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Volerman A, Balachandran U, Zhu M, Akel M, Hull A, Siros M, Luna V, Xu I, Press VG. Evaluating inhaler education interventions for hospitalized children with asthma: A randomized controlled trial. Ann Allergy Asthma Immunol 2023; 131:217-223.e1. [PMID: 36870528 PMCID: PMC10440276 DOI: 10.1016/j.anai.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity. OBJECTIVE To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized vs brief intervention (BI, reading steps aloud). METHODS A single-center randomized controlled trial of V-TTG vs BI was conducted with 5-to-10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre- and post-education using 12-step validated checklists (misuse: < 10 steps correct). RESULTS Among 70 children enrolled, mean age was 7.8 years (SD = 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100%→74%, P = .002) and BI (92%→69%, P = .04) groups, with no difference between groups at both time points (P = .2 and .9). On average, children performed 1.5 more steps correctly (SD = 2.0), with greater improvement with V-TTG (mean [SD] = 1.7 [1.6]) vs BI (mean [SD] = 1.4 [2.3]), though not significant (P = .6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change = 1.9 vs 1.1, P = .002). CONCLUSION A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact. CLINICAL TRIAL REGISTRATION NCT04373499.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois.
| | - Uma Balachandran
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mary Akel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ashley Hull
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Michelle Siros
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Viridiana Luna
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Isabella Xu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Valerie G Press
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois
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Sleath B, Carpenter D, Davis SA, Garcia N, Reuland DS, Tudor G, Loughlin CE. Adolescent asthma management self-efficacy and responsibility: impact on asthma control and quality-of-life. J Asthma 2023; 60:331-338. [PMID: 35286174 DOI: 10.1080/02770903.2022.2051541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the extent to which adolescent asthma management self-efficacy, outcome expectations, and asthma responsibility were associated with asthma control and quality-of-life. Adolescent self-efficacy and outcome expectations are important components of social cognitive theory, which guided this research. METHODS English- and Spanish-speaking adolescents ages 11-17 with persistent asthma were recruited at four pediatric clinics. Adolescents were interviewed and parents completed questionnaires. Multiple linear regression was used to analyze the data. RESULTS Three hundred and fifty-nine adolescents were recruited. Older adolescent age, male gender, and higher adolescent asthma management self-efficacy were significantly associated with higher adolescent responsibility; outcome expectations were not significantly associated with responsibility. Adolescent ratings of their own responsibility were higher than parent ratings of their child's responsibility for almost all asthma management tasks. Adolescents with higher reported asthma management self-efficacy were significantly more likely to have better quality-of-life and controlled asthma. Adolescents with more positive outcome expectations were significantly more likely to have controlled asthma. Being Native American was associated with worse quality-of-life and asthma not being controlled. Being Black was associated with asthma not being controlled. CONCLUSIONS Parents and providers should work to improve adolescent self-efficacy in managing their asthma because it is associated with asthma responsibility, asthma control, and quality-of-life. Providers need to especially work with Native American and Black adolescents to improve quality-of-life and asthma control.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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O'Connor A, Tai A, Brinn M, Hoang ANTH, Cataldi D, Carson-Chahhoud K. The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis. JMIR Pediatr Parent 2023; 6:e40231. [PMID: 36637889 PMCID: PMC9883739 DOI: 10.2196/40231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. OBJECTIVE The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). METHODS An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. RESULTS Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users' value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. CONCLUSIONS AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/16094069211042229.
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Affiliation(s)
- Antonia O'Connor
- Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Andrew Tai
- Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Malcolm Brinn
- Translational Medicine and Technology Research Group, University of South Australia, Adelaide, Australia.,Australian Centre for Precision Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Daniele Cataldi
- Paediatric Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Kristin Carson-Chahhoud
- School of Medicine, The University of Adelaide, Adelaide, Australia.,Translational Medicine and Technology Research Group, University of South Australia, Adelaide, Australia.,Australian Centre for Precision Health, South Australian Health and Medical Research Institute, Adelaide, Australia
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Smith MJ, Gao Z, Chafe R, Alwashmi M. A mobile health intervention for improving the technique of inhaled medications among children with asthma: A pilot study. Digit Health 2023; 9:20552076231216589. [PMID: 38033513 PMCID: PMC10685774 DOI: 10.1177/20552076231216589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Objective BreatheSuite MDI is a Bluetooth-enabled inhaler attachment and mobile application which aims to improve asthma control. The objective was to compare pressurized metered dose inhaler (pMDI) technique and asthma control test (ACT) scores pre- and post-use of the device and mobile application. Secondary objectives were to assess user satisfaction and therapy adherence. Methods Patients between the ages of 8 and 18 were recruited from several pediatric asthma clinics. Technique and ACT scores were assessed at baseline. Users were given no prompts on technique during the first month of device use. For the subsequent three months, users were given technique scores through the mobile application after each inhaler use and provided weekly performance summaries. At the end of the study, technique and ACT scores were analyzed and an exit survey was completed. Conditional logistic regression was used to examine the association between well-controlled asthma (ACT score > 19) and the intervention. Results 24 patients completed the study. Technique scores improved following the use of Breathesuite (44.19 vs. 62.54; P = 0.01). Well-controlled asthma did not significantly improve (OR = 1.20 [0.4-3.9], P = 0.76). 87% of study subjects agreed or strongly agreed that their asthma control improved while using BreatheSuite; 79% were satisfied with the device and mobile application; and 91% preferred using the device compared to a standard logbook to track inhaler usage. Conclusions In this pilot study, the use of BreatheSuite device was associated with improved technique scores. These results need to be confirmed by a randomized controlled trial. There was high user satisfaction with the BreatheSuite device.
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Affiliation(s)
- Mary Jane Smith
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
- Janeway Children’s Health and Rehabilitation Centre, Eastern Health, St John’s, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
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Davis SA, Beznos B, Carpenter DM, Tudor G, Garcia N, Sleath B. Trends in Adolescent Asthma Responsibility Over a 12-Month Study Period. J Adolesc Health 2022; 70:478-482. [PMID: 34823985 PMCID: PMC8889904 DOI: 10.1016/j.jadohealth.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to assess factors that influence adolescent asthma responsibility and how patient- and parent-reported asthma responsibility changes over a 12-month period. METHODS One hundred sixty-four adolescents and their parents completed questionnaires at baseline and 12 months, including the asthma responsibility questionnaire, in which higher scores indicate greater adolescent responsibility. Multiple linear regression was used to assess how baseline asthma responsibility, self-efficacy, outcome expectations, and demographic characteristics were associated with 12-month asthma responsibility. RESULTS Asthma responsibility as reported by both adolescents and parents shifted significantly toward the adolescent over the study period (p < .001). Most individual scale items (e.g., noticing signs and symptoms of asthma, starting treatment when symptoms occur) also showed significant shifts toward greater adolescent responsibility. In the regression models, higher baseline asthma responsibility and older age were significant predictors of both higher adolescent- and parent-reported 12-month asthma responsibility, while female gender and mild asthma severity also predicted higher parent-reported asthma responsibility. CONCLUSIONS Asthma responsibility shifted toward adolescents over a 12-month period. Regardless of age and gender, all types of adolescents were able to improve their responsibility level based on adolescent-reported results. Older females, according to parent-reported results, were more likely to improve their responsibility. Providers need to make sure adolescents are learning all the necessary skills to manage asthma independently before they reach adulthood.
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Affiliation(s)
- Scott A. Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Delesha M. Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Wei H, Press VG, Volerman A. Is guideline-based education prehospitalization associated with improved inhaler technique in high-risk children? Ann Allergy Asthma Immunol 2022; 128:333-334. [PMID: 34861366 PMCID: PMC8942067 DOI: 10.1016/j.anai.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/17/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Helen Wei
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Valerie G Press
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL
| | - Anna Volerman
- Departments of Medicine and Pediatrics, The University of Chicago, Chicago, Illinois.
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Lizano-Barrantes C, Garin O, Dima AL, van Ganse E, de Bruin M, Belhassen M, Mayoral K, Pont À, Ferrer M. The Inhaler Technique Questionnaire (InTeQ): Development and Validation of a Brief Patient-Reported Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052591. [PMID: 35270283 PMCID: PMC8909835 DOI: 10.3390/ijerph19052591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
There is a need for instruments designed for patients with asthma to self-report their performance of inhaling steps. We aimed to develop an accessible and easy-to-use patient-reported tool for inhaler technique assessment, which could also serve as a training and monitoring resource for any type of inhaler device, and to evaluate its feasibility, validity, and reliability in adults with asthma. The development was based on literature review and pilot testing with clinicians and patients. The Inhaler Technique Questionnaire (InTeQ) asks about the frequency of performing five steps when using inhalers (on a five-point Likert scale). We analyzed data from adults with persistent asthma (n = 361). We examined the measurement model using Mokken scaling analysis, construct validity by assessing hypotheses on expected discrimination among known groups, and reliability based on internal consistency and reproducibility. Means of the InTeQ items were in the range of 0.23–1.61, and coefficients of homogeneity were above the cutoff point, demonstrating the unidimensionality of the scale. Known groups’ global score differences were statistically significant between patients reporting having “Discussed in detail” or having “Not discussed/Only in general” the inhaler technique with their healthcare providers (p = 0.023). The Cronbach’s alpha coefficient was 0.716, and the intraclass correlation coefficient was 0.775. The InTeQ is a feasible, valid, and reliable instrument for self-reporting inhaler technique on any type of device.
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Affiliation(s)
- Catalina Lizano-Barrantes
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmacy, Universidad de Costa Rica, San Jose 2060, Costa Rica
| | - Olatz Garin
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Alexandra L. Dima
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Correspondence:
| | - Eric van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Respiratory Medicine, Croix-Rousse University Hospital, 69004 Lyon, France
- PELyon, Pharmacoepidemiology, 69007 Lyon, France;
| | - Marijn de Bruin
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | | | - Karina Mayoral
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
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Gillette C, Ludwig N, Bodner G, Sisson CGB, Perry CJ, McKinnond A, Lindaman K, Jensen CT. Psychometric properties of two instruments measuring self-efficacy and outcome expectations of providing inhaler technique education to patients. J Asthma 2021; 59:2305-2313. [PMID: 34806541 DOI: 10.1080/02770903.2021.2008428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Both the National Heart, Lung, and Blood Institute (NHLBI) and Global Initiative for Asthma (GINA) asthma practice guidelines recommend that providers routinely check inhaler technique and correct any mistakes that patients may make when using these devices. Providers, however, rarely check inhaler technique during asthma visits. The objectives of this study were to: (1) describe the development of an instrument to measure self-efficacy and outcome expectations regarding inhaler technique patient education, (2) evaluate the internal consistency reliability of the new scales, and (3) provide preliminary evidence of construct validity. Methods: First- and second-year physician assistant (PA) students at two institutions completed an anonymous and voluntary survey evaluating two new instruments, the Teaching Inhalers to Patients: Self-efficacy (TIP-SE) and the Teaching Inhalers to Patients: Outcome Expectations (TIP-OE) scales and sociodemographic characteristics. The data were analyzed using Principal Components Analysis (PCA), Cronbach's α, and multivariable logistic regression. Results: We had usable responses from 146 PA students (71.9% participation rate). The PCA identified one factor for the TIP-SE and TIP-OE, respectively. The internal consistency of the TIP-SE and TIP-OE was α = 0.96 and α = 0.92, respectively. The logistic regression found that second-year PA students who had higher mean TIP-SE scores were significantly more likely to report teaching patients to use inhalers during rotations (OR = 1.8, 95% CI = 1.1, 2.9). There was not a statistically significant relationship between reporting teaching patients to use inhalers during rotations and mean TIP-OE scores. Conclusion: The TIP-SE and TIP-OE show preliminary evidence of reliability and validity. Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008428 .
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Affiliation(s)
- Chris Gillette
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicole Ludwig
- Physician Assistant Program, Seton Hill University, Greensburg, PA, USA
| | - Gayle Bodner
- Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Courtney J Perry
- Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrea McKinnond
- Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kristin Lindaman
- Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Charles T Jensen
- Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Alwashmi MF, Mugford G, Vokey B, Abu-Ashour W, Hawboldt J. Effectiveness of the BreatheSuite Device in Assessing the Technique of Metered-Dose Inhalers: Validation Study. JMIR BIOMEDICAL ENGINEERING 2021. [DOI: 10.2196/26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications.
Objective
This study aimed to validate the effectiveness of the BreatheSuite MDI device in assessing the technique of taking a dose via an MDI.
Methods
The study was a validation study. Thirty participants who self-reported a diagnosis of asthma or COPD were recruited from community pharmacies in Newfoundland and Labrador, Canada. Participants used a BreatheSuite MDI device attached to a placebo MDI and resembled taking 3 doses. Pharmacists used a scoring sheet to evaluate the technique of using the MDI. An independent researcher compared the results of the pharmacist’s scoring sheet with the results of the BreatheSuite device.
Results
This study found that the BreatheSuite MDI can objectively detect several errors in the MDI technique. The data recorded by the BreatheSuite MDI device showed that all participants performed at least one error in using the MDI. The BreatheSuite device captured approximately 40% (143/360) more errors compared to observation alone. The distribution of participants who performed errors in MDI steps as recorded by BreatheSuite compared to errors reported by observation alone were as follows: shaking before actuation, 33.3% (30/90) versus 25.5% (23/90); upright orientation of the inhaler during actuation, 66.7% (60/90) versus 18.87% (17/90); coordination (actuating after the start of inhalation), 76.6% (69/90) versus 35.5% (32/90); and duration of inspiration, 96.7% (87/90) versus 34.4% (31/90).
Conclusions
The BreatheSuite MDI can objectively detect several errors in the MDI technique, which were missed by observation alone. It has the potential to enhance treatment outcomes among patients with chronic lung diseases.
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Ramphul M, Lo DKH, Gaillard EA. Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction. J Asthma Allergy 2021; 14:525-538. [PMID: 34045872 PMCID: PMC8144021 DOI: 10.2147/jaa.s265657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including environmental, immunological and genetic factors. Severe asthma in children is associated with increased hospitalisation rates, a lower quality of life, increased healthcare costs and an increased mortality. In the era of new molecular biologics treatments, it is essential to improve deep phenotyping of children with severe asthma in order to deliver the most effective treatment to each individual child. In this review, we discuss the personalised approach to the assessment and management of severe asthma. We explore the indications and use of the currently licensed biologics, as well as the potential of other emerging treatments.
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Affiliation(s)
- Manisha Ramphul
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
| | - David K H Lo
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
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van der Kolk A, Lammers N, Brusse-Keizer M, van der Palen J, Faber J, Spenkelink-Visser R, Thio BJ. Comparison of inhalation technique with the Diskus and Autohaler in asthmatic children at home. ERJ Open Res 2021; 7:00215-2019. [PMID: 33898617 PMCID: PMC8053909 DOI: 10.1183/23120541.00215-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to 1) compare daily inhalation technique with the Diskus and Autohaler in asthmatic children by filming inhalations at home and 2) compare daily inhalation technique with technique demonstrated in the hospital. Methods We performed a randomised study in asthmatic children (aged 6–18 years) from the outpatient clinic of Medisch Spectrum Twente hospital (Enschede, The Netherlands) from July 2014 to April 2016. Children received inhalation instructions for the Diskus and Autohaler and were randomised to use one device in the morning and the other in the evening. During the 28-day study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for seven critical errors per device. Results 636 videos with the Diskus and 663 with the Autohaler were provided by 27 children. The most common critical error in daily life was an incorrect device position during preparation of the Diskus (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler. Percentage of correct days using the Diskus was 44%, compared to 96% with the Autohaler (p<0.001). The two most common errors with the Diskus were made at least twice as often at home than in the hospital. Conclusion Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus. Inhalation technique at home is markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.https://bit.ly/3cYK4eq
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Affiliation(s)
| | - Natasja Lammers
- Dept of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Dept of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Joyce Faber
- Dept of Pediatrics, Deventer Ziekenhuis, Deventer, The Netherlands
| | | | - Bernard J Thio
- Dept of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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12
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Ari A. A path to successful patient outcomes through aerosol drug delivery to children: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:593. [PMID: 33987291 PMCID: PMC8105845 DOI: 10.21037/atm-20-1682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/03/2020] [Indexed: 11/06/2022]
Abstract
Although using aerosolized medications is a mainstay of treatment in children with asthma and other respiratory diseases, there are many issues in terms of device and interface selection, delivery technique and dosing, as well as patient and parental education that have not changed for half a century. Also, due to many aerosol devices and interfaces available on the market and the broad range of patient characteristics and requirements, providing effective aerosol therapy to children becomes a challenge. While aerosol delivery devices are equally effective, if they are age-appropriate and used correctly, the majority of aerosol devices require multiple steps to be used efficiently. Unfortunately, many children with pulmonary diseases have problems with the correct delivery technique and do not gain therapeutic benefits from therapy that result in poor disease management and increased healthcare costs. Therefore, the purpose of this paper is to review the current knowledge on aerosol delivery devices used in children and guide clinicians on the optimum device- and interface-selection, delivery technique, and dosing in this patient population. Strategies on how to deliver aerosolized medications in crying and distressed children and how to educate parents on aerosol therapy and promote patient adherence to prescribed medications are also provided. Future directions of aerosol therapy in children should focus on these issues and implement policies and clinical practices that highlight the potential solutions to these problems.
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Affiliation(s)
- Arzu Ari
- Department of Respiratory Care, Texas State University, Round Rock, TX, USA
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13
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Volerman A, Kan K, Carpenter D, Press VG. Strategies for Improving Inhalation Technique in Children: A Narrative Review. Patient Prefer Adherence 2021; 15:665-675. [PMID: 33824582 PMCID: PMC8018416 DOI: 10.2147/ppa.s267053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. Given the significant consequences of improper inhaler use in children, the goal of this review is to comprehensively describe existing and potential solutions to improve inhaler technique. Because children move through various settings, including clinical practices, schools, pharmacies, and homes, in their daily routine, there is great opportunity to teach and reinforce proper inhaler technique across settings. Within each setting, in-person and technology-based interventions have shown promise to improve technique. These solutions need to be more broadly adopted to deliver tailored education with support for provider training, team-based care, communication structures, and reimbursement. Such solutions hold the potential to improve inhaler use among children, with potential for decreasing morbidity and costs.
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Affiliation(s)
- Anna Volerman
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Advanced General Pediatrics Division, Department of Pediatrics, Chicago, IL, USA
| | - Delesha Carpenter
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
| | - Valerie G Press
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
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14
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Litt HK, Press VG, Hull A, Siros M, Luna V, Volerman A. Association between inhaler technique and confidence among hospitalized children with asthma. Respir Med 2020; 174:106191. [PMID: 33152551 DOI: 10.1016/j.rmed.2020.106191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Proper use of respiratory inhalers is crucial to asthma self-management and associated with improved outcomes. Previous studies conducted in outpatient and community settings show parents and children are overconfident in children's ability to use inhalers properly, which may lead healthcare providers to not teach or review inhaler technique. This study examined whether children and parents' confidence were associated with proper inhaler technique among children hospitalized with asthma. METHODS Children between 5 and 10 years old hospitalized with asthma at an urban academic medical center demonstrated inhaler technique using metered dose inhalers and spacers. Technique was scored based on a validated 12-step scale. Confidence was measured using three items assessing 1. Knowledge to use inhaler, 2. Skills to use inhaler, and 3. Ability to independently use inhaler. These items were five-point scales and analyzed as binary variables. Independent t-tests were used to measure associations between confidence and number of steps performed correctly. RESULTS None of the confidence items, when asked to parents or children (n = 70), were associated with the number of steps performed correctly. Further, while the majority of children and parents (59-70%) were confident based on each item, the mean number of steps correctly completed was 6.4 out of 12. CONCLUSIONS Children and parents' confidence in children's knowledge, skills, and ability to independently use an inhaler were all poor proxies for proper inhaler technique. Inpatient healthcare professionals should objectively evaluate technique and teach proper inhaler use to all children with asthma to optimize outcomes.
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Affiliation(s)
- Henry K Litt
- University of Chicago Pritzker School of Medicine, 924 E 57 St. Suite 104, Chicago, IL, 60637, USA.
| | - Valerie G Press
- University of Chicago Departments of Medicine and Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Ashley Hull
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Michelle Siros
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Viridiana Luna
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Anna Volerman
- University of Chicago Departments of Medicine and Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
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15
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Azak M, Mutlu B, Tamay Z. The effect of training of metered-dose inhaler technique on asthma control and quality of life in children with asthma: a randomized trial. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1821376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Merve Azak
- Faculty of Nursing, Department of Pediatric Nursing, Istanbul University - Cerrahpasa Florence Nightingale, Istanbul, Turkey
| | - Birsen Mutlu
- Faculty of Nursing, Department of Pediatric Nursing, Istanbul University - Cerrahpasa Florence Nightingale, Istanbul, Turkey
| | - Zeynep Tamay
- Istanbul Medical Faculty, Division of Allergy and Chest Diseases, Department of Pediatrics, Istanbul University, Istanbul, Turkey
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16
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Sleath B, Carpenter DM, Davis SA, Sayner R, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Provider-adolescent discussion and provider education about asthma triggers during pediatric visits: results of a randomized trial. J Asthma 2020; 58:1565-1573. [PMID: 32867560 DOI: 10.1080/02770903.2020.1817936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We examined how an asthma question prompt list with video intervention influenced discussion of and provider education about asthma triggers. METHODS English or Spanish-speaking adolescents ages 11-17 with persistent asthma and their caregivers were enrolled from four pediatric clinics. Adolescents were randomized to the intervention or usual care groups. Adolescents in the intervention group watched the video on an iPad and then completed a one-page asthma question prompt list before their visits. All visits were audio-recorded. Generalized Estimating Equations were used to predict the number of trigger areas discussed and the number of areas providers educated adolescents about during visits. RESULTS Forty providers and 359 patients participated. Triggers were discussed during 89% of intervention group visits and 81% of usual care visits; providers educated adolescents about triggers during 59% of intervention group visits and 46% of usual care visits. More triggers were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents in the intervention group and when adolescents asked one or more questions during visits. More trigger areas were significantly more likely to be discussed if the adolescent was White and male. Providers were significantly more likely to educate adolescents whose family spoke Spanish at home about more trigger areas than adolescents who spoke English at home. CONCLUSIONS More trigger areas were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents who received the intervention and when adolescents asked one or more questions.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Health Professions at Southern, New Hampshire University, Manchester, NH, USA
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17
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Sleath B. Improving Youth Confidence in Using Asthma Medication Devices Correctly: An Important Step Toward Improving Health Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2031-2032. [PMID: 31279469 DOI: 10.1016/j.jaip.2019.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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18
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Volerman A, Carpenter D, Press V. What can be done to impact respiratory inhaler misuse: exploring the problem, reasons, and solutions. Expert Rev Respir Med 2020; 14:791-805. [PMID: 32306774 DOI: 10.1080/17476348.2020.1754800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Respiratory inhalers, when used correctly, provide critical treatments for managing pulmonary conditions. However, many patients misuse inhalers, negatively affecting disease control, quality of life, healthcare utilization, and costs. Numerous factors are associated with misuse and are nested within four levels of influence: individual, interpersonal, organizational/institutional, and policy. AREAS COVERED This review analyzed published literature and identified the most salient factors at each socio-ecological framework level. English language articles from any year were identified from PubMed, Google Scholar, and Embase databases. Misuse exists across clinical settings, patient populations, and device types. Several potential solutions are highlighted. Published interventions to improve inhaler technique have utilized handouts, in-person, virtual, and biofeedback approaches both inside and outside of healthcare settings with varied effectiveness. However, some interventions have superior effectiveness for improving technique and reducing acute care utilization. EXPERT OPINION To robustly address inhaler misuse, future solutions should focus on multi-level approaches to account for the myriad of factors contributing to inhaler misuse. Solutions should also streamline inhaler equipment, identify innovative technology-based solutions, support collaborations across healthcare and non-healthcare settings, and ensure reimbursement to healthcare professionals for inhaler education. Rigorous research studies must be funded and supported to identify and disseminate solutions.
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Affiliation(s)
- Anna Volerman
- University of Chicago Biological Sciences Division, Departments of Medicine and Pediatrics , Chicago, IL, USA
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy , Asheville, NC, USA
| | - Valerie Press
- University of Chicago Biological Sciences Division, Departments of Medicine and Pediatrics , Chicago, IL, USA
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19
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Sleath B, Carpenter D, Sayner R, Davis SA, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Questions and reported medication problems from pediatric patients and caregivers after intervention. Am J Health Syst Pharm 2020; 76:366-373. [PMID: 31361837 DOI: 10.1093/ajhp/zxy057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The effectiveness of an asthma question prompt list with video intervention to increase question-asking during pediatric office visits among youth who reported medication problems was evaluated. METHODS English- or Spanish-speaking youth age 11-17 years with persistent asthma and their caregivers were enrolled from 4 pediatric clinics in a randomized controlled trial. Youth were randomized to intervention or usual care groups. Youth in the intervention group watched an educational video with their caregivers on an iPad. The youth then received a 1-page asthma question prompt list to complete before their visits. The audio of all baseline medical visits was recorded. Youth were interviewed and caregivers completed questionnaires at baseline and 6 months later. RESULTS A total of 40 providers and 359 of their patients participated. Youth who reported at least 1 medication problem who were in the intervention group were significantly more likely to ask 1 or more questions about medications during their visits than youth in the usual care group (odds ratio = 3.1, 95% confidence interval = 2.0, 4.1). Seventy-four percent of youth and 71% caregivers who reported the youth had problems using asthma medications at baseline still reported 1 or more problems 6 months later. CONCLUSION Among youth who reported 1 or more problems with using their asthma medications, the intervention significantly increased youth question-asking. Many youth- and caregiver-reported problems with using asthma medications persisted over time.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Ceila E Loughlin
- Professor, Clinical Associate Professor, Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, ME
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20
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Al-Otaibi HM. Evaluation of health-care providers' knowledge in the science of aerosol drug delivery: Educational sessions are necessary. J Family Community Med 2020; 27:62-66. [PMID: 32030080 PMCID: PMC6984029 DOI: 10.4103/jfcm.jfcm_138_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND: Aerosolized drugs are widely used to treat and control a variety of pulmonary diseases. However, there is increasing evidence that patients are unable to use their drug delivery device correctly. The failure of aerosolized treatment is usually the result of poorly communicated instructions. The aim of this investigation was to evaluate the knowledge of health-care providers in the science of aerosol drug delivery (ADD) and assess the impact of further education on their knowledge. MATERIALS AND METHODS: One hundred and seventeen health-care providers attended a 4-hour educational course on ADD science. The course was conducted from June to August 2018 in Jeddah, Riyadh, and Dammam. Pre-course assessment done with a 12-item multiple-choice questionnaire. Post-course assessment was conducted after the end of course in which participants were asked to rate their knowledge of ADD on a scale of 1–10 (before and after the course). RESULTS: Sixty-six health-care providers (physicians, pharmacists, respiratory therapists, and health educators) completed the course. The participants' clinical experience, on average (±standard deviation), was 7.6 ± 7.3 years. Clinical experience favored physicians over other groups. The precourse score for all participants was 3.2 ± 1.9 out of 12 and the postcourse score was 6.97 ± 2.7. There was a significant statistical difference between pre- and postcourse assessment scores (P < 0.05). Differences between the four specialties were insignificant (P = 0.216), without a correlation between clinical experience and preassessment scores (P = 0.202). CONCLUSION: The present data indicate that health-care providers' knowledge of ADD is completely inadequate. There is an urgent need to introduce an ADD educational package in the curricula. An annual competency-based evaluation for health-care providers is critical as well.
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Affiliation(s)
- Hajed M Al-Otaibi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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21
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Morton RW, Elphick HE, Craven V, Shields MD, Kennedy L. Aerosol Therapy in Asthma-Why We Are Failing Our Patients and How We Can Do Better. Front Pediatr 2020; 8:305. [PMID: 32656165 PMCID: PMC7325940 DOI: 10.3389/fped.2020.00305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
In order for inhaled corticosteroids to be delivered adequately to the airways they require patients to take them regularly using an effective technique. Patients often have a poor inhaler technique, and this has been shown to result in sub-optimal asthma control. It is important for all clinicians prescribing inhaled medication to be experienced in the correct technique, and take time to train children so that they have mastered corrected inhaler technique. Using Teach to Goal or teach back methodology is a simple and effective way to provide this in the clinic setting. More than one training session is typically needed before children can master correct inhaler technique. Adherence to inhaled therapy has been shown to be sub-optimal in pediatric populations, with studies showing an average rate of around 50%. Subjective methods of measuring adherence have been shown to be inaccurate and overestimate rates. The advent of new technology has allowed adherence rates to be measured electronically, and it has been shown that regular feedback of these data can be effective at improving asthma control. New mobile apps and smart technology aim to engage patients and families with their asthma care. Effective use of these apps in collaboration with health care professionals has a vast potential to improve adherence rates and inhaler technique, resulting in improved asthma control.
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Affiliation(s)
| | | | - Vanessa Craven
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Michael D Shields
- Queen's University Belfast, Belfast, United Kingdom.,Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | - Lesley Kennedy
- Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
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22
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Simoneau T, Langton CR, Kuo CL, Marrero J, Gherlone N, Cloutier MM, Hollenbach JP. A School Nurse-Led Asthma Program Reduces Absences: Evaluation of Easy Breathing for Schools. Acad Pediatr 2020; 20:73-80. [PMID: 31365880 DOI: 10.1016/j.acap.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate whether school nurses can assist pediatricians in providing asthma care and reduce school absenteeism through a program called Easy Breathing for Schools (EzBfS), a 5-element school nurse-led asthma management program and the effectiveness in reducing school absenteeism. METHODS Fifteen public school nurses in an urban community implemented EzBfS during the 2015-16 and 2016-17 school years. Program elements included assessment of asthma risk and asthma control, asthma education, medication review, and a pediatrician communication tool. School absence for any reason was the primary outcome; absentee rates for students with asthma enrolled in the program were compared to students with asthma in the entire school population using negative binomial regression. RESULTS School nurses enrolled 251/2,126 students with physician-confirmed asthma (2015-16: n = 114 and 2016-17: n = 137). Sixty eight percent of participants were Latino and 25% were Black with a mean age of 8.7 ± 2.2 years. Absentee rates were higher in children with asthma compared to children without asthma (8.3% vs 7.0% absent, respectively P < .001). Students enrolled in the program experienced a 25% decrease in absentee rate after adjusting for age, sex, race/ethnicity, and school year (rate ratio = 0.75, 95% confidence interval, 0.67, 0.85) as compared to students with asthma not enrolled in the program. Participants also demonstrated improvement in inhaler technique score (P < .001). Ninety two percent of the nurses were satisfied with the program. CONCLUSION EzBfS, a pragmatic, nurse-led asthma management program, was successfully implemented by school nurses and significantly decreased school absences among a sample of students with asthma.
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Affiliation(s)
- Tregony Simoneau
- Department of Pediatrics (T Simoneau, J Marrero, and JP Hollenbach), UCONN Health, Farmington, Conn; Connecticut Children's Medical Center (T Simoneau, J Marrero, and JP Hollenbach), Hartford, Conn; The Asthma Center (T Simoneau, CR Langton, MM Cloutier, and JP Hollenbach), Connecticut Children's Medical Center, Hartford, Conn
| | - Christine R Langton
- The Asthma Center (T Simoneau, CR Langton, MM Cloutier, and JP Hollenbach), Connecticut Children's Medical Center, Hartford, Conn
| | - Chia-Ling Kuo
- Department of Community Medicine & Health Care (C-L Kuo), Connecticut Institute for Clinical and Translational Science, UCONN Health, Farmington, Conn
| | - Jing Marrero
- Department of Pediatrics (T Simoneau, J Marrero, and JP Hollenbach), UCONN Health, Farmington, Conn; Connecticut Children's Medical Center (T Simoneau, J Marrero, and JP Hollenbach), Hartford, Conn
| | - Nicole Gherlone
- Frank H. Netter School of Medicine (N Gherlone), Quinnipiac University, North Haven, Conn
| | - Michelle M Cloutier
- The Asthma Center (T Simoneau, CR Langton, MM Cloutier, and JP Hollenbach), Connecticut Children's Medical Center, Hartford, Conn
| | - Jessica P Hollenbach
- Department of Pediatrics (T Simoneau, J Marrero, and JP Hollenbach), UCONN Health, Farmington, Conn; Connecticut Children's Medical Center (T Simoneau, J Marrero, and JP Hollenbach), Hartford, Conn; The Asthma Center (T Simoneau, CR Langton, MM Cloutier, and JP Hollenbach), Connecticut Children's Medical Center, Hartford, Conn.
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23
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Spaggiari S, Gehri M, Di Benedetto L, Hafen GM, Pauchard JY, Gervaix A, Pannatier A, Sadeghipour F, Di Paolo ER. Inhalation technique practical skills and knowledge among physicians and nurses in two pediatric emergency settings. J Asthma 2019; 58:190-196. [PMID: 31566459 DOI: 10.1080/02770903.2019.1674329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped with a valved holding chamber (VHC) or spacer provides an important advantage for adequate control of asthma and virus-induced wheezing in young children. The aim of this study was to assess the ability and knowledge of physicians and nurses to use a pMDI with a masked VHC in two pediatric emergency units.Methods: Study design: Two-center observational study. Inhaler use technique was assessed in 50 physicians and 50 nurses using a child mannequin and a validated videotaped nine-step scoring method. The participants' knowledge was evaluated by a questionnaire.Results: The inhalation technique was perfectly mastered by 49% of the study participants and almost perfectly mastered by another 34% (mean score 8.3 ± 0.7; range 5-9). Nurses were more likely than doctors to demonstrate the technique perfectly (66% vs. 32%, p < 0.05). The two most common errors were forgetting to shake the pMDI between two consecutive puffs (38% of the participants) and putting the patient in an incorrect position (11%). About half of the participants reported that they checked each patient's inhalation technique at every opportunity and knew how to clean the VHC. A large majority did not employ a reliable method to determine the amount of medication remaining in pMDIs without a counter.Conclusion: Healthcare professionals' practical skills and knowledge on inhalation therapy were not completely mastered and could be improved with a mandatory training program.
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Affiliation(s)
- Stéphanie Spaggiari
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Mario Gehri
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Di Benedetto
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gaudenz M Hafen
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Respiratory Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Yves Pauchard
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - André Pannatier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Farshid Sadeghipour
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Ermindo R Di Paolo
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Volerman A, Fierstein J, Boon K, Kanaley M, Kan K, Vojta D, Gupta R. Factors associated with effective inhaler technique among children with moderate to severe asthma. Ann Allergy Asthma Immunol 2019; 123:511-512.e1. [PMID: 31491542 DOI: 10.1016/j.anai.2019.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois.
| | - Jamie Fierstein
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago Illinois
| | - Kathy Boon
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago Illinois
| | - Madeleine Kanaley
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago Illinois
| | - Kristin Kan
- Division of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | - Ruchi Gupta
- Division of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
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Sleath B, Carpenter D, Davis SA, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE. The impact of a question prompt list and video intervention on teen asthma control and quality-of-life one year later: results of a randomized trial. J Asthma 2019; 57:1029-1038. [PMID: 31311361 DOI: 10.1080/02770903.2019.1633542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study examined whether youth who received an asthma question prompt list/video intervention were more likely to have their asthma controlled and better quality-of-life at 12 months than youth who received usual care.Methods: English or Spanish-speaking youth ages 11-17 were enrolled and randomized to intervention or usual care. The 185 youth and parents in the intervention group watched the video on an iPad and then received a one-page asthma question prompt list to complete before their visits. One hundred seventy-four received usual care. Baseline and 6-month visits were audio-tape recorded. Generalized Estimating Equations were used to predict a youth's quality-of-life and whether asthma was controlled at 12 months.Results: Asthma control and quality-of-life improved significantly from baseline to 12-month follow-up in both intervention and usual care groups. Baseline asthma control and quality-of-life were significantly associated with 12-month asthma control and quality-of-life, respectively. Adolescents on a control medication at baseline were significantly more likely to have their asthma controlled at 12 months.Conclusions: Asthma control and quality-of-life did not improve significantly more in the intervention group than in the usual care group.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Severe asthma accounts for only a small proportion of the children with asthma but a disproportionately high amount of resource utilization and morbidity. It is a heterogeneous entity and requires a step-wise, evidence-based approach to evaluation and management by pediatric subspecialists. The first step is to confirm the diagnosis by eliciting confirmatory history and objective evidence of asthma and excluding possible masquerading diagnoses. The next step is to differentiate difficult-to-treat asthma, asthma that can be controlled with appropriate management, from asthma that requires the highest level of therapy to maintain control or remains uncontrolled despite management optimization. Evaluation of difficult-to-treat asthma includes an assessment of medication delivery, the home environment, and, if possible, the school and other frequented locations, the psychosocial situation, and comorbid conditions. Once identified, aggressive management of issues related to poor adherence and drug delivery, remediation of environmental triggers, and treatment of comorbid conditions is necessary to characterize the degree of control that can be achieved with standard therapies. For the small proportion of patients whose disease remains poorly controlled with these interventions, the clinician may assess steroid responsiveness and determine the inflammatory pattern and eligibility for biologic therapies. Management of severe asthma refractory to traditional therapies involves considering the various biologic and other newly approved treatments as well as emerging therapies based on the individual patient characteristics.
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Volerman A, Toups MM, Hull A, Press VG. Does inhaler technique align with confidence among African-American children and their parents? Ann Allergy Asthma Immunol 2019; 123:100-101. [PMID: 31051238 DOI: 10.1016/j.anai.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/31/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois; Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois.
| | - Madeleine M Toups
- University of Chicago Harris School of Public Policy, Chicago, Illinois
| | - Ashley Hull
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Valerie G Press
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois; Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois
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Haktanir Abul M, Phipatanakul W. Severe asthma in children: Evaluation and management. Allergol Int 2019; 68:150-157. [PMID: 30648539 DOI: 10.1016/j.alit.2018.11.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines1,2, should be referred to an asthma specialist with expertise in severe asthma.
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Affiliation(s)
- Mehtap Haktanir Abul
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, MA, USA; Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.
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Volerman A, Toups MM, Hull A, Press VG. A feasibility study of a patient-centered educational strategy for rampant inhaler misuse among minority children with asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2028-2030. [PMID: 30711556 DOI: 10.1016/j.jaip.2019.01.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago Medicine, Chicago, Ill; Department of Pediatrics, University of Chicago Medicine, Chicago, Ill.
| | | | - Ashley Hull
- Department of Medicine, University of Chicago Medicine, Chicago, Ill
| | - Valerie G Press
- Department of Medicine, University of Chicago Medicine, Chicago, Ill; Department of Pediatrics, University of Chicago Medicine, Chicago, Ill
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Maitra A. Severe Asthma: Challenges and Pitfalls in Management. Indian J Pediatr 2018; 85:763-772. [PMID: 29736695 DOI: 10.1007/s12098-018-2686-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/03/2023]
Abstract
A small but significant subset of asthmatic children show a lack of response to standard management, resulting in further intensification of therapy to optimise symptom control and may remain symptomatic despite maximal therapy. Severe asthma results in increased risk of adverse outcomes whilst contributing significantly to the economic burden on the nation's health resources. The ERS / ATS guidelines were published in 2014 and form the basis of identifying, evaluating and managing severe asthmatic children. However, much of this evidence is extrapolated from adult studies and may be inappropriate in children as unlike adults, children have a more atopic phenotype. Severe asthma is an umbrella term and may represent several overlapping heterogeneous wheezing entities. This chapter aims at discussing the strategies employed in managing severe asthmatic children with particular focus on diagnostic challenges and management pitfalls. Particular emphasis is put into the logical and systematic approach to a child with severe asthma and describes the multidisciplinary approach to manage these children. Finally, this chapter describes the novel therapies available in children and in adults in managing this challenging condition.
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Affiliation(s)
- Anirban Maitra
- Pediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK.
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A model to integrate patient preferences into delivery systems: the importance of end-user input into pulmonary delivery. Ther Deliv 2018; 7:591-3. [PMID: 27582231 DOI: 10.4155/tde-2016-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Improving youth question-asking and provider education during pediatric asthma visits. PATIENT EDUCATION AND COUNSELING 2018; 101:1051-1057. [PMID: 29402570 PMCID: PMC5963523 DOI: 10.1016/j.pec.2018.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits. METHODS English or Spanish-speaking youth ages 11-17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the video on an iPad and then completed an asthma question prompt list before their visits. Generalized estimating equations were used to analyze the data. RESULTS Forty providers and 359 patients participated. Intervention group youth were significantly more likely to ask one or more questions about medications, triggers, and environmental control than usual care youth. Providers were significantly more likely to educate intervention group youth about rescue medications, triggers, and environmental control. Intervention group caregivers were not significantly more likely to ask questions. CONCLUSION The intervention increased youth question-asking and provider education about medications, triggers, and environmental control. The intervention did not impact caregiver question-asking. PRACTICE IMPLICATIONS Providers/practices should consider having youth complete question prompt lists and watch the video with their parents before visits to increase youth question-asking during visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, USA
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Sleath B, Carpenter DM, Walsh KE, Davis SA, Hayes Watson C, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Factors associated with adolescent and caregiver reported problems in using asthma medications. J Asthma 2018; 56:451-457. [PMID: 29668340 DOI: 10.1080/02770903.2018.1466312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to: (a) describe the types of medication problems/concerns youth with asthma and their caregivers reported and (b) examine the association between sociodemographic characteristics and youth and caregiver reported medication problems/concerns. METHODS English- and Spanish-speaking youth ages 11-17 with persistent asthma were recruited at four pediatric clinics. Youth were interviewed and caregivers completed questionnaires about reported asthma medication concerns/problems. Multiple logistic regression was used to analyze the data. RESULTS Three hundred and fifty-nine youth were recruited. Eighty percent of youth and 70% of caregivers reported one or more problems in using asthma medications. The most commonly reported problems by youth were: (a) hard to remember when to take the asthma medication (54%) and (b) hard to use asthma medication at school (34%). Younger children were significantly more likely to report difficulty in understanding their asthma medication's directions and difficulty reading the print on the medication's package. Caregivers' top-reported problem was that it is hard for their child to remember to take their asthma medications (49%). Caregivers without Medicaid were significantly more likely to express difficulty paying for their child's asthma medications. CONCLUSIONS Difficulty remembering to take asthma medication was a significant problem for youth and their caregivers. Providers should work with youth and their caregivers to identify asthma medication problems and discuss strategies to address those problems.
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Affiliation(s)
- Betsy Sleath
- a University of North Carolina at Chapel Hill, Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , Chapel Hill , USA
| | - Delesha M Carpenter
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Kathleen E Walsh
- c The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center , Cincinnati , USA
| | - Scott A Davis
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Claire Hayes Watson
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Charles Lee
- g Polyglot Systems, Inc. , Morrisville , USA
| | - Ceila E Loughlin
- d University of North Carolina at Chapel Hill, Division of Pediatric Pulmonology, School of Medicine , Chapel Hill , USA
| | - Nacire Garcia
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Daniel S Reuland
- e Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Gail Tudor
- f Department of Science and Mathematics , Husson University , Bangor , USA
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Sleath B, Carpenter DM, Coyne I, Davis SA, Hayes Watson C, Loughlin CE, Garcia N, Reuland DS, Tudor GE. Provider use of a participatory decision-making style with youth and caregivers and satisfaction with pediatric asthma visits. PATIENT-RELATED OUTCOME MEASURES 2018; 9:147-154. [PMID: 29785146 PMCID: PMC5953316 DOI: 10.2147/prom.s152068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background We conducted a randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to engage the youth during clinic visits. We examined whether the intervention was associated with 1) providers including youth and caregiver inputs more into asthma treatment regimens, 2) youth and caregivers rating providers as using more of a participatory decision-making style, and 3) youth and caregivers being more satisfied with visits. Methods English- or Spanish-speaking youth aged 11–17 years with persistent asthma and their caregivers were recruited from four pediatric clinics and randomized to the intervention or usual care groups. The youth in the intervention group watched the video with their caregivers on an iPad and completed a one-page asthma question prompt list before their clinic visits. All visits were audiotaped. Generalized estimating equations were used to analyze the data. Results Forty providers and their patients (n=359) participated in this study. Providers included youth input into the asthma management treatment regimens during 2.5% of visits and caregiver input during 3.3% of visits. The youth in the intervention group were significantly more likely to rate their providers as using more of a participatory decision-making style (odds ratio=1.7, 95% confidence interval=1.1, 2.5). White caregivers were significantly more likely to rate the providers as more participatory (odds ratio=2.3, 95% confidence interval=1.2, 4.4). Youth (beta=4.9, 95% confidence interval=3.3, 6.5) and caregivers (beta=7.5, 95% confidence interval=3.1, 12.0) who rated their providers as being more participatory were significantly more satisfied with their visits. Youth (beta=−1.9, 95% confidence interval=−3.4, −0.4) and caregivers (beta=−8.8, 95% confidence interval=−16.2, −1.3) who spoke Spanish at home were less satisfied with visits. Conclusion The intervention did not increase the inclusion of youth and caregiver inputs into asthma treatment regimens. However, it did increase the youth’s perception of participatory decision-making style of the providers, and this in turn was associated with greater satisfaction.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail E Tudor
- Department of Science and Mathematics, Husson University, Bangor, ME, USA
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Ramratnam SK, Bacharier LB, Guilbert TW. Severe Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:889-898. [PMID: 28689839 DOI: 10.1016/j.jaip.2017.04.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
Severe asthma in children is associated with significant morbidity and is a highly heterogeneous disorder with multiple clinical phenotypes. Cluster analyses have been performed in several groups to explain some of the heterogeneity of pediatric severe asthma, which is reviewed in this article. The evaluation of a child with severe asthma includes a detailed diagnostic assessment and excluding other possible diagnoses and addressing poor control due to comorbidities, lack of adherence to asthma controller medications, poor technique, and other psychological and environmental factors. Children with severe asthma require significant resources including regular follow-up appointments with asthma education, written asthma action plan, and care by a multidisciplinary team. Management of pediatric severe asthma now includes emerging phenotypic-directed therapies; however, continued research is still needed to further study the long-term outcomes of pediatric severe asthma and its treatment.
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Affiliation(s)
- Sima K Ramratnam
- University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Leonard B Bacharier
- Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Theresa W Guilbert
- Division of Pulmonology Medicine, Cincinnati Children's Hospital & Medical Center, Cincinnati, Ohio
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Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, Garcia N, Etheridge D, Rivera-Duchesne L, Reuland DS, Batey K, Duchesne C, Tudor G. Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits. PATIENT EDUCATION AND COUNSELING 2017; 100:2005-2011. [PMID: 28550963 PMCID: PMC5600669 DOI: 10.1016/j.pec.2017.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objectives of this study were to: (a) describe teen feedback on an asthma question prompt list/video intervention designed to motivate teens to be more engaged during visits and (b) examine teen demographics associated with teen acceptance of the intervention. METHODS Two hundred and fifty-nine teens ages 11 to 17 with persistent asthma were enrolled into a randomized, controlled trial and assigned to either a standard care or an intervention group where they watched an educational video with their parents and received a prompt list to complete before visits. Teens were interviewed after visits. RESULTS Of the 185 teens randomized to the intervention group: 93% said teens should complete the prompt lists before visits; 95% recommended teens should watch the video before visits; teens with moderate/severe persistent asthma were significantly more likely to find the prompt list useful; non-White teens were significantly more likely to find the prompt list and video more useful. CONCLUSIONS Teens exposed to the question prompt list/video had very positive feedback about the intervention. PRACTICE IMPLICATIONS Providers/practices should consider having teens complete question prompt lists during pre-visit wait time for use during visits and watch the video with their parents before visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Charles Lee
- Polyglot Systems, Inc., 2000 Aerial Center Pkwy, Morrisville, NC 27560, USA.
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, CB 7217, Chapel Hill, NC 27599-7217, USA.
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Dana Etheridge
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Laura Rivera-Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Daniel S Reuland
- University of North Carolina at Chapel Hill, School of Medicine, Division of General Internal Medicine and Clinical Epidemiology, USA
| | - Karolyne Batey
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Cristina Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Gail Tudor
- Department of Science and Mathematics, Director of Institutional Research, Husson University, Bangor, ME 04401-2929, USA.
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Carpenter DM, Geryk LL, Sage A, Arrindell C, Sleath BL. Exploring the theoretical pathways through which asthma app features can promote adolescent self-management. Transl Behav Med 2017; 6:509-518. [PMID: 27118115 DOI: 10.1007/s13142-016-0402-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Asthma apps often lack strong theoretical underpinnings. We describe how specific features of asthma apps influenced adolescents' self-observation, self-judgment, and self-reactions, which are key constructs of Self-Regulation Theory (SRT). Adolescents (ages 12-16) with persistent asthma (n = 20) used two asthma self-management apps over a 1-week period. During semi-structured interviews, participants identified their asthma goals and the app features that best promoted self-observation, self-judgment, and fostered positive self-reactions. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically using MAXQDA. Adolescents' goals were to reduce the impact of asthma on their lives. Adolescents reported that self-check quizzes, reminders, and charting features increased their ability to self-observe and self-judge their asthma, which, in turn, helped them feel more confident they could manage their asthma independently and keep their asthma well-controlled. Asthma apps can positively influence adolescents' self-management behaviors via increased self-observation, self-judgment, and increased self-efficacy.
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Affiliation(s)
- Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 1 University Heights, CPO 2125, Asheville, NC, 28804, USA.
| | - Lorie L Geryk
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Adam Sage
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Courtney Arrindell
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
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Geryk LL, Roberts CA, Carpenter DM. A systematic review of school-based interventions that include inhaler technique education. Respir Med 2017; 132:21-30. [PMID: 29229099 DOI: 10.1016/j.rmed.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proper use of inhaled medication is essential for the successful treatment of childhood asthma; yet, improper inhaler technique among school-aged children is common. There are many schoolbased asthma education programs, but the extent to which these programs teach inhaler technique is unknown. METHODS We systematically reviewed the literature to identify schoolbased asthma interventions that included inhaler technique instruction. We searched several databases, including PubMed, for relevant articles. Studies were included if they were asthma interventions of any type (programs, curriculums, education) conducted at kindergarten through twelfth grade schools that taught inhaler technique and included inhaler technique as an outcome measure. Of the 285 citations identified, the final nine studies (selected from 71 full-text articles) met the inclusion criteria. RESULTS Findings from this systematic review identified a very small number of school-based interventions that evaluated improvements in students' inhaler technique. Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique instruction varied in length, from 15 min to 1 h and nurses implemented inhaler technique instruction in six of the nine (67%) interventions. Existing studies offer mixed evidence for sustained technique improvements up to a 12-month follow-up period. CONCLUSIONS Evidence suggests that students benefit from school-based inhaler technique education; however, inconsistencies in how technique was measured limit our ability to draw firm conclusions regarding the effectiveness of inhaler technique education on student outcomes. Future studies are needed to identify the most appropriate and feasible inhaler technique education components for use in comprehensive asthma self management interventions.
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Affiliation(s)
- Lorie L Geryk
- Center for Health Systems Effectiveness, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Mail Code: MDYCHSE, Portland, OR 97239, USA.
| | - Courtney A Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA
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Carpenter DM, Roberts CA, Sage AJ, George J, Horne R. A Review of Electronic Devices to Assess Inhaler Technique. Curr Allergy Asthma Rep 2017; 17:17. [PMID: 28290015 DOI: 10.1007/s11882-017-0684-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.). RECENT FINDINGS We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all. Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, CPO 2125, Asheville, NC, 28804, USA.
| | - Courtney A Roberts
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Adam J Sage
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
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Brown S, Lehr VT, French N, Giuliano CA. Can a Short Video Improve Inhaler Use in Urban Youth? J Pediatr Pharmacol Ther 2017; 22:293-299. [PMID: 28943825 DOI: 10.5863/1551-6776-22.4.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary aim was to determine whether watching a short video in the inpatient setting could produce an immediate improvement in pediatric patients' asthma knowledge and inhaler technique. METHODS This prospective, quasi-experimental, pre-post study was conducted in a single center, in Detroit, Michigan, which primarily serves an urban, African-American population. Patients were eligible if they were between 8- and 16-years-old, had asthma, and would be discharged with an albuterol metered-dose inhaler. The primary outcome was improvement in the composite score of a knowledge and technique assessment before and after watching a 5-minute video. The lead author developed the video with content validation by pharmacists, pediatricians, elementary school teachers, and a pediatric health education specialist. Secondary outcomes at 30 days included change in asthma control and whether the video was revisited after discharge. RESULTS Thirty patients were enrolled. Their average age was 11 ± 2.1 years; they were primarily African American (83%), female (53%), and insured by Medicaid (87%). The composite score of technique assessment and written quiz increased by 3.53 (95% confidence interval [CI] 2.81 to 4.85) of a possible 16 points after watching the video. There was no significant change in asthma control at 30 days as measured by the asthma control test (2, 95% CI -0.53 to 4.53). Eight of 22 patients revisited the video after discharge. CONCLUSIONS A brief educational video delivered during a pediatric inpatient visit in an urban medical center resulted in an immediate improvement in patients' disease knowledge and inhaler technique.
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Guarnaccia S, Pecorelli G, Bianchi M, Cartabia M, Casadei G, Pluda A, Quecchia C, Gretter V, Bonati M. IOEASMA: an integrated clinical and educational pathway for managing asthma in children and adolescents. Ital J Pediatr 2017. [PMID: 28646883 PMCID: PMC5483293 DOI: 10.1186/s13052-017-0374-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the lack of real life clinical and educational studies, "Io e l'Asma" Centre performed this implementation research (IR). Evaluate long-term effectiveness on bronchial asthma control of an integrated clinical and educational pathway for asthmatic children and adolescents. METHODS An observational retrospective pre-post intervention IR study was conducted among 262 children with asthma, ages 6-15 yrs. The intervention protocol included three clinical visits 8 weeks apart; an educational course at visit 1, post intervention consisted in two follow-up visits 6 months apart. The primary outcome was to verify the percentage of children who achieved bronchial asthma control at each visit. Secondary outcomes were based on daily therapy modulation, hospital admissions and the number of school days missed. An economic assessment was also included. RESULTS Two hundred sixty two children with bronchial asthma completed the pathway and were included in the analysis. The percentage of children who obtained disease control increased from 44% at visit 1 to 79% at visit 3 and at 1-year follow-up was 83%. Hospital admissions represent 11% of children: 8% before the intervention, 2% during the intervention, and 1% before and during the intervention; no hospitalizations related to bronchial asthma exacerbations were reported during the 2 follow-up visits. CONCLUSIONS The therapeutic-educational pathway was adapted according to the international guidelines and the primary performance indicators. Our findings confirmed that the clinical plus educational approach, shared between specialists and family physicians, is an effective template for asthma management. These findings also demonstrated a strong economic advantage.
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Affiliation(s)
- Sebastiano Guarnaccia
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Gaia Pecorelli
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marina Bianchi
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Cartabia
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gianluigi Casadei
- CESAV, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ada Pluda
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Quecchia
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valeria Gretter
- "Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Bonati
- Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Arumugom A, Chandrasekaran V. A Randomized Comparison between Video Demonstration and Verbal Instruction in Improving Rota Haler Technique in Children with Persistent Asthma: A Pilot Study. J Clin Diagn Res 2017; 11:SC05-SC07. [PMID: 28764257 DOI: 10.7860/jcdr/2017/26720.10060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Inhalation therapy is the cornerstone in management of asthma. Failure to use the device properly is one of the factors incriminated in poor control of asthma. AIM To compare the technique of rota haler use in children with persistent asthma immediately after receiving either verbal instruction or a video based demonstration and again at one month following intervention. MATERIALS AND METHODS A total of 28 children, older than six years attending the childhood asthma clinic of our hospital, who were prescribed rota halers for the first time and who were technique naïve were enrolled into the study, after obtaining informed consent from the parents after meeting inclusion and exclusion criteria. They were then randomly assigned to either verbal instructions (group of 14) or video demonstration group (group of 14), for teaching them the rota haler technique. Their technique was then assessed using a modified version of the inhaler device assessment tool immediately after education and one month after the intervention. The proportions of children with good technique in both groups at both time points were compared. RESULTS There was no significant difference in the baseline variables like age, gender, location, socio-economic status and disease duration between both groups. The proportion of children achieving good technique was significantly more in the video group than the oral instruction group at immediate assessment and also at one month post intervention with an odds of 8 and 23.40 respectively (p=0.0262 and 0.0075 respectively). CONCLUSION Video demonstration is effective in improving the technique of rota haler use at immediate assessment and at one month post intervention. Further studies are needed to validate this study and to assess factors that predict successful device use.
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Affiliation(s)
- Archana Arumugom
- Undergraduate Student, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkatesh Chandrasekaran
- Assistant Professor, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Gillette C, Stanton RB, Anderson HG. Student performance on a knowledge-based exam may predict student ability to communicate effectively with a standardized patient during an objective structured clinical examination. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:201-207. [PMID: 29233404 DOI: 10.1016/j.cptl.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/03/2016] [Accepted: 11/25/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND The purpose of this article is to describe the extent that student performance on in-class exams in a drug information course is associated with student performance on medication counseling in a high-stakes assessment using standardized patients (SP). METHODS Students completed two traditional knowledge-based exams during a drug information and communication course. The objective structured clinical examination (OSCE) was the final exam for the course. The OSCE consisted of the student counseling an SP on the use of a medication. A counseling rubric was developed for use in a second-year (P2) OSCE based on the Indian Health Services counseling model and social cognitive theory. Multiple linear regression was used to examine if traditional exams and student admission characteristics were associated with student performance on the OSCE. RESULTS A total of 78 P2 students took the in-class exams and the OSCE. Students with higher scores on the second in-class traditional, knowledge-based exam had significantly higher scores on the OSCE. CONCLUSION A traditional knowledge-based exam on pharmacist-patient communication was associated with students' actual counseling performance on an OSCE. Faculty may be able to use exam scores to target students at high risk of doing poorly on a medication counseling OSCE.
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Affiliation(s)
- Chris Gillette
- Marshall University School of Pharmacy, Huntington, WV 25755.
| | | | - H Glenn Anderson
- Marshall University School of Pharmacy, 1 John Marshall Dr., Huntington, WV 25755.
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Orfanos S, Carsin A, Baravalle M, Dubus JC. [Health care providers' knowledge and abilities to use inhalation devices and spacers]. Rev Mal Respir 2016; 34:561-570. [PMID: 27863828 DOI: 10.1016/j.rmr.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Inhaled therapy is the mainstay of asthma treatment due to its local and rapid action. However, its efficiency relies on the teaching of a good inhalation technique by health care providers. We assessed health care providers' knowledge and practical skills in the use of inhalation devices. METHODS An observational multicenter study was conducted in the pulmonology and paediatric wards in Marseille. The departments' common practices, theoretical knowledge and practical skills were assessed through a questionnaire and a demonstration using a spacer device. RESULTS Forty health care providers were interviewed (9 attending physicians, 14 residents, 16 nurses and 1 physiotherapist), in 8 different pulmonology and paediatric wards. A total of 42.5% reported previous training in inhalation device technique. When evaluating theoretical knowledge, we found a mean of 54% correct answers. Attending physicians did significantly better than residents and nurses. With regard to practical skills, we found a mean of 1.12 failed steps out of 7. Here again attending physicians did significantly better than residents and nurses. CONCLUSION Based on the results of our study, we recommend that attending physicians provide training of inhalation technique to nurses and residents, as they did significantly better theoretically and practically.
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Affiliation(s)
- S Orfanos
- Faculté de médecine, Aix Marseille université, 13000 Marseille, France.
| | - A Carsin
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
| | - M Baravalle
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
| | - J-C Dubus
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
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Soo YY, Luckie KH, Saini B, Kritikos V, Brannan JD, Moles RJ. Improving childcare staff management of acute asthma exacerbation - An Australian pilot study. J Asthma 2016; 54:732-740. [PMID: 27834496 DOI: 10.1080/02770903.2016.1258076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of an asthma first-aid training tool for childcare staff in Australia. The effects of training on both asthma knowledge and skills were assessed. METHODS A pre/post-study design was utilised to assess changes in asthma knowledge and asthma first-aid skills in childcare staff before and after an educational intervention. Asthma first-aid skills were assessed from the participant's response to two scenarios in which a child was having a severe exacerbation of asthma. Asthma knowledge and asthma skills scores were collected at base-line and 3 weeks post the education session, which involved feedback on each individual's skills and a brief lecture on asthma delivered via PowerPoint presentation. RESULTS There was a significant improvement after intervention in asthma knowledge (Z = -3.638, p < 0.001) and asthma first-aid skills for both scenario 1 (Z = -6.012, p < 0.001) and scenario 2 (Z = -6.018, p < 0.001). In scenario 1 and 2, first-aid skills improved by 65% (p < 0.001) and 57% (p < 0.001), respectively. Asthma knowledge was high at baseline (79%) and increased by 7% (p < 0.001) after the educational intervention. These asthma knowledge results were not significant when adjusted for prior knowledge. Results suggest that knowledge assessment alone may not predict the practical skills needed for asthma first-aid. CONCLUSIONS Skills assessment is a useful adjunct to knowledge assessment when gauging the ability of childcare staff to manage acute asthma exacerbation. Skills assessment could be considered for incorporation into future educational interventions to improve management of acute asthma exacerbation.
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Affiliation(s)
- Yien Yien Soo
- a National Prescribing Service , Learning Specialist Program & Product Development , Surry Hills , Australia
| | - Kate Helen Luckie
- b Department of Pharmacy, University of Sydney , Camperdown Campus , Sydney , Australia
| | - Bandana Saini
- b Department of Pharmacy, University of Sydney , Camperdown Campus , Sydney , Australia
| | - Vicky Kritikos
- c The University of Sydney , Woolcock Institute of Medical Research , Sydney , Australia
| | - John D Brannan
- d Department of Respiratory and Sleep Medicine , John Hunter Hospital , Hunter , 2310 Australia
| | - Rebekah Jane Moles
- b Department of Pharmacy, University of Sydney , Camperdown Campus , Sydney , Australia
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Gillette C, Rockich-Winston N, Kuhn JA, Flesher S, Shepherd M. Inhaler Technique in Children With Asthma: A Systematic Review. Acad Pediatr 2016; 16:605-15. [PMID: 27130811 DOI: 10.1016/j.acap.2016.04.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pediatric asthma is an important public health problem worldwide. The primary methods of medication delivery are inhalation devices. OBJECTIVES This systematic review examined: 1) what is the prevalence of correct inhaler technique among children with asthma, 2) are educational interventions associated with improved rates of correct inhalation technique, and 3) is improved inhaler technique associated with improved asthma outcomes? DATA SOURCES We included experimental and observational studies through searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, and clinicaltrials.gov. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies were eligible for this review if at least 1 outcome measure of the study included and reported results of child/adolescent inhaler technique. STUDY APPRAISAL AND SYNTHESIS METHODS The following information was extracted from each included study: study design (experimental vs observational), and outcomes data. The Downs and Black checklist was used to appraise study quality. RESULTS Twenty-eight studies were eligible for inclusion. We found that inhaler technique is generally very poor among children, but is better when children use their metered-dose inhalers (MDIs) with spacers. Technique in using turbuhalers and diskus inhalers is better than in MDI, but still poor. Counseling children on correct inhaler technique was associated with improved technique among children in multiple studies. LIMITATIONS We examined articles published in English. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Inhaler technique in children is generally poor. Physicians and other members of the health care team should instruct children and their caregivers on the proper use of their inhalation devices at every opportunity and correct mistakes when made to ensure effective medication delivery. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO CRD42015025070 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025070).
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Affiliation(s)
- Chris Gillette
- Marshall University School of Pharmacy, Huntington, WVa; Marshall University College of Health Professions, Huntington, WVa.
| | | | - JoBeth A Kuhn
- Marshall University School of Pharmacy, Huntington, WVa
| | - Susan Flesher
- Marshall University Joan C. Edwards School of Medicine, Huntington, WVa
| | - Meagan Shepherd
- Marshall University Joan C. Edwards School of Medicine, Huntington, WVa
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Sleath B, Carpenter DM, Lee C, Loughlin CE, Etheridge D, Rivera-Duchesne L, Reuland DS, Batey K, Duchesne CI, Garcia N, Tudor G. The development of an educational video to motivate teens with asthma to be more involved during medical visits and to improve medication adherence. J Asthma 2016; 53:714-9. [PMID: 27145093 DOI: 10.3109/02770903.2015.1135945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our objective was to develop a series of short educational videos for teens and parents to watch before pediatric visits to motivate teens to be more actively involved during their visits. METHODS The development of the short educational videos was theoretically guided by Social Cognitive Theory. First we conducted four focus groups with teens (ages 11 to 17) with asthma, four focus groups with the teens' parents, and seven focus groups with pediatric providers from four clinics. The research team, which included two teens with asthma and their parents, analyzed the focus group transcripts for themes and then developed the initial video script. Next, a visual storyboard was reviewed by focus groups with parents and four with teens to identify areas of the script for improvement. The English videos were then produced. Focus groups with Hispanic parents and teens were then conducted for advice on how to modify the videos to make a more culturally appropriate Spanish version. RESULTS Based on focus group results, teen newscasters narrate six one- to two-minute videos with different themes: (a) how to get mom off your back, (b) asthma triggers, (c) staying active with asthma, (d) tracking asthma symptoms, (e) how to talk to your doctor and (f) having confidence with asthma. Each video clip has three key messages and emphasizes how teens should discuss these messages with their providers. CONCLUSIONS Teens, parents, and providers gave us excellent insight into developing videos to increase teen involvement during medical visits.
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Affiliation(s)
- Betsy Sleath
- a Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Delesha M Carpenter
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Charles Lee
- c Polyglot Systems Inc. , Morrisville , NC , USA
| | - Ceila E Loughlin
- d University of North Carolina at Chapel Hill, School of Medicine , Chapel Hill , NC , USA
| | - Dana Etheridge
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Laura Rivera-Duchesne
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Daniel S Reuland
- e School of Medicine, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Karolyne Batey
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Cristina I Duchesne
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Nacire Garcia
- a Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Welch MJ. Pharmacokinetics, pharmacodynamics, and clinical efficacy of albuterol RespiClick(™) dry-powder inhaler in the treatment of asthma. Expert Opin Drug Metab Toxicol 2016; 12:1109-19. [PMID: 27424535 DOI: 10.1080/17425255.2016.1209485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Incorrect use of inhaler devices by patients with asthma is common and can adversely affect clinical outcomes. Devices that are straightforward to use are less likely to result in dosing errors and can improve patients' satisfaction with therapy and adherence. A novel dry-powder formulation of the rescue bronchodilator albuterol (salbutamol) administered using a multidose dry-powder inhaler (mDPI; RespiClick™) has recently been approved in the USA. AREAS COVERED Studies on the albuterol mDPI were identified in searches of PubMed and www.clinicaltrials.gov . Pharmacokinetic, pharmacodynamic, efficacy, and safety data, and patients' experiences with the albuterol mDPI are presented. EXPERT OPINION The albuterol mDPI has an efficacy/tolerability profile consistent with other inhaled forms of albuterol, and is reliable, easy to use, and associated with a high level of patient satisfaction. This is the first albuterol dry-powder inhaler (DPI) to become available in the USA, with most other formulations being delivered using a pressurized metered-dose inhaler (pMDI). The availability of a breath-actuated device avoids the challenge of coordinating actuation and breathing when using pMDIs, and could simplify treatment for patients also using a DPI for controller medication. Additional features of RespiClick, such as an integrated dose counter and minimal pre-inhalation preparation, facilitate its use.
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Affiliation(s)
- Michael J Welch
- a University of California , School of Medicine , San Diego , CA , USA.,b Allergy & Asthma Medical Group & Research Center , San Diego , CA , USA
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Carpenter DM, Alexander DS, Elio A, DeWalt D, Lee C, Sleath BL. Using Tailored Videos to Teach Inhaler Technique to Children With Asthma: Results From a School Nurse-Led Pilot Study. J Pediatr Nurs 2016; 31:380-9. [PMID: 26947730 DOI: 10.1016/j.pedn.2016.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Our purpose was to test whether a tailored inhaler technique video intervention: (1) could be feasibly implemented by school nurses and (2) improve the inhaler technique of children with asthma. METHODS School nurses recruited a convenience sample of 25 children with asthma (ages 7-17) and assessed their inhaler technique. Children then watched a tailored video that provided: (1) step-by-step feedback on which steps (out of 8) they performed correctly, (2) praise for correctly-performed steps, and (3) statements about why incorrectly-performed steps are important. Nurses reassessed the child's inhaler technique immediately after watching the video and again 1month later. Non-parametric Wilcoxon signed rank tests were calculated to assess whether children's technique significantly improved from baseline to post-video and baseline to 1-month follow-up. A focus group with the school nurses was conducted post-intervention to discuss feasibility issues. RESULTS Children's inhaler technique improved by 1.2 steps (with spacer; p=0.03) and 2.7 steps (without spacer; p<0.01) from baseline to post-video. These improvements were maintained at 1-month follow-up. School nurses believed the intervention was feasible to implement and met an important educational need. CONCLUSIONS A school nurse-led tailored video intervention is feasible to implement and a promising method for improving children's inhaler technique.
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Affiliation(s)
| | | | - Alice Elio
- Buncombe County Department of Health, Asheville, NC
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Boise E, Rotella M. ABCs of asthma inhaler and device training. Int Forum Allergy Rhinol 2016; 5 Suppl 1:S71-5. [PMID: 26335839 DOI: 10.1002/alr.21605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/15/2015] [Accepted: 06/23/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of poor adherence and medication administration is well documented, as are the difficulties with asthma inhaler and device usage. However, difficulties with these devices and inhalers continue to present significant challenges to many healthcare providers and patients. METHODS A systematic review of the published, peer-reviewed international literature was performed to identify likely teaching needs as well as available and recommended resources to address same. RESULTS Asthma inhaler and device use and educational needs vary as widely as do the types and severity of usage errors committed. Multiple interventions have been studied and found to be effective at improving both patient technique and overall asthma outcomes. CONCLUSION Providers must ensure that patient teaching is performed by suitably prepared staff members. Education should be device-specific, patient-centered, and repeated at frequent intervals. Providers must frequently reassess patient understanding and ability with regard to asthma inhalers and devices in order to maximize therapeutic outcomes.
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Affiliation(s)
- Elizabeth Boise
- Department of Otolaryngology-Head and Neck Surgery, Division of Sinus and Allergy, The Ohio State University, Columbus, OH
| | - Melissa Rotella
- Department of Otolaryngology-Head and Neck Surgery, Rhinology Division, The Emory Clinic, Atlanta, GA
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