Asthma Education Program Research Articles

Knowledge of self-management and asthma control among asthma patients attending a polyclinic in Western part of Singapore

BACKGROUND: Self-management is important for asthma control, yet it is unclear whether asthmatic patients have sufficient knowledge to optimally manage their disease. We examined the associations between the knowledge of self-management in adult patients attending a polyclinic in Singapore, sociodemographic factors, and asthma control. MATERIALS AND METHODS: A cross-sectional survey was conducted among adult asthmatic patients in a public primary care clinic (polyclinic) using convenience sampling. A a structured and validated self-administered questionnaire solicited the responses of study participants. Questionnaire comprised three sections: (1) Sociodemographic and asthma-related variables, (2) Modified Asthma Self-Management Questionnaire (ASMQ), and (3) The GINA assessment of asthma control. Participants completed the questionnaire in the clinic waiting area and returned them into a sealed box in the same area. Data were analyzed using SPSS version 29.0. Summary statistics were used to describe the study sample; t-test or analysis of variance (ANOVA), as appropriate, tested the differences in self-management knowledge by sociodemographic characteristics. Logistic regression was used to determine the association between asthma control and self-management knowledge controlling for sociodemographic characteristics. RESULTS: The sample comprised 141 asthma patients; Out of a total of 100 points, the mean ASMQ score was 46.8 (standard deviation 21.7). The scores for the knowledge of self-management of Asthma differed by age, level of education, and having been taught about asthma on bivariate analyses (P < 0.05). Linear regression showed a significant association of asthma self-management knowledge with educational level only. No association was observed between ASMQ scores and asthma control. CONCLUSION: There were gaps in patients’ knowledge about asthma self-management, although they were generally knowledgeable about the inhaler technique. Higher education levels were associated with higher levels of knowledge beyond the effect of age and having been instructed about asthma, suggest that it is crucial that educational programs on asthma are made accessible to patients with lower levels of education. Further research needs to determine whether asthma educational programs targeting the knowledge gaps found in this study can improve knowledge of self-management and asthma control.

Assessing the implementation of a tertiary care comprehensive pediatric asthma education program using electronic medical records and decision support tools

Background Self-management education is integral for proper asthma management. However, there is an accessibility gap to self-management education following asthma hospitalizations. Most pediatric patients and their families receive suboptimal or no education. Objective To implement a comprehensive pediatric asthma education program and evaluate subsequent self-management knowledge in patients as well as behavior change outcomes reflected in the frequency of asthma related repeat emergency department visits and hospitalization. The program implementation was informed by the Knowledge to Translation Action Framework and the i-PARIHS model for quality improvement and involved several iterative stages. Methods We implemented a comprehensive asthma education program for the families of all children 0-18 years old who had been admitted for an asthma exacerbation to the Children’s Hospital of Eastern Ontario (CHEO), beginning on April 1, 2018. The program was adapted to the stages of the Knowledge Translation to Action Framework including undertaking an environmental scan, expert stakeholder feedback, reviews, addressing barriers, and tailoring the intervention, along with evaluating knowledge and health outcomes. Education was delivered over 1-2 h in personalized individual or small group settings, within 4 wk of hospital discharge. All education was provided by registered nurses or respiratory therapists who were also certified asthma educators. The EPIC electronic medical record was used to facilitate referral and scheduling of asthma education sessions, and to track subsequent acute asthma visits. We compared the frequency of a repeat asthma emergency department (ED) visit or hospitalization within 1-year following an initial asthma hospitalization for children who would have received comprehensive asthma education, to a historical cohort of children who were hospitalized between April 9, 2017 – Apr 8, 2018, and did not receive asthma education. Results The program had a high enrollment, capturing nearly 75% of the target population. Most families found the program to be acceptable and reported increased knowledge of how to manage asthma. We identified a crude overall 54% reduction in repeat hospitalizations among children 1 year after implementation of the asthma education program (i.e. 10.2% (23/225) repeat hospitalization rate pre- implementation versus 4.8% (11/227) post-implementation). In adjusted time-to event analysis, this reduction was prominent at 3 months among those who received comprehensive asthma education, relative to those who did not, but this improvement was not sustained by 1 year (HR =1.1, 95% CI =0.55- 2.05; p-value = 0.6). Discussion Although we did not find long-term improvements in ED visits, or hospitalizations, in children of caregivers who participated in comprehensive asthma education, the asthma education program holds potential given that most patients found it to be acceptable and that it increased asthma management knowledge. A future asthma education program should include multiple sessions to ensure that the knowledge and behavior change will be sustained, leading ultimately to long-term reductions in repeat ED visits and hospitalizations.

Effectiveness of pediatric asthma education program in the context of a general hospital in France: A retrospective real-life study

ObjectiveTo assess the feasibility and effectiveness of a pediatric asthma education program delivered in the context of a French suburban general hospital. DesignMonocentric retrospective study including children with asthma in Melun, Île-de-France, from January to December 2019. Data collected concerned asthma management, symptoms, education, and knowledge. ResultsWe included 262 patients with a median age of 4.5 years. Asthma education (AE) was taught to 226 (86 %) children, 36 with minimal education (ME), 155 (69 %) with an unstructured asthma education program (USEP) and 71 (31 %) a structured asthma education program (SEP). Patients with an SEP had better knowledge of the disease and its treatment as compared with those with a USEP or ME (p < 0.05). Lung function was evaluated for 70 % of children with ME, 90 % with a USEP (p = 0.144) and 77 % an SEP (p = 0.455). Allergy testing was assessed for 42 % of children with ME, 69 % a USEP (p = 0.020) and 57 % an SEP (p = 0.185). Almost all children with USEP (93 %) and SEP (94 %) also had a written asthma action plan as compared with 49 % of the children with ME (p < 0.001). Also, 76 % of children with ME did not have an asthma follow-up as compared with 37 % with a USEP and 52 % an SEP. Overall, 69 % of children with ME had at least one hospitalization within the year as compared with 32 % with a USEP (p = 0.001) and 59 % an SEP (p = 0.506). ConclusionsAn asthma education program delivered in a general hospital resulted in increased disease knowledge for children and their caregivers, together with reduced acute interventions.

The relationship between neighborhood economic deprivation and asthma-associated emergency department visits in Maryland.

Asthma represents a substantial public health challenge in the United States, affecting over 25 million adults. This study investigates the impact of neighborhood economic deprivation on asthma-associated Emergency Department (ED) visits in Maryland, using the Distressed Communities Index (DCI) for analysis. A retrospective analysis of Maryland's Emergency Department Databases from January 2018 to December 2020 was conducted, focusing on asthma-associated ED visits. The study involved 185,317 ED visits, majority of which were females (56.3%) and non-Hispanic whites (65.2%). A significant association was found between increased neighborhood socioeconomic deprivation and asthma-related ED visits. The poorest neighborhoods showed the highest rates of such visits. Compared to prosperous areas, neighborhoods classified from Comfortable to Distressed had progressively higher odds for asthma-related ED visits (Comfortable: OR = 1.14, Distressed OR = 1.65). Other significant asthma predictors included obesity, female gender, tobacco smoking, and older age. There is a substantive association between higher asthma-related ED visits and high neighborhood economic deprivation, underscoring the impact of socioeconomic factors on health outcomes. Addressing healthcare disparities and improving access to care in economically distressed neighborhoods is crucial. Targeted interventions, such as community health clinics and asthma education programs, can help mitigate the impact of neighborhood disadvantage.

Impact of School Nurse Asthma Education Program on School Nurses’ Asthma Knowledge and Self-Efficacy Levels: A QuasiExperimental Study

Impact of School Nurse Asthma Education Program on School Nurses’ Asthma Knowledge and Self-Efficacy Levels: A QuasiExperimental Study

Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2021-2022.

Asthma affects more than 25 million Americans, including 4.2 million children. The burden of asthma disproportionately affects people enrolled in Medicaid, among other disparate groups. Improved availability and accessibility of guidelines-based treatments and services may ensure positive health outcomes for people with asthma. In this article, we provide an update to the American Lung Association's Asthma Guidelines-Based Care Coverage Project (the Project) to determine the extent of asthma care coverage and associated barriers in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico, and examine improvements in coverage since 2017. Findings from the Project, representing coverage from 2016-2017, were first published in Preventing Chronic Disease in 2018. The Project was updated in 2021 to reflect the National Asthma Education and Prevention Program guidelines 2020 Expert Panel Report-3 updates, which were finalized in December 2020. It now tracks coverage for 8 areas of guidelines-based care and 7 barriers to care in Medicaid programs by reviewing publicly available plan documents and engaging with Medicaid programs to review and confirm findings. Results from the Project, which reflect coverage in 2021-2022, show an increase in comprehensive coverage in Medicaid programs over the last 5 years. However, coverage remains inconsistent across programs, and barriers to accessing asthma care still exist. Although substantial improvement has been made to coverage, certain gaps and barriers to care must be addressed for patients to fully benefit from guidelines-based care to manage their asthma and improve health outcomes.

Beginning to Address an Implementation Gap in Asthma: Clinicians' Views of Prescribing Reliever Budesonide-Formoterol Inhalers and SMART in the United States.

The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians-particularly in the United States-are not prescribing new inhaler paradigms. Clinician-level reasons for this implementation gap remain largely unexplored. To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States. Community and academic primary care providers, pulmonologists, and allergists who reported regularly caring for adults with asthma were interviewed. Interviews were recorded, transcribed, qualitatively coded, and analyzed using the Consolidated Framework for Implementation Research. Interviews were continued until theme saturation. Among 20 interviewed clinicians, only 6 clinicians described regularly prescribing ICS-formoterol inhalers as a reliever inhaler (either alone or within SMART). Significant barriers to new inhaler approaches included concerns surrounding a lack of Food and Drug Administration labeling for ICS-formoterol as a reliever therapy, a lack of awareness regarding a patient's formulary-preferred ICS-long-acting β-agonist choices, the high cost of combination inhalers, and time constraints. Facilitators to using new inhaler approaches included clinicians' beliefs that the latest inhaler recommendations are simpler and more congruent with real-world patients' behavior, and that a potential change in management strategy would offer a valuable opportunity for shared decision making. Although new guidelines exist in asthma, many clinicians described significant barriers to using them including medicolegal issues, pharmaceutical formulary confusion, and high drug costs. Nonetheless, most clinicians believed that the latest inhaler approaches would be more intuitive for their patients and would offer an opportunity for patient-centered collaboration and care. Stakeholders may find these results useful in future attempts to increase the real-world adoption of recent asthma recommendations.

A pilot study to improve provider adherence to NAEPP guidelines

The prevalence and morbidity of Asthma in the United States has increased since the 1991 National Asthma Education and Prevention Program (NAEPP) and updated Expert Panel Report −3 (EPR-3) guidelines in 2007 were published. To improve provider adherence to the NAEPP EPR-3 guidelines Children's Hospital of Orange County (CHOC) in California integrated the HealtheIntentSM Pediatric Asthma Registry (PAR) into the electronic medical record (EMR) in 2015. MethodsA serial cross-sectional design was used to compare provider management of CHOC MediCal asthma patients before 2014 (N = 6606) and after 2018 (N = 6945) integration of the Registry with NAEPP guidelines into the EMR. Four provider adherence measures (Asthma Control Test [ACT], Asthma Action Plan [AAP], inhaled corticosteroids [ICS] and spacers) were evaluated using General Linear Mixed Models and Chi square. FindingsIn 2018, patients were more likely to receive an ACT, (OR = 14.95, 95% CI 12.67, 17.65, p < .001), AAP (OR = 12.70, 95% CI 11.10, 14.54, p < .001), ICS (OR = 1.85, 95% CI 8.52, 14.54, p < .001) and spacer (OR = 1.45, 95% CI 1.31, 1.6, p < .001) compared to those in 2014. DiscussionThe pilot study showed integration of the Pediatric Asthma Registry into the EMR, as a computer decision support tool that was an effective intervention to increase provider adherence to NAEPP guidelines. Ongoing monitoring and education are needed to promote and sustain provider behavioral change. Additional research to include multi-sites and decreased time between evaluation years is recommended. Application to practiceCan be used for excellent health policy decision making as a direct impact on patient care and outcomes, by improving provider adherence to the NAEPP guidelines.

Student knowledge gains among first-time and repeat attendees of school-based asthma education program

BackgroundBecause children spend much of their time in schools, schools can play an important role in asthma education for the one in 12 affected children in the United States. School-based asthma education programs are commonly repeated annually, however few studies have evaluated the impact of repeated participation in asthma education in school-based programs.MethodsThis observational study evaluated the impact of Fight Asthma Now© (FAN), a school-based asthma education program for children in Illinois schools. Participants completed a survey at the start and end of the program, including demographics, prior asthma education, and 11 asthma knowledge questions (maximum knowledge score = 11).ResultsAmong 4,951 youth participating in the school-based asthma education program, mean age was 10.75 years. Approximately half were male and Black. Over half reported no prior asthma education (54.6%). At baseline, repeat attendees had significantly higher knowledge versus first-time attendees (mean: 7.45 versus 5.92; p < 0.001). After the program, both first-time and repeat attendees had significant knowledge improvements (first-time: mean = 5.92◊9.32; p < 0.001; repeat: mean = 7.45◊9.62; p < 0.001).ConclusionsSchool-based asthma education is effective for increasing asthma knowledge. Notably, repeated asthma education in school leads to incremental benefits for knowledge. Future studies are needed to understand the effects of repeated asthma education on morbidity.

ADHERENCE TO ASTHMA CONTROLLER THERAPY AMONG CHILDREN

Asthma is a chronic respiratory condition that affects millions of children worldwide, necessitating diligent adherence to prescribed asthma controller therapy. This research paper explores the impact of adherence to asthma controller therapy on asthma control and health outcomes in pediatric patients. The study examines various factors influencing adherence rates, such as parental involvement, socio-economic status, and healthcare provider-patient communication. The research utilizes a quantitative approach, and data collected through structured surveys and medical records review. The study population includes children aged 5 to 17 years who were receiving asthma controller therapy. The results demonstrated a significant positive correlation between adherence to asthma controller therapy and improved asthma control. Children with high adherence rates experienced better lung function, reduced asthma symptoms, and fewer asthma exacerbations. Effective adherence also led to decreased healthcare utilization, with fewer emergency department visits and hospitalizations for asthma-related issues. Parental involvement emerged as a crucial factor influencing adherence, with actively engaged parents positively impacting adherence rates. Additionally, effective healthcare provider-patient communication and higher socio-economic status were associated with better adherence. Addressing concerns about potential side effects of medications was identified as a barrier to adherence. The implications of this research extend to healthcare professionals and policy makers. Healthcare providers should prioritize adherence in asthma management and involve parents as active partners in their child's treatment. Implementing comprehensive asthma education programs and promoting effective communication can enhance adherence rates. Policy makers should recognize the cost-effectiveness of adherence interventions and work towards reducing financial barriers to asthma controller therapy.

Impact of Asthma Education Program 2020-2021 on Asthma Control Among Bronchial Asthma Children in Madinah City, Saudi Arabia.

Asthma control among asthmatic children still remains suboptimal. Saudi literature are scarce in this context, and there is a paucity of reports that compare asthma control level pre- and post-education program directed to asthmatic patients and their parents. The objective of this study was to assess the impact of asthma education and flu vaccination on asthma control in asthmatic children in Madinah region from2020 to 2021, in terms of ED visits, hospitalization, pediatric intensive care unit (PICU) admission, and asthma control level. A cross-sectional study was conducted at primary health care (PHC) centers in Al-Madinah City, Saudi Arabia. The study analyzed data from 804 asthmatic children patients from randomly selected six PHC centers. The data were collected by a valid structured questionnaire. The questionnaire included socio-demographic and clinical data. Child asthma symptoms control was examined by the Childhood Asthma Control Test (C-ACT) for children aged 5-12 years, and the Test for Respiratory and Asthma Control in Kids (TRACK) for children less than five years of age. The collected data were analyzed using the appropriate statistical tests. The mean age of the studied children was 6.1±3.0 (1-14 years), with 59.8% of them being males. There have been statistically significant reductions for asthmatic children in ED visits/month, hospitalization, and pediatric ICU admission/years in the post-education groups for all studied patients and patients <five years and five to 12 years. The average ACT and TRACK scores were significantly higher in the post-education group. The controlled asthma was also significantly higher among post-education groups. The rate of ED visits, hospitalization, critical care needs, and PICU admission significantly decreased among children receiving flu vaccination. This study emphasizes the role of asthma education and flu vaccination in improving asthma control status of asthmatic children and in decreasing the rate of ED visits, hospitalization, and critical care needs. More longitudinal and experimental studies are needed to confirm these findings.

American College of Allergy, Asthma and Immunology members' preferred steps 1 to 3 asthma maintenance and reliever therapy and incomplete insurance coverage indicated as main practice hurdle

BackgroundNew asthma guidelines (GINA, 2022; NAEPP EPR-4, 2020) include considerable changes in treatment recommendations, specifically regarding anti-inflammatory rescue and Single MAintenance and Reliever Therapy (SMART). ObjectiveTo explore American College of Allergy, Asthma and Immunology members’ preferred treatment and perceived hurdles. MethodsA survey (SurveyMonkey) regarding steps 1 to 3 asthma therapy was e-mailed to American College of Allergy, Asthma and Immunology members. ResultsThe allergists completed 147 surveys (46% with >20 years of experience; 98% from United States; 29% academic, 75% [also] private practice). In addition, 69% follow the National Asthma Education and Prevention Program and 81% the Global Initiative for Asthma recommendations. Of 147 allergists, 117 (80%) indicated correctly what SMART strategy is; 21%/36%/50%/39% would use SMART in step 3 treatment of a below 5-year-old/5- to 11-year-old/12- to 65-year-old/above 65-year-old patient, respectively. In this group, 11% to 14% incorrectly chose inhaled corticosteroid (ICS) plus salmeterol and 9% ICS plus vilanterol for SMART. In a 4-year-old needing step 1 therapy (N = 129), 55% of the respondents would add anti-inflammatory therapy; for step 2 treatment, most would prescribe ICS 100 to 200 µg budesonide equivalent daily; in step 3, 49% would prescribe ICS plus long-acting beta-agonist (LABA). In a 7-year-old needing step 1 treatment (N = 134), 40% would prescribe only short-acting beta-agonist; in step 3, 45% would institute SMART strategy, but only 8 of 135 (6%) chose very-low dose ICS plus formoterol (as recommended in Global Initiative for Asthma); most (39%) use low-dose ICS plus formoterol. As for rescue therapy, 59% is now instituting some form of anti-inflammatory rescue. Finally, in a 25-year-old patient (N = 144): in step 1, 39% would prescribe exclusively short-acting beta-agonist; in step 2, 4% only anti-inflammatory rescue and the rest prescribes ICS maintenance; one-third begins SMART strategy at step 2 and 50% in step 3.Major hurdles for prescribing one's preferred strategy included incomplete insurance coverage, insurance not approving more than one canister of ICS-formoterol per month, and cost. ConclusionAsthma therapy varies among physicians, with respondents suggesting underutilization of the recommended anti-inflammatory rescue and SMART therapy. A major hurdle is lack of insurance coverage of medication in line with the guidelines.

The Use of Lactobacillus reuteri as an Adjunct in the Treatment of Children with Newly Diagnosed Asthma in a Tertiary Hospital in the Philippines

Rationale: Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease. Objectives: The objective of the study was to determine the efficacy of L. reuteri as an adjunct for the control of newly diagnosed asthma in children. Methodology and Population: In this analytical, experimental, prospective, randomized controlled trial, 44 asthmatic patients aged 6–18 years were recruited from the University of Santo Tomas Hospital outpatient department, for a study period of three months. Baseline clinical assessment included skin prick test to aeroallergens, spirometry, and Childhood Asthma Control Test. Asthma severity and level of control was based on the National Asthma Education and Prevention Program’s Expert Panel 3 (EPR-3) and the Global Initiative for Asthma Guidelines 2018, respectively. Patients were randomized and half of them received L. reuteri 26.5 mg/chewable tab (at least 100 million colony forming units) once daily for 30 days, while the other half did not. Spirometry and C-ACT test were conducted at the start of intervention as baseline, after one month, two months, and three months post intervention. The results of patients from the experimental group were compared to results of patients in the control group. Results: The FEV1 of patients in the L. reuteri group was significantly higher than those in the control group (p = 0.045). The median FVC of the two groups significantly differed from each other through time (p = 0.007), with the L. reuteri group having significantly higher FVC than the control group. There were statistically significant improvements in ACT scores between patients in the L. reuteri and control groups, particularly at two months and three months of treatment. Among polysensitized patients, there were significant improvements in the FEV1, FEF25–75, and FVC between the L. reuteri and control group. Conclusion: The use of L. reuteri as an adjunct was associated with significant lung function improvement and asthma symptom control amongst newly diagnosed asthmatic children. Key Words: Lactobacillus reuteri, Probiotics, Asthma, Children

Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

The Impact of Cultural Factors, The Level of Health Education Received by the Caregivers, and Stigma on Asthma Treatment among Children in Southern Jordan

For asthma treatment in children, caregivers need good knowledge and attitudes regarding the disease and its treatment. This study aimed to determine the impact of cultural factors, the level of health education provided to patients and their families, as well as the impact of stigmatization on the treatment awareness of children with asthma in southern Jordan. A validated questionnaire was used to collect data from a sample of ninety-seven caregivers selected from three hospitals in southern Jordan. Open ended questions were answered after demonstrating the inhaler technique in and evaluated according to the instructions of the National Asthma Education and Prevention Program (NAEPP, 2013). The result revealed moderate knowledge of asthma with a mean score of (22.36/32), as well as moderate knowledge of asthma treatment (24.26/40). A high mean was found for the impact of cultural and environmental factors (22.93/28), whereas low impact was found for stigma with a mean value of (4.73/12). Therefore, to improve future asthma management, additional efforts are required to educate caregivers and improve their asthma awareness and rectify any falsehoods regarding asthma medications by health care providers.

Comparison of National and Global Asthma Management Guiding Documents.

Asthma is a common chronic disease that affects both adults and children, and that continues to have a high economic burden. Asthma management guidelines were first developed nearly 30 years ago to standardize care, maintain asthma control, improve quality of life, maintain normal lung function, prevent exacerbations, and prevent asthma mortality. The two most common asthma guidelines used today were developed by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Working Group and the Global Initiative for Asthma Science Committee. Both guiding documents use scientific methodology to standardize their approach for formulating recommendations based on pertinent literature. Before the 2020 National Asthma Education and Prevention Program (Expert Panel Report 4), nothing had been released since the 2007 guidelines, whereas the Global Initiative for Asthma publishes updates annually. Although each of these asthma strategies is similar, there are some noted differences. Over the years, the focus of asthma treatment has shifted from acute to chronic management. Frontline respiratory therapists and other health-care providers should have a good understanding of these 2 guiding references and how they can impact acute and chronic asthma management. The primary focus of this narrative is to look at the similarities and differences of these 2 guiding documents as they pertain to the 6 key questions identified by the Expert Panel of the National Asthma Education and Prevention Program.

Factors Associated With Persistence of Severe Asthma From Late Adolescence to Early Adulthood

To determine risk factors in childhood that predict severe persistent asthma in late adolescence and early adulthood.Patients aged 5 to 12 years with mild to moderate asthma and a positive methacholine challenge enrolled in the Childhood Asthma Management Program (CAMP) trial.The CAMP participants above who had data available from late adolescence to early adulthood were included. The first study visit at age 18 years was used to determine asthma activity in late adolescence, whereas the first study at age 22 years was used to determine asthma activity in early adulthood. The American Thoracic Society definition of severe asthma was used for patients on high dose inhaled corticosteroids and the National Asthma Education and Prevention Program Expert Panel Report (NAEPP EPR) 3 definition of severe asthma was used for those not receiving high dose inhaled corticosteroids. Additional criteria for intermittent and persistent asthma were included. The following factors were analyzed: secondhand smoke exposure, maternal smoking during pregnancy, body mass index percentile, hay fever, eczema, food allergy, parental asthma being sensitized and exposed to any perennial aeroallergen, bronchial hyperreactivity, prebronchodilator FEV1/FVC ratio, post bronchodilator FEV1/FVC ratio, bronchial hyperresponsiveness to methacholine challenge, log10 of serum total IgE and log10 of serum absolute eosinophil count. Characteristics were compared from baseline to late adolescence and from baseline to early adulthood.Six hundred eighty-two CAMP participants were included. Of these participants, severe asthma was present in 81 (12%) participants in late adolescence and 131 (19%) participants in early adulthood. Half of the patients with severe asthma in late adolescence continued to have severe asthma into early adulthood. About 18% of patients improved severity, 61% did not change, and 21% of patients worsened in severity from late adolescence to early adulthood. The postbronchodilator percent predicted FEV1 and pre and post bronchodilator FEV1/FVC ratio significantly decreased from childhood to late adolescence and from late adolescence to early adulthood (P < .0001), whereas prebronchodilator FEV1 values increased from childhood to late adolescence (P < .0001) and stabilized in early adulthood (P = .040). Bronchodilator reversibility and bronchial hyperresponsiveness each decreased from childhood to late adolescence (P < .0001), whereas bronchial hyperresponsiveness also significantly decreased from childhood to early adulthood (P = .0003). Patients with persistent and severe asthma had higher serum IgE in late adolescence and were more likely to have a positive aeroallergen skin test, along with sensitization and exposure to perennial allergens in childhood. Significant factors in early childhood that were associated with persistence of severe asthma from late adolescence to early adulthood included a younger age, male sex, no reported hay fever, a low prebronchodilator FEV1/FVC ratio, a low postbronchodilator FEV1/FVC ratio, and a physician diagnosis of moderate asthma during the screening period. Notably, for every 5% decrease in post bronchodilator FEV1/FVC ratio in childhood, the odds of severe asthma persistence increased by 2.36-fold (P < .0001) as well as maternal smoking during pregnancy increased odds of severe asthma persistence by 3.17-fold (P = .020). There was a strong association between a reduced-growth lung function trajectory and severe asthma persistence.Lower FEV1/FVC ratio in childhood and maternal smoking during pregnancy were the strongest predictors for severe asthma between late adolescence and early adulthood.Understanding early factors for persistence of asthma into adulthood can help develop targeted primary prevention measures such as reduction of smoking during pregnancy as well as early intervention measures with therapies to preserve lung function in childhood.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1164/rccm.202010-3763OC

IMPLEMENTING THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ®) AND ASTHMA CHECKLIST INTO DIVERSE CLINICAL PRACTICES

<h3>Introduction</h3> The Asthma Impairment and Risk Questionnaire (AIRQ®) is a 10 item, yes/no, impairment- and risk-based control assessment. Scores of 0-1 indicate well-controlled (WC), 2-4 not-well controlled (NWC), and 5-10 very poorly controlled (VPC) asthma. The Asthma Checklist is a decision support tool designed to facilitate implementation of Guideline and Expert Report recommendations into practice at point-of-care. <h3>Methods</h3> 840 patients with asthma aged ≥13 years completed AIRQ® at the start of a practice implementation study in primary care (n=6), specialty practice (n=6), and an educational asthma coaching program (n=1). Clinicians/educators reviewed AIRQ® responses with their patients in face-to-face or telehealth visits and indicated which Asthma Checklist items they planned to address. Items chosen were compared among AIRQ® control levels and practice types (Chi-square, p≤0.05). <h3>Results</h3> 70.5% were female; age 45.4(±18.4) years; AIRQ®: 42.3% WC, 31.5% NWC, 26.2% VPC. Adherence and appropriate therapy were assessed for the majority of patients, regardless of control (<b>TABLE</b>). Overall and individually for primary and specialty care, all other Asthma Checklist items were assessed more frequently with worsening control (p<0.01, for each). Aside from phenotyping, evaluating alternative diagnoses/hidden comorbidities, and considering advanced/add-on therapies, the educational coaching program assessed more Asthma Checklist items (p<0.01 for each) without regard for control level. <h3>Conclusion</h3> The asthma educational coaching program addressed more concepts from the Asthma Checklist; whereas primary care and specialty clinicians' assessments were more targeted to control level. Longitudinal follow-up is planned to determine the impact of implementing AIRQ® and Asthma Checklist into primary and specialty practices.

Asthma management: How the guidelines compare

This quick guide details the similarities and differences between recommendations from the National Asthma Education and Prevention Program and the Global Initiative for Asthma.

HOME MONITORING & TELEHEALTH EDUCATION FOR ASTHMA DISEASE MANAGEMENT

<h3>Introduction</h3> Asthma disease management requires self-management skills and personalized clinical interventions. Allergy and Asthma Network (AAN) collaborated with CurieAI and VitalFlo to monitor patient symptoms and spirometry as part of a personalized telehealth asthma education program. <h3>Methods</h3> The Not-One-More-Life telehealth AAN program enrolled participants with severe asthma between July and December 2021 for a 6-week virtual asthma telehealth coaching program. Participants were provided with a cellular-connected bedside tablet device for passive nighttime symptom monitoring. The CurieAI software running on the tablet device enabled daily overnight monitoring for objective assessment of audible symptoms; like cough, sneeze, throat-clearing, wheezing, obstructive-snoring, grunting. VitalFlo solution using a MIR spirometer was provided to measure FEV1, FVC, FEV1/FVC parameters. <h3>Results</h3> 22 participants used the two home monitoring devices. There were a total of 862 nights of monitoring for symptoms (39+ nights per participant in the 6 weeks). 20 high-level alerts were generated for severe or worsening symptoms. An asthma coach followed these symptoms with the participant, provided treatment plan guidance, and advised them to see the healthcare provider. Participants used VitalFlo solution for an average of 3.5 days per participant during the same 6-week period. 32% of participants experienced improvement in their FEV1 and FVC, and 27% improvement in FEV1/FVC. <h3>Conclusion</h3> Asthma disease management telehealth program with home monitoring devices successfully followed participants' health status. Participants who used the Vitalflo platform to document spirometry use indicated improvement between pre-and-post recordings and the nighttime monitoring identified worsening of symptoms for timely follow-up.