease was related to several aspects of asthma management, which are potentially accessible for improvements.
Collapse
Affiliation(s)
- Sanne C Hammer
- Department of Paediatric Pulmonology, University Hospital Maastricht, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
The Prevalence of Anxiety Disorders Among Adults with Asthma: A Meta-Analytic Review. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9087-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Abstract
Few child asthma studies address the specific content and techniques needed to enhance child communication during asthma preventive care visits. This study examined the content of child and parent communications regarding their asthma management during a medical encounter with their primary care provider (PCP). The majority of parents and children required prompting to communicate symptom information to the PCP during the clinic visit. Some high-risk families may require an asthma advocate to ensure that the clinician receives an accurate report of child's asthma severity and asthma control to ensure prescribing of optimal asthma therapy.
Collapse
Affiliation(s)
- Arlene M Butz
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland 21287, USA.
| | | | | | | | | |
Collapse
|
26
|
Burkhart PV, Rayens MK, Oakley MG, Abshire DA, Zhang M. Testing an intervention to promote children's adherence to asthma self-management. J Nurs Scholarsh 2007; 39:133-40. [PMID: 17535313 DOI: 10.1111/j.1547-5069.2007.00158.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To test the hypothesis that compared with the control group, 7 through 11-year-old children with persistent asthma who received asthma education plus a contingency management behavioral protocol would show higher adherence to peak expiratory flow (PEF) monitoring for asthma self-management and would report fewer asthma episodes. DESIGN AND METHODS A randomized, controlled trial was conducted with 77 children with persistent asthma in a southeastern U.S. state. Both the intervention and control groups received instruction on PEF monitoring. Only the intervention group received asthma education plus contingency management, based on cognitive social learning theory, including self-monitoring, a contingency contract, tailoring, cueing, and reinforcement. At-home adherence to daily PEF monitoring during the 16-week study was assessed with the AccuTrax Personal Diary Spirometer, a computerized hand-held meter. Adherence was measured as a percentage of prescribed daily PEF uses at Weeks 4 (baseline), 8 (postintervention), and 16 (maintenance). RESULTS At the end of the baseline period, the groups did not differ in adherence to daily PEF monitoring nor at Week 8. At Week 16, the intervention group's adherence for daily electronically monitored PEF was higher than that of the control group. Children in either group who were >or= 80% adherent to at least once-daily PEF monitoring during the last week of the maintenance period (weeks 8 to 16) were less likely to have an asthma episode during this period compared with those who were less adherent. CONCLUSIONS The intervention to teach children to adhere to the recommended regimen for managing their asthma at home was effective.
Collapse
Affiliation(s)
- Patricia V Burkhart
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA. pvburk2@email.@uky.edu
| | | | | | | | | |
Collapse
|
27
|
Kae Kintner E. Testing the acceptance of asthma model with children and adolescents. West J Nurs Res 2007; 29:410-31. [PMID: 17538124 DOI: 10.1177/0193945907299657] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older school-age children and early adolescents with asthma have demonstrated and verbalized difficulty in accepting their condition. Although researchers have explored adult acceptance, few have explored child or adolescent acceptance. The purpose was to explore the fit of the data to a specified latent variable acceptance of asthma model. School-age children and early adolescents (N = 118), ages 9 to 14 years enrolled in Grades 4 to 9, diagnosed with asthma and their parents completed self-report instruments. EQS was used for structural equation modeling analyses. The specified model was a good fit to the data and accounted for more than 70% in the explained variance of vigilance, 30% of participation in life activities, 25% of taking control, and 20% of asthma health behaviors. Support for the model possess implications for development of theory-based education and counseling interventions to support participation in life activities by targeting cognitive, behavioral, and psychosocial aspects of living with the asthma.
Collapse
|
28
|
Burkhart PV, Rayens MK, Revelette WR, Ohlmann A. Improved health outcomes with peak flow monitoring for children with asthma. J Asthma 2007; 44:137-42. [PMID: 17454329 DOI: 10.1080/02770900601182517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Evaluate the effects of peak flow monitoring (PFM) on health outcomes of school-age children with asthma. METHOD AND SAMPLE Seventy-seven children who previously relied on symptom monitoring were taught PFM. Adherence to PFM during the 16-week study was assessed by a computerized monitor. Health outcomes over time were based on parent report. RESULTS Decreases occurred from baseline to week 16 in the incidence of one or more asthma episodes (p = 0.0002), physician/clinic visits (p = 0.0002), emergency department visits (p = 0.03), and missed school days (p = 0.002). CONCLUSIONS PFM significantly reduced pediatric asthma morbidity in this sample.
Collapse
Affiliation(s)
- Patricia V Burkhart
- College of Nursing at the University of Kentucky in Lexington, KY 40536-0232, USA. pvburk2@email.@uky.edu
| | | | | | | |
Collapse
|
29
|
Rhee H, Wenzel J, Steeves RH. Adolescents' psychosocial experiences living with asthma: a focus group study. J Pediatr Health Care 2007; 21:99-107. [PMID: 17321909 DOI: 10.1016/j.pedhc.2006.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Revised: 04/03/2006] [Accepted: 04/04/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Asthma is influenced by and influences psychosocial experiences in adolescents. Therefore, the purpose of this study was to explore psychosocial experiences and coping strategies of a sample of adolescents with asthma based on their own accounts. METHODS Six focus group interviews were conducted in Central Virginia with 19 adolescents with asthma ages 12 to 18 years. RESULTS Three general descriptions of experiences with asthma were found in the data: "Doing less with more effort," "Missing out," and "Not all bad." Adolescents' negative emotions were compounded by perceptions of others' responses. Three coping strategies, "Toughening," "Guardedness," and "Modifying" also were identified. DISCUSSION Findings enhance understanding of particular patterns of psychosocial experiences in adolescents and lay a foundation for developmentally appropriate asthma interventions.
Collapse
Affiliation(s)
- Hyekyun Rhee
- Department of Family, Community and Mental Health Systems, University of Virginia, School of Nursing, McLeod Hall, PO Box 800782, Charlottesville, VA 22908-0782, USA.
| | | | | |
Collapse
|
30
|
Abstract
PURPOSE To explore asthma symptom perception and the relationship between asthma symptom perception and adherence to asthma treatment. DESIGN Adult patients (N=120) of asthma/allergy specialty clinics, taking Advair as a controller medication, were enrolled in this cross-sectional descriptive study. METHODS Ninety-seven participants completed 4 weeks of daily diaries to assess subjective symptom perception and measured peak expiratory flow rates (PEFR), both done twice daily. Individual perceptual accuracy scores (PAS) were determined by correlating the subjective symptom perception scores with the PEFRs. Measures included demographic variables, illness identity (personal control and treatment control, consequences, and timeline-cyclical subscales of the IPQ-R), asthma severity (FEV1 percentage) and a single-item indicator of perceived asthma severity. Adherence was measured by the Medication Adherence Report Scale (MARS) and by an Advair dose count (percentage of doses taken as prescribed). FINDINGS Independent t tests comparing adherence rates of good versus poor perceivers were not significant, using either the percentage Advair dose count or the MARS. Multiple regression analyses showed that years with asthma, illness identity, and peak flow variability were all significant explanatory variables for perceptual accuracy. CONCLUSION Peak flow variability adds complexity to the relationship between perceptual accuracy and adherence that warrants further investigation.
Collapse
Affiliation(s)
- Ruth Ohm
- Baker University School of Nursing, Stormont-Vail HealthCare, Topeka, KS, USA.
| | | |
Collapse
|
31
|
Mittal V, Khanna P, Panjabi C, Shah A. Subjective symptom perceptual accuracy in asthmatic children and their parents in India. Ann Allergy Asthma Immunol 2006; 97:484-9. [PMID: 17069103 DOI: 10.1016/s1081-1206(10)60939-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inaccurate symptom perception is a key factor in increased morbidity and mortality in asthmatic patients. Information is sparse on whether children and their parents can accurately perceive severity of symptoms. OBJECTIVE To determine symptom perceptual accuracy in children with asthma and either of their parents. METHODS Fifty-two asthmatic children and either of their parents recorded independently, for 2 weeks, subjective evaluation of the child's symptoms on a 100-mm visual analog scale (VAS). Peak expiratory flow (PEF) was used as an objective measurement. Both VAS and PEF data were graded into green, yellow, and red zones. The 2 sets of VAS zones (children and parents) were separately matched with PEF zones to determine perceptual accuracy. RESULTS Children and parents were accurate more than half of the time (60% and 62%, respectively), but accuracy decreased when the "child was unstable" (PEF <80% of personal best), with underestimation being significant (P < .001). Among the readings obtained, underestimation of severity of symptoms was significant in children with severe asthma (125 [45%] of 278 readings), those affected by environmental tobacco smoke (130 [24%] of 532), and those in the younger age group (127 [45%] of 280). Underestimation was significantly greater when PEF readings were in the yellow zone (P < .001). CONCLUSIONS Symptom perception by children was as reliable as that by their parents. However, parents and children tended to underestimate severity when the child was unstable. An early decline in PEF readings was missed by children and their parents, which could contribute to increased morbidity and mortality in this vulnerable age group.
Collapse
Affiliation(s)
- Vikas Mittal
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | | | | |
Collapse
|
32
|
Halterman JS, Yoos HL, Kitzman H, Anson E, Sidora-Arcoleo K, McMullen A. Symptom reporting in childhood asthma: a comparison of assessment methods. Arch Dis Child 2006; 91:766-70. [PMID: 16705016 PMCID: PMC2082923 DOI: 10.1136/adc.2006.096123] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND One barrier to receiving adequate asthma care is inaccurate estimations of symptom severity. AIMS To interview parents of children with asthma in order to: (1) describe the range of reported illness severity using three unstructured methods of assessment; (2) determine which assessment method is least likely to result in a "critical error" that could adversely influence the child's care; and (3) determine whether the likelihood of making a "critical error" varies by sociodemographic characteristics. METHODS A total of 228 parents of children with asthma participated. Clinical status was evaluated using structured questions reflecting National Asthma Education and Prevention Panel (NAEPP) criteria. Unstructured assessments of severity were determined using a visual analogue scale (VAS), a categorical assessment of severity, and a Likert scale assessment of asthma control. A "critical error" was defined as a parent report of symptoms in the lower 50th centile for each method of assessment for children with moderate-severe persistent symptoms by NAEPP criteria. RESULTS Children with higher severity according to NAEPP criteria were rated on each unstructured assessment as more symptomatic compared to those with less severe symptoms. However, among the children with moderate-severe persistent symptoms, many parents made a critical error and rated children in the lower 50th centile using the VAS (41%), the categorical assessment (45%), and the control assessment (67%). The likelihood of parents making a critical error did not vary by sociodemographic characteristics. CONCLUSIONS All of the unstructured assessment methods tested yielded underestimations of severity that could adversely influence treatment decisions. Specific symptom questions are needed for accurate severity assessments.
Collapse
Affiliation(s)
- J S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Children's Hospital at Strong, and School of Nursing, University of Rochester, NY, USA. jill_
| | | | | | | | | | | |
Collapse
|
33
|
Butz AM, Tsoukleris MG, Donithan M, Hsu VD, Zuckerman I, Mudd KE, Thompson RE, Rand C, Bollinger ME. Effectiveness of nebulizer use-targeted asthma education on underserved children with asthma. ACTA ACUST UNITED AC 2006; 160:622-8. [PMID: 16754825 PMCID: PMC2269706 DOI: 10.1001/archpedi.160.6.622] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the effectiveness of a home-based asthma education intervention in increasing appropriate nebulizer use and reducing symptom frequency, emergency department (ED) visits, and hospitalizations over 12 months. DESIGN A randomized clinical trial. Settings Pediatric primary care, pulmonary/allergy, and ED practices associated with the University of Maryland Medical System and The Johns Hopkins Hospital, Baltimore. PARTICIPANTS Children with persistent asthma, aged 2 to 9 years, with regular nebulizer use and an ED visit or hospitalization within the past 12 months. Children were randomized into the intervention (n = 110) or control (n = 111) group. Follow-up data were available for 95 intervention and 86 control children. INTERVENTION Home-based asthma education, including symptom recognition, home treatment of acute symptoms, appropriate asthma medication, and nebulizer practice. MAIN OUTCOME MEASURES Estimates of mean differences in asthma symptom frequency, number of ED visits and hospitalizations and appropriate quick relief, controller medication, and nebulizer practice over 12 months. RESULTS Of the 221 children, 181 (81.9%) completed the study. There were no significant differences in home nebulizer practice, asthma morbidity, ED visits, or hospitalizations between groups (P range, .11-.79). Although most children received appropriate nonurgent asthma care (mean, 2 visits per 6 months), more than one third of all children received at least 6 quick-relief medication prescriptions during 12 months, with no difference by group. CONCLUSIONS A nebulizer education intervention had no effect on asthma severity or health care use. Of concern is the high quick-relief and low controller medication use in young children with asthma seen nearly every 3 months for nonurgent care.
Collapse
Affiliation(s)
- Arlene M Butz
- Division of General Pediatrics, Department of Pulmonary and Critical Care, The Johns Hopkins University Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Butz AM, Syron L, Johnson B, Spaulding J, Walker M, Bollinger ME. Home-based asthma self-management education for inner city children. Public Health Nurs 2005; 22:189-99. [PMID: 15982192 DOI: 10.1111/j.0737-1209.2005.220302.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment. The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma. Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and randomized into either a standard asthma education (SAE) or a symptom/nebulizer education intervention (SNEI). Data included home visit records and parent's self-report on questionnaires. Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration dates and the frequency of cleaning nebulizer device and equipment. However, significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group (p = 0.05). Of concern is that only 38% of all parents reported having an asthma action plan in the home. A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma. Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices.
Collapse
Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
Current evidence suggests that patients with mild asthma are often under-recognised, and those that are diagnosed can remain with this initial classification and be treated accordingly, despite worsening of their condition. There is considerable overlap between mild and more severe asthma in terms of the underlying pathophysiology and poorly reversible airway changes, such as subepithelial fibrosis and airway wall remodelling, which are present very early in the progression of asthma in patients with normal lung function. Life-threatening exacerbations can also occur in patients with mild asthma. In view of these factors and given that asthma is a two-component disease (airway inflammation and smooth muscle dysfunction), recent studies have examined the effects of both early intervention with steroids and combination therapy comprising an inhaled steroid and a long acting beta(2)-agonist. These studies suggest that early intervention is likely to provide better asthma control and possibly prevent or delay the worsening of disease and fatalities in patients considered to be mild asthmatics.
Collapse
Affiliation(s)
- L M Fabbri
- University of Modena and Reggio Emilia, Modena, Italy.
| | | |
Collapse
|
36
|
Lane MM. Advancing the science of perceptual accuracy in pediatric asthma and diabetes. J Pediatr Psychol 2005; 31:233-45. [PMID: 15829612 DOI: 10.1093/jpepsy/jsj008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To review research on perceptual accuracy in pediatric asthma and diabetes and to provide recommendations for future research efforts and clinical applications of the construct in these populations. METHODS A literature search was conducted using Medline and PsychInfo databases as well as the bibliographies of relevant articles. RESULTS Children and adolescents with asthma or diabetes evidence considerable variability in perceptual accuracy and frequently make clinically relevant errors that have the potential to affect self-management behavior. CONCLUSIONS Recommendations for future research include studying distinct types of perceptual errors, empirically supporting the relationship between perceptual accuracy and relevant outcomes, identifying factors related to perceptual inaccuracy, and conducting longitudinal research and intervention studies. Recommendations for applying the construct in clinical practice include adopting an individualized approach to symptoms to guide patient education and management, identifying patients prone to making clinically relevant errors, and developing and implementing interventions to improve accuracy.
Collapse
|
37
|
Butz AM, Huss K, Mudd K, Donithan M, Rand C, Bollinger ME. Asthma management practices at home in young inner-city children. J Asthma 2004; 41:433-44. [PMID: 15281329 DOI: 10.1081/jas-120033985] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Information on parental asthma management practices for young children is sparse. The objective of this article is to determine if specific caregiver asthma management practices for children were associated with children's asthma morbidity. Caregivers of 100 inner-city children diagnosed with persistent asthma and participating in an ongoing asthma intervention study were enrolled and interviewed to ascertain measures of asthma morbidity, medication use, health care use (acute and primary care), and asthma management practices. Overall, asthma morbidity was high with almost two thirds of caregivers reporting their child having one or more emergency department visits within the last 6 months and 63% receiving specialty care for their asthma. Appropriate medication use was reported predominantly as albuterol and inhaled steroids (78%). However, only 42% of caregivers reported administering asthma medicines when their child starts to cough and less than half (39%) reported having an asthma action plan. There were no significant differences by asthma severity level for any asthma management practice. In conclusion, caregivers lack knowledge regarding cough as an early asthma symptom. Caregivers should be encouraged to review asthma action plans with health care providers at each medical encounter.
Collapse
Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Boyle JS, Baker RR, Kemp VH. School-based asthma: a study in an African American elementary school. J Transcult Nurs 2004; 15:195-206. [PMID: 15189641 DOI: 10.1177/1043659604265112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ISSUES AND PURPOSE Chronic illnesses, such as asthma experienced by children, are difficult for families and school professionals to manage. This study explored beliefs about asthma and asthma management among schoolchildren, parents, and teachers in an African American school. DESIGN AND METHODS Focus groups were conducted with schoolchildren, parents, and teachers. Data were analyzed by content analysis; segments of information were categorized into groups that were later abstracted into themes illustrating beliefs and behaviors about asthma. RESULTS The children reported fear of not being able to breathe and the limitations of living with asthma. The teachers were concerned that they did not have a sufficient understanding of asthma to manage children's asthma during the school day. Parents described complex lifestyles and the challenges of asthma management.
Collapse
|
39
|
Burkhart PV, Ward HJ. Children's self-reports of characteristics of their asthma episodes. J Asthma 2004; 40:909-16. [PMID: 14736091 DOI: 10.1081/jas-120023583] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our purpose was to examine school-age children's self-reports of characteristics of their asthma episodes including the precipitating events, symptoms experienced during the episodes, and interventions used to resolve the episodes. Children's self-reports of their asthma episodes were assessed over a 6-week period for 42 children with persistent asthma who participated in a randomized, controlled clinical trial to evaluate the efficacy of an asthma self-management program on adherence to recommended daily peak expiratory flow rate monitoring. Children were instructed to answer the following questions on the Asthma Report Form each time they experienced an asthma episode: 1) What were you doing; 2) How did you feel; and 3) What did you do to help your breathing? Of the children, 71% experienced at least one asthma episode during the 6 weeks. There were a total of 206 episodes. Physical activity (51%) was the most cited trigger, cough alone or combined with other symptoms (84%) was the predominant symptom, and rescue asthma medication (59%) was identified most often as the intervention used by the children to resolve the asthma episode. Children's self-reports provided valuable information about their asthma episodes. The finding that most of the children experienced at least one asthma episode during the 6-week period underscores the importance of family education on how to handle asthma episodes effectively at home. Because physical activity was cited most often as a trigger for asthma episodes, families should receive education on preventive steps for averting an asthma episode prior to the child engaging in physical activity.
Collapse
Affiliation(s)
- Patricia V Burkhart
- College of Nursing, University of Kentucky, Lexington, Kentucky 40536-0232, USA.
| | | |
Collapse
|
40
|
Meng A, McConnell S. Symptom perception and respiratory sensation: clinical applications. Nurs Clin North Am 2004; 38:737-48. [PMID: 14763374 DOI: 10.1016/s0029-6465(03)00096-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article has described symptom perception and its relation to asthma management. Underestimation of airway obstruction in persons with asthma is a common and serious problem that is linked to fatalities in persons with asthma. Strategies to identify and manage the poor perceiver have been suggested.
Collapse
Affiliation(s)
- Anne Meng
- School of Nursing, University of Texas Medical Branch, 310 University Boulevard, Galveston, TX 77555-1029, USA.
| | | |
Collapse
|
41
|
Annett RD, Bender BG, DuHamel TR, Lapidus J. Factors influencing parent reports on quality of life for children with asthma. J Asthma 2003; 40:577-87. [PMID: 14529108 DOI: 10.1081/jas-120019030] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Children and parents often differ in their perceptions of a complex disease such as asthma. This ancillary study of children with mild to moderate asthma that was conducted at four of the eight clinics in the Childhood Asthma Management Program had two aims: (1) to relate quality of life to asthma symptoms, sociodemographic characteristics, child psychosocial adjustment and family social support and (2) to relate agreement between child- and parent-reported quality of life to child age. For this study participants completed the Caregiver's Pediatric Asthma Quality of Life Questionnaire (C-PAQLQ), Pediatric Asthma Quality of Life Questionnaire, and a battery of psychosocial health outcomes questionnaires at the 12-month follow-up. The average asthma symptom score from diary cards for the 2 weeks before the visit was also collected. Parent-reported family burden was the strongest correlate of C-PAQLQ scores. Although the average asthma symptom score was not associated with parent-reported quality of life, the study had low power to detect a relationship because of the few episodes of asthma reported during the assessment period. The correlation between child and parent reported quality of life improved with increasing age of the child, suggesting increased child-parent agreement about quality of life outcomes was associated with increasing age of the child. Family characteristics, such as degree of cohesion among family members, are not associated with quality of life ratings.
Collapse
Affiliation(s)
- Robert D Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-5311, USA.
| | | | | | | |
Collapse
|
42
|
Abstract
The purpose of this study was to describe patient education from the perspective of adolescents. Data were collected by interviewing adolescents who had asthma, epilepsy, juvenile rheumatoid arthritis, and insulin-dependent diabetes mellitus. The sample consisted of 40 Finnish adolescents aged between 13 and 17 years. The interview data were analysed with methods of content analysis. From the perspective of adolescents with a chronic disease, patient education can be divided into the following categories: routine programmes, problematic planning issues, atmosphere of patient education session and written patient education material. Some features of ideal patient education also emerged. In a routine programme, patient education was based on the professional knowledge of the physicians and nurses rather than the needs of the adolescents. It was provided at a time that was good for the nurses or physicians. The level of education was not compatible with each developmental level of the adolescent. Problematic planning issues included a poorly outlined plan of education and a lack of systematic and continuous education. Educational communication consisted of dialogue between the adolescent and the educator. An encouraging atmosphere developed when the educators motivated the adolescents, respected them and their opinions and encouraged them to express their feelings, to ask questions and to relate experiences. Also, it was important that the adolescents' opinions were respected. In ideal patient education, the sessions had been planned well beforehand based on the adolescents' needs and written patient education material. Ideal patient education helped adolescents to acquire skills to take care of themselves and provided information on how to adjust to different situations and problems. The results provided useful insight into patient education and served to raise awareness of the problems and difficulties experienced by adolescents with a chronic disease.
Collapse
Affiliation(s)
- Helvi Kyngäs
- Department of Nursing and Health Administration, University Hospital, University of Oulu, Oulu, Finland.
| |
Collapse
|
43
|
Abstract
BACKGROUND Exercise induced asthma (EIA) plays an important role in clinical evaluation. There has been little previous work validating EIA as reported directly by children and indirectly by their parents. AIMS (1) To determine the strength of the association between children's symptoms of EIA and their physiological response to exercise in a laboratory setting. (2) To compare parents' perception of EIA with that of their children. (3) To seek factors influencing the perception of EIA. METHODS Forty three asthmatic children and their parents answered a questionnaire, which included measures of symptom perception in EIA using visual analogue (VAS) and Likert scales. The children underwent a standardised treadmill exercise challenge, using spirometry to measure the physiological outcome, after which they and their parents independently completed the symptom scores. Twenty four subjects agreed to return for a second visit, in order to assess repeatability. RESULTS The VAS and Likert scales were highly correlated. Children's symptom perception as measured by change in VAS scores related weakly to change in FEV(1) after exercise, and was unaffected by confounding factors such as age, gender, medication, and habitual exercise. Parents' perception of symptoms was unrelated to any physiological measure. There was no significant relation between parent and child VAS scores after exercise, and there was poor agreement between the Likert scale scores after exercise. The repeatability of the perception of change in FEV(1) after exercise was poor for both parents and children. CONCLUSION Physicians should obtain reports of EIA from children rather than parents, but be aware of their limited accuracy and repeatability.
Collapse
Affiliation(s)
- S Panditi
- Department of Child Health & Institute for Lung Health, University of Leicester, UK
| | | |
Collapse
|
44
|
Yoos HL, Kitzman H, McMullen A. Barriers to anti-inflammatory medication use in childhood asthma. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2003; 3:181-90. [PMID: 12882595 DOI: 10.1367/1539-4409(2003)003<0181:btamui>2.0.co;2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify parental barriers to anti-inflammatory medication use and to develop an instrument for use in research and health care settings to identify at-risk populations. METHODS Instrument development consisted of 4 phases: 1) gaining the professional perspective (N = 8 experts in asthma management), 2) gaining the perspective of parents of children with asthma (qualitative interviews with 21 parents), 3) instrument pretesting and refinement (N = 133 parents), and 4) determining the instrument's psychometric properties. Study participants were diverse in race, socioeconomic status, and the child's illness severity. The final instrument consisted of 51 questions in 5 domains (nature of disease, cause, ideas about medications, treatment expectations, and health care provider relationship). RESULTS The final instrument exhibited strong reliability (Cronbach alpha =.87) and validity. Significant barriers to appropriate anti-inflammatory medication use were parents' diminished treatment expectations and fears about anti-inflammatory medications. Minority families were more likely than white families to view asthma as unpredictable and uncontrollable (P =.01) and to have negative attitudes toward anti-inflammatory medications (P =.004). Eight questions were significantly correlated with a suboptimal medication regimen and may serve as a "quick screen" for potential nonadherence in clinical settings. CONCLUSIONS Diminished treatment expectations and negative attitudes toward anti-inflammatories may be powerful predictors of nonadherence to medications.
Collapse
Affiliation(s)
- H Lorrie Yoos
- University of Rochester Medical Center, Department of Pediatrics, and the University of Rochester School of Nursing, Rochester, NY 14642, USA.
| | | | | |
Collapse
|
45
|
Yoos HL, Kitzman H, McMullen A, Sidora K. Symptom perception in childhood asthma: how accurate are children and their parents? J Asthma 2003; 40:27-39. [PMID: 12699209 DOI: 10.1081/jas-120017204] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Accurate symptom perception on the part of the patient is a critical component of asthma management. Limited data are available about how accurate children and their parents are in evaluating asthma symptoms. This study was designed to determine the symptom perceptual accuracy of families and to identify risk factors associated with inaccurate symptom perception. One hundred children (6-19 years) and their parents evaluated symptoms using subjective (visual analog scales) as well as objective (peak expiratory flow rates) measures of symptom severity. Accuracy was evaluated by comparing the match in zones (based on NHLBI clinical practice guidelines) indicated on the subjective measure with the objective measure. Children and parents were inaccurate about one-third of the time overall. Poor and minority families initially appeared to be less accurate; however, when we adjusted for the child's illness severity, these sociodemographic features were no longer significant risk factors. Children were as accurate as parents. When we evaluated symptom accuracy at "sick times" (when the child's peak flow reading was <80% personal best) accuracy decreased markedly to only about one-third of the episodes being correctly evaluated.
Collapse
Affiliation(s)
- H Lorrie Yoos
- School of Nursing, University of Rochester Medical Center, Rochester, New York 14642, USA.
| | | | | | | |
Collapse
|
46
|
Abstract
PURPOSE To learn how children with asthma and their parents make treatment-related decisions. DATA SOURCES Verbatim transcripts of focus group interviews of 28 school age children with asthma and their parents. Children had attended an educationally based asthma camp program. Questions related to choices parents and children made regarding implementation of their asthma treatment plans both, at home and at school. CONCLUSIONS Parents and children made many non-adherence decisions especially with respect to preventive aspects of the treatment plan. Symptoms were the driving force for children's decisions. Parents and children had concerns about implementing the management plan at school. Parents and children may not perceive asthma treatment options as true choices, thus affecting motivation for adherence. IMPLICATIONS Practitioners need to form partnerships with parents and children in developing treatment goals. Goals should focus on achievement of normal daily activities. Asthma education needs to be concrete and include school personnel. Practitioners need to give families positive, informational feedback.
Collapse
Affiliation(s)
- Anne Meng
- School of Nursing University of Texas Medical Branch, Galveston, TX, USA.
| | | |
Collapse
|
47
|
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in the United States. Since the first Surgeon General's Report in 1964 on the health risks of tobacco use, overwhelming evidence regarding increased tobacco-attributable morbidity and mortality has been reported. The purpose of this review was to explore nursing research contributions to this public health issue by evaluating the emergence of publications focused on tobacco in a leading nursing research journal. OBJECTIVES The specific aims of this review were to determine, among data-based articles published in Nursing Research (1952-2000), how often tobacco use was included (a) in sample descriptions, (b) as a variable potentially associated with study outcomes, and (c) as a finding. Additionally, the frequency of publication of research instruments developed to study tobacco use was evaluated. METHODS Data-based articles (n = 1,705) and research briefs (n = 197) were evaluated. Inter-rater reliability (100%) was established by the re-review of 20% of the issues in each decade. RESULTS A total of 40 data-based articles (2% of those reviewed) either included tobacco use in the sample description only (n = 11), as an independent or mediating variable (n = 11), or as a finding (n = 18). The majority (53%) of the articles were published since 1990; and 71% of the outcome studies were published within the past 5 years. One study focused on tobacco use among youth, and 1 of 197 instrument articles reviewed focused on tobacco. None of the studies reviewed addressed prevention of tobacco use or strategies to decrease exposure to second-hand smoke. CONCLUSIONS This review demonstrates that the cessation of tobacco use is emerging as a topic for nursing research, reflecting the increased public health attention on this topic. Increased research efforts are needed in the areas of tobacco cessation and prevention of tobacco use. Researchers should be encouraged to consider tobacco use as a variable potentially affecting outcomes in other research studies.
Collapse
Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles 90095-6918, USA.
| | | |
Collapse
|
48
|
Abstract
There have been few studies of childhood asthma among families who live in nonmetropolitan settings. This work is part of the baseline assessment conducted before implementing a health education program to study the impact of asthma risk factors (gender, ethnicity, socioeconomic status, asthma severity) on home asthma management. Data analysis yielded no significant differences in home asthma management performed by parents or children with asthma based on the child's gender, ethnicity, asthma severity, or family socioeconomic status. Factors that define the child's experienced asthma pattern, such as activity limitations, number of allergens, and school absenteeism, were associated with the parent's work of asthma management. Trends in the data for the different ethnic and gender subgroups that have implications for clinical practice were identified. Future directions for research to address questions that emerged in this analysis are discussed.
Collapse
Affiliation(s)
- Sharon D Horner
- University of Texas at Austin, School of Nursing, 78701-1499, USA.
| | | | | |
Collapse
|
49
|
Cabral ALB, Conceição GM, Saldiva PHN, Martins MA. Effect of asthma severity on symptom perception in childhood asthma. Braz J Med Biol Res 2002; 35:319-27. [PMID: 11887209 DOI: 10.1590/s0100-879x2002000300006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Individual ability to perceive airway obstruction varies substantially. The factors influencing the perception of asthma are probably numerous and not well established in children. The present study was designed to examine the influence of asthma severity, use of preventive medication, age and gender on the association between respiratory symptoms (RS) and peak expiratory flow (PEF) rates in asthmatic children. We followed 92 asthmatic children, aged 6 to 16 years, for five months. Symptom scores were recorded daily and PEF was measured twice a day. The correlations among variables at the within-person level over time were analyzed for each child and for the pooled data by multivariate analysis. After pooling the data, there was a significant (P<0.05) correlation between each symptom and PEF; 60% of the children were accurate perceivers (defined by a statistically significant correlation between symptoms and PEF across time) for diurnal symptoms and 37% for nocturnal symptoms. The accuracy of perception was independent of asthma severity, age, gender or the use of preventive medication. Symptom perception is inaccurate in a substantial number of asthmatic children, independently of clinical severity, age, gender or use of preventive medication. It is not clear why some asthmatic patients are capable of accurately perceiving the severity of airway obstruction while others are not.
Collapse
Affiliation(s)
- A L B Cabral
- Divisão de Pediatria, Hospital Darcy Vargas, São Paulo, SP, Brasil
| | | | | | | |
Collapse
|
50
|
Flaskerud JH, Lesser J, Dixon E, Anderson N, Conde F, Kim S, Koniak-Griffin D, Strehlow A, Tullmann D, Verzemnieks I. Health disparities among vulnerable populations: evolution of knowledge over five decades in Nursing Research publications. Nurs Res 2002; 51:74-85. [PMID: 11984377 DOI: 10.1097/00006199-200203000-00003] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considerable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge. PURPOSE The purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made. METHODS Criteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year's bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles. RESULTS Seventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time. CONCLUSIONS Nursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.
Collapse
|