Asthma Inhaler Research Articles

Chiesi launches postal asthma inhaler recycling scheme

Chiesi launches postal asthma inhaler recycling scheme

Community pharmacies will be paid to check patients' asthma inhaler technique from September 2021

Community pharmacies will be paid to check patients' asthma inhaler technique from September 2021

Contact Tracing (Honolulu, HI, March 22, 2020)

I try not to touch my face while shopping at a crowded Costco. I'm lucky to still have a job, to afford food and rent in the most expensive place in the world to buy toilet paper. Today, the governor issued a work-from-home order. Community spread, panic. Yet thousands of tourists continue arriving aboard cheap flights and cruise ships—reservoirs of disease. Not even a pandemic can shutdown paradise. Then I fill my car at the gas station, pick up my daughter's prescription pills and asthma inhaler at the pharmacy. I sanitize my hands after every errand. When I return home, my wife and daughter are playing dress-up. CNN echoes on the television (‘250,000 cases worldwide’). I put away the groceries in the pantry and fridge (‘10,000 deaths’). Freeze enough meat to last a month (‘bats and pangolins butchered’). Disinfect handles and doorknobs (‘habitats destroyed’). My mom calls. Cough, sore throat— “Just allergies,” she reassures. ‘It's cold in California.’ I ask about grandma (92-years-old, dementia). ‘Her care home is quarantined,’ she answers. ‘If she dies, we aren't allowed to have a funeral service.’ Yet isn't grieving together our most essential business? ‘Tomorrow, I'll visit her,’ my mom continues. ‘Wave through the window.’ I feel an ocean length apart (‘rising like an invisible tide’). My daughter falls asleep on the couch: her body curls like a flattened curve. My wife takes her temperature: 99.5 degrees. How long can we shelter-in-place? How long can we shelter each other in a world where children can't play with friends at school, where elders can't breathe without ventilators, where we can't touch without fear? How long can we shelter a planet where there's no vaccine for the virulent outbreaks of human greed and violence? ‘I want to hug my grandkids,’ my mom sighs, no longer able to hold our tears at a safe distance. even on maps tracking the coronavirus pandemic the pacific islands are invisible as if we are quarantined from sight don't fear ‘social distancing’ the ocean will always connect us Craig Santos Perez is a Chamoru poet from Guam. He is the author of five books of poetry and the co-editor of five anthologies. He is a Professor of Creative Writing in the English department at the University of Hawai'i at Mānoa.

Dual-combination maintenance inhaler preferences in asthma and chronic obstructive pulmonary disease: A patient-centered benefit-risk assessment

BackgroundA variety of dual-combination maintenance inhalers are used to treat asthma and chronic obstructive pulmonary disease (COPD). Understanding patient preferences for treatment attributes may help select an optimal treatment from the patient perspective. MethodsPatient preferences for maintenance inhaler device and medication attributes were elicited through a discrete choice experiment and used in benefit-risk assessments to calculate predicted choice probabilities (PrCPs) for 14 dual-combination maintenance inhalers in four treatment classes: lower- and higher-dose inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) inhalers for asthma, and ICS/LABA and long-acting muscarinic antagonist (LAMA)/LABA inhalers for COPD. ResultsFor all treatment classes, reduced exacerbations and faster onset of action were the most important attributes. For all classes, patients were willing to tolerate an extra yearly exacerbation to decrease the medication's onset of action from 30 to 5 min. For patients with asthma using lower-dose ICS/LABA (n = 497), budesonide/formoterol fumarate dihydrate (80 μg/4.5 μg) pressurized metered-dose inhaler (pMDI) had the highest PrCP (28.4%), and for those using a higher-dose ICS/LABA (n = 285), PrCPs were highest for mometasone furoate/formoterol fumarate dihydrate (200 μg/5 μg) pMDI (27.0%) and budesonide/formoterol fumarate dihydrate (160 μg/4.5 μg) pMDI (26.9%). For patients with COPD using an ICS/LABA (n = 574), budesonide/formoterol fumarate dihydrate (160 μg/4.5 μg) pMDI had the highest PrCP (56.6%), and for those using a LAMA/LABA inhaler (n = 217), tiotropium/olodaterol (2.5 μg/2.5 μg) soft mist inhaler had the highest PrCP (42.3%). ConclusionsPatient preference data for maintenance inhaler attributes can be used to identify a preference order of inhalers in different treatment classes.

Perceptions, attitudes, and behaviors of short-acting beta2 agonist users: an Australian cross-sectional community pharmacy-based study

Background High use of short-acting beta-2-agonist (SABA) medication is a significant problem. Attitudes and perceptions toward asthma of over-the-counter (OTC) reliever users are unknown. The study aimed to describe the asthma attitudes, perceptions, medication knowledge and information gathering behavior of people with asthma with recent high SABA use (i.e. SABA use > twice a week in the last 4 weeks) and compare them to people with asthma with no recent high SABA use. Method A real-world cross-sectional observational study in Australian community pharmacies was conducted; surveying patients ages ≥ 16 years requesting SABA medication OTC. Data collected included; demographics, medication usage, asthma control, asthma-related perceptions and behaviors. Data were summarized by using descriptive analyses. Results 375 participants completed the survey, 73.9% were high SABA users. Of the 375, 90.4% reported that their asthma symptoms were controlled or somewhat controlled and 56.0% felt that their asthma was not serious. However, only 17.6%, had controlled asthma according to GINA-defined criteria. High SABA users tended to be more anxious about their asthma and worried about its impact in the future (50.5% vs. 28.6%, p < 0.001). High SABA users were more likely to agree with the statements suggesting that asthma impacted on activities of daily living (46.6% vs. 16.3%, p < 0.001); were socially conscious about their asthma and more likely to feel embarrassed carrying (21.3% vs 9.2%, p = 0.007) and using (29.2% vs 18.4%, p = 0.036) their asthma inhaler. Conclusion This study revealed the extent of uncontrolled asthma and uncovered an anxious and socially conscious group of OTC SABA users. There is a need to better understand patient perceptions and their relationships to high-SABA use, to ensure targeted educational interventions are developed and implemented.

Outcome of An Educational Program on Bronchial Asthma Self-Management

Background: Bronchial asthma is a highly prevalent chronic respiratory disease that affects over 300 million persons worldwide with a mortality rate of approximately 250,000 annually. Instructing asthma patients about their illness is significant and the principle accentuation is to build patients' information and to elevate patients' adherence to medication plans. The absence of data about self-management had prompted reluctance of asthmatic patients to disease management activities. Objective: To improve bronchial asthma control in asthmatic patients. This study arranged and executed the bronchial asthma instructive program and assessed and elevated the level of information about asthma self-management strategy of inhaler use and asthma control after training program among adult asthmatic patients. Patients and Methods: An intervention study was conducted on 97 asthmatic patients attended Chest Hospital at Menoufia Governorate. All studied patients were evaluated through four questionnaires titled sociodemographic characteristics, Asthma Self-Management Questionnaire (ASMQ), GINA-2017 criteria of asthma control and a checklist to assess technique of inhaler use. All participants were subjected to health education program. Results: The results revealed that there was a statistically significant difference between patients’ knowledge of asthma self-management, accuracy of inhaler use technique and asthma control before and after the educational program where P < 0.001. Conclusion: Based upon the results of this study, it could be concluded that implementation of educational program had a positive effect on improvement of the patients’ knowledge, practices and self-care strategies post program implementation compared to pre-program implementation.

S1973 Achalasia With Diffuse Esophageal Dilation Causing Tracheal Compression and Severe Asthma

INTRODUCTION: Achalasia is a rare esophageal disorder that is caused by the lack of relaxation of the lower esophageal sphincter, causing loss of peristalsis and a dilated esophagus. Patients present with various upper gastrointestinal complaints. Here, we present the case of a 16-year-old female with history of uncontrolled asthma, including intubation at age 14 for status asthmaticus, who was found to have a massively dilated esophagus causing compression of the trachea. Peroral endoscopic myotomy (POEM) was performed and she experienced complete regression of her asthma symptoms. CASE DESCRIPTION/METHODS: 16-year-old female with history of uncontrolled asthma presents to pulmonology clinic. Pulmonary function testing (PFT) demonstrates severe obstruction (FEV1 33%, FEV1/FVC 45%) with little improvement following a 5-day course of oral steroids. She endorses mild, nonproductive cough. She appears well, speaking full sentences and ambulating without difficulty. She has diminished breath sounds bilaterally. Labs reveal only mild normocytic anemia. She is started on intravenous steroids and inhaler therapy. CT chest without contrast shows diffusely distended esophagus filled with liquid and food debris, exerting mass effect on the trachea and proximal mainstem bronchi, as well as diffuse groundglass opacities and scattered pulmonary nodules. Upon further assessment, the patient endorses occasional dysphagia with solid foods. She has infrequent vomiting episodes but denies odynophagia or weight loss. Eckardt score is 5. EGD reveals dilation in the entire esophagus; EndoFLIP reveals decreased distensibility and absent contractility consistent with type I achalasia. The following day, POEM procedure is performed. Post-procedure Eckardt score is 0. She is discharged home on lansoprazole 30 mg twice daily for 2 months. Over the next 6 months, she experiences complete remission of her asthma symptoms and inhaler therapy is discontinued. She also has complete resolution of dysphagia and gains 50 pounds. DISCUSSION: In our case, the patient had worsening PFT despite adequate treatment for asthma. Chest CT found a dilated esophagus, which may have been present 2 years prior when she was intubated for status asthmaticus. Her respiratory symptoms regressed completely after POEM for achalasia. This case demonstrates the importance of diagnostic review, especially in cases of primary treatment failure. Maintaining a broad differential can help clinicians think critically and correct potential reversible causes.Figure 1.: Chest CT shows diffusely dilated esophagus, likely secondary to achalasia.Figure 2.: Dilated esophagus causing compression of proximal mainstem bronchus.Figure 3.: Liquid and food debris in dilated esophagus near the LES.

Treatment of eosinophlic esophagitis with swallowed topical corticosteroids.

Eosinophilic esophagitis (EoE) is an emerging chronic local immune-mediated disease of the esophagus. Beside proton pump inhibitors and food-restriction-diets swallowed topical corticosteroids (STC) can be offered as a first line therapy according to current guidelines. This review describes the background and practical management of STCs in EoE. So far, mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications “off label”. Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85% - an orodispersible tablet of budesonide has been approved as the first “in label” medication for EoE in Europe in June 2018. Whereas it was shown that disease remission induction of EoE by STCs is highly effective, there is still a lack of data regarding long-term and maintenance therapy. However, current studies on STC maintenance therapy add some movement into the game.

CPD article: Poisons affecting the cardiovascular system

Cardiac and cardiovascular function can be affected by numerous substances, including overdose of drugs for cardiac and cardiovascular conditions, drugs used in the management of other diseases, over-the-counter medicines and supplements, foods and natural toxins such as plants. A common cause of tachycardia in dogs is exposure to salbutamol from piercing an asthma inhaler. Cardiac drugs such as beta-blockers and calcium-channel blockers can cause hypotension and disrupt cardiac rhythm. Although severe cases are not common in companion animals, management may be complex, requiring high dose insulin therapy and/or lipid emulsion therapy. The methylxanthines caffeine and theobromine, which are found in foods, and caffeine in supplements, are readily accessible to pets and can cause central nervous system and muscle (including cardiac muscle) stimulation. Animals with pre-existing cardiac disease or those with a mixed cardiotoxic drug overdose are likely to be more at risk of effects after exposure to substances affecting the cardiovascular system. Support of cardiac and cardiovascular function is essential to prevent cardiac injury and maintain tissue perfusion. Specific management depends on the severity of clinical signs and the particular substance involved.

Poisons affecting the cardiovascular system

Cardiac and cardiovascular function can be affected by numerous substances, including overdose of drugs for cardiac and cardiovascular conditions, drugs used in the management of other diseases, over-the-counter medicines and supplements, foods and natural toxins such as plants. A common cause of tachycardia in dogs is exposure to salbutamol from piercing an asthma inhaler. Cardiac drugs such as beta-blockers and calcium-channel blockers can cause hypotension and disrupt cardiac rhythm. Although severe cases are not common in companion animals, management may be complex, requiring high dose insulin therapy and/or lipid emulsion therapy. The methylxanthines caffeine and theobromine, which are found in foods, and caffeine in supplements, are readily accessible to pets and can cause central nervous system and muscle (including cardiac muscle) stimulation. Animals with pre-existing cardiac disease or those with a mixed cardiotoxic drug overdose are likely to be more at risk of effects after exposure to substances affecting the cardiovascular system. Support of cardiac and cardiovascular function is essential to prevent cardiac injury and maintain tissue perfusion. Specific management depends on the severity of clinical signs and the particular substance involved.

Respiratory and atopic conditions in children two to four years after the 2014 Hazelwood coalmine fire.

To evaluate associations between exposure during early life to mine fire smoke and parent-reported indicators of respiratory and atopic illness 2-4 years later. The Hazelwood coalmine fire exposed a regional Australian community to markedly increased air pollution during February - March 2014. During June 2016 - October 2018 we conducted a prospective cohort study of children from the Latrobe Valley. Seventy-nine children exposed to smoke in utero, 81 exposed during early childhood (0-2 years of age), and 129 children conceived after the fire (ie, unexposed). Individualised mean daily and peak 24-hour fire-attributable fine particulate matter (PM2.5 ) exposure during the fire period, based on modelled air quality and time-activity data. Parent-reported symptoms, medications use, and contacts with medical professionals, collected in monthly online diaries for 29 months, 2-4 years after the fire. In the in utero exposure analysis (2678 monthly diaries for 160 children exposed in utero or unexposed), each 10μg/m3 increase in mean daily PM2.5 exposure was associated with increased reports of runny nose/cough (relative risk [RR], 1.09; 95% CI, 1.02-1.17), wheeze (RR, 1.56; 95% CI, 1.18-2.07), seeking health professional advice (RR, 1.17; 95% CI 1.06-1.29), and doctor diagnoses of upper respiratory tract infections, cold or flu (RR, 1.35; 95% CI, 1.14-1.60). Associations with peak 24-hour PM2.5 exposure were similar. In the early childhood exposure analysis (3290 diaries for 210 children exposed during early childhood, or unexposed), each 100μg/m3 increase in peak 24-hour PM2.5 exposure was associated with increased use of asthma inhalers (RR, 1.26; 95% CI, 1.01-1.58). Exposure to mine fire smoke in utero was associated with increased reports by parents of respiratory infections and wheeze in their children 2-4 years later.

Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program.

Patients with asthma typically increase short-acting β2-agonists (SABA) use with worsening symptoms. Excessive SABA use may lead to a higher risk of adverse outcomes. We evaluated, in a large population cohort, an association between SABA inhaler use and asthma exacerbations and healthcare utilization. As part of the SABINA (SABA use IN Asthma) global program, we conducted a retrospective longitudinal observational study (SABINA I) using UK primary care electronic healthcare records (Clinical Practice Research Datalink; 2007-2017) from asthma patients aged ≥ 12years. SABA inhaler use was classified as 'high use', ≥ 3 canisters/year versus 'low use', 0-2canisters/year. Taking into consideration all their asthma prescriptions, patients were categorized into a treatment step according to 2016 British Thoracic Society (BTS) asthma management guidelines. Multivariable regression assessed the association of SABA inhaler use by BTS treatment steps (grouped as BTS steps 1/2 and 3-5), separately, and with outcomes of exacerbations or asthma-related healthcare utilization (primary care and hospital outpatient consultations); only patients with linked hospital data were included in this analysis. Of the 574,913 patients included, 218,365 (38%) had high SABA inhaler use. Overall, 336,412 patients had linked hospital data. High SABA inhaler use was significantly associated with an increased risk of exacerbations [adjusted hazard ratio, 95% confidence interval (CI): BTS steps 1/2 = 1.20, 1.16-1.24; BTS steps 3-5 = 1.24, 1.20-1.28], asthma-related primary care consultations [adjusted incidence rate ratio (IRR), 95% CI: BTS steps 1/2 = 1.24, 1.23-1.26; BTS steps 3-5 = 1.13, 1.11-1.15], and asthma-related hospital outpatient consultations (adjusted IRR, 95% CI: BTS steps 1/2 = 1.19, 1.12-1.27; BTS steps 3-5 = 1.19, 1.13-1.26). High SABA inhaler use was frequent across BTS steps and was associated with a significant increase in exacerbations and asthma-related healthcare utilization.

Vocal cordopathy consequent to bronchial asthma inhalation therapy

BackgroundVocal cords signify an imperative lane for air flow in and out of the respiratory tract along with a phonetic role. So, the aim of this work is to assess the impact of habitual versus occasional utilization of inhalation therapy of patients with bronchial asthma on their vocal cords regarding visual endoscopic pathological changes in addition to phonetic dysfunction. This study was conducted on 112 diagnosed bronchial asthma patients (66 male and 46 females). They were classified into the following: group A (habitual user), 65 patients with severe persistent asthma with regular frequent intake of inhalation therapy, and group B (occasional user), 47 patients with intermittent asthma with alternating intake of inhalation therapy. They were submitted to clinical, vocal assessment plus laryngoscopic examination.ResultsThe habitual users group demonstrated that laryngeal edema and hyperemia attained the higher percentage in the adult than children age group (60%, 40–67.3%, 50%) respectively together after 6 and 9 months of study followed by laryngeal nodules (5.4%, 0–9%, 10%). Occasional users presented the same findings comparable to the habitual group (27%, 10–32.4%, 20%). Cord paresis, cord dysfunction, and fungal plaques were in the second frequencies in both age groups with the same percentage (3.6%) at the end of the study; however, in occasional users, fungal plaques illustrated low percentage (2.7%, 5.4–0, 10%, respectively).ConclusionInhalation therapy as a form of asthma medication correlated with major counter effects on vocal cords with well-recorded laryngeal hyperemia, edema, and vocal nodules in addition to fungal plaques moreover phonetic dysfunction.

Subcutaneous terbutaline as an alternative to metered-dose inhalers for asthma during the COVID-19 pandemic.

In a well-written and informative article, Whittle et al1 “Respiratory Support for Adult Patients with COVID-19,” correctly recommend against using nebulizer therapy for asthmatics and suggests metered-dose inhalers. During the COVID-19 epidemic, asthmatics will continue to have exacerbations, frequently requiring emergency room care in a physician's office, urgent care center, or emergency department of a hospital. It is recommended that asthmatic patients continue to be managed according to asthma guideline recommendations.2 Nebulizer use is discouraged unless essential during a pandemic because nebulized therapy is more likely to aerosolize SARS-CoV-2 and increase risk of contagion. As such, asthma therapy delivered by a metered-dose inhaler would be more appropriate in the healthcare setting.3 Nevertheless, some patients are so tight that using a metered-dose inhaler, even with a spacer, might be problematic, particularly if they have uncontrolled coughing, have severe life-threatening asthma, or those who are uncooperative or unable to follow directions required for the metered-dose inhaler, even with a spacer. A recent article4 demonstrated that, in a prospective study, 85 asthmatic patients treated with subcutaneous terbutaline significantly improved after already receiving multiple albuterol treatments with either nebulized aerosols or albuterol metered-dose inhalers. Advantages of terbutaline over epinephrine include: (1) a more pronounced effect with a longer duration of action on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC),5 and (2) preferred over epinephrine in pregnancy.6 Terbutaline is inexpensive and readily accessible, even though a previous survey of physicians in the Cleveland area reveal that 98% of physicians rarely or never use subcutaneous terbutaline for an exacerbation of asthma.7 From a colleague in New York City reading about my work with terbutaline, “This is great! Not only that, but the feasibility of subcutaneous terbutaline as an administration route during a high-volume/war-like situation is underappreciated.” Additionally, the American College of Allergy, Asthma, and Immunology (ACAAI) has reported that some areas around the country are experiencing shortages in albuterol inhalers as a result of an increased demand, because hospitals are using inhalers rather than nebulizers to treat COVID-19 patients.8 Finally, although metered-dose inhalers frequently work, the use of subcutaneous terbutaline would obviate the need for these inhalers or aerosols.

19 Y/o Male Marine Experiencing Exercise-induced Laryngeal Obstruction (eilo) During Military Training.

HISTORY: 19 year old male with a long history of shortness of breath on exertion. States that since childhood he has had inspiratory wheezing and tightness in chest with exertion, but he was told he would outgrow it. More recently, he has noted that it has worsened with maximal exertion during military training. He states that he is unable to run all out once around the track without experiencing inspiratory difficulty with gasping. It takes about 10 minutes for him to recover. If he resumes exercise it will recur. Asthma inhalers have not helped. Episodes are associated with pain and dysphagia. PHYSICAL EXAMINATION: Laryngeal examination shows that there is reduced abduction of the vocal folds, with a maximum glottic space of about 6 mm. During high ventilatory output tasks there is evidence of paradoxical movement of the vocal folds, most prominently on inspiration, resulting in shortness of breath, and loud stridor on inspiration. Cardiac: RRR, without murmur Lungs: Clear to Auscultation bilaterally"at rest", Loud inspiratory stridor during “high ventilation”.MSK: Significant muscle tension dyspnea, an inefficient breathing pattern with an upper torso / clavicular breathing, and hyperfunction of strap muscles. DIFFERENTIAL DIAGNOSIS:- Hypertrophic Obstructive Cardiomyopathy (HOCM)- Asthma- Exercise-Induced Bronchoconstricion (EIB)- Exercise-Induced Laryngeal Obstruction (EILO)- Exercise-Induced Anaphylaxis (EIA) TEST AND RESULTS: Cardiopulmonary Exercist Test (CPET): negative. Spirometry with methacholine challenge: negative. Laryngeal function Study: videoendoscopy with stroboscopy revealed reduced abduction of the vocal folds. During high ventilatory provocative challenge, there was evidence of paradoxical movement of the vocal folds, most prominently on inspiration, resulting in shortness of breath, and loud stridor on inspiration. FINAL/WORKING DIAGNOSIS: Exercise-Induced Laryngeal Obstruction (EILO) Patient has developed poor breathing patterns with reduced bilateral vocal fold abduction. TREATMENT AND OUTCOMES: Breathing Retraining Therapy (4-6 sessions). Patient report significant improvement in symptoms after 2nd session, and complete resolution of symptoms following the 5th session. Remaining symptom free for 4 months.

Cross-sectional analysis of consumer-facing mHealth apps associated with inhaler monitoring for asthma

ObjectiveThis study aimed to describe the current landscape of consumer-directed mHealth apps that communicate with inhalers for asthma. MethodsWe performed a cross-sectional and systematic analysis of Google Play and the Apple App Stores to identify apps that are consumer-direct and available in English, intended for patients with asthma and communicate with an inhaler-based sensor. We collected information about each app using the app stores and publicly available manufacturer websites. We reported the results descriptively. ResultsWe identified 6 apps, released as early as 2012. Of these, 5 apps require an external sensor available over the counter to be attached to the patient’s inhaler, and 1 app communicates with a prescription-only inhaler that has a built-in sensor and will be dispensed from the pharmacy. Aside from passively monitoring inhaler adherence, all apps facilitate provider communication; serve as a diary; and use notifications, reminders, or alarms for things such as inhaler dose reminders. Additional features vary across apps, including direct pharmacy access for refill requests and telehealth and artificial intelligence to predict future asthma exacerbations. ConclusionWe identified 6 consumer-directed mHealth apps that communicate with inhalers for asthma management. Pharmacists must be prepared to evaluate these apps, particularly in comparison with the first prescription-only inhaler built to communicate with an mHealth app to be released this year. To do so, further research on the outcomes and use of these apps is needed so that pharmacists can make evidence-based recommendations.

Wearable Technology and How This Can Be Implemented into Clinical Practice.

Purpose of ReviewOur day-to-day life is saturated with health data that was previously out of reach. Over the last decade, new devices and fitness technology companies are attempting to tap into this data, uncovering a treasure trove of useful information that, when applied correctly, has the potential to revolutionize the way we approach healthcare and chronic conditions like asthma, especially in the wake of the COVID-19 pandemic.Recent FindingsBy harnessing exciting developments in personalization, digitization, wellness, and patient engagement, care providers can improve health outcomes for our patients in a way we have never been able to do in the past. While new technologies to capture individual health metrics are everywhere, how can we use this information to make a real difference in our patients’ lives? Navigating the complicated landscape of personal wearable devices, asthma inhaler sensors, and exercise apps can be daunting to even the most tech savvy physician.SummaryThis manuscript will give you the tools necessary to make lasting changes in your patients’ lives by exposing them to a world of usable, affordable, and relatable health technology that resonates with their personal fitness and wellness goals. These tools will be even more important post-COVID-19, as the landscape of clinical outpatient care changes from mainly in-person visits to a greater reliance on telemedicine and remote monitoring.

Maximizing the Role of the Nurse: Strategies to Address Gaps in Asthma Care in Schools

PurposeThe purpose of this project was to describe differences in the numbers of children with a diagnosis of asthma identified through two methods, determine barriers to receiving asthma interventions in elementary school settings, and make recommendations for action and advocacy for school nurses to increase the number of children with access to asthma medications at school. Design and methodsThe authors conducted a review of the asthma diagnosis process from the initial identification of a diagnosis to the delivery of interventions with 349 enrolled students in one large, urban public school in Tennessee. ResultsSixty children were identified using the school's existing parent identification process and 91 children who participated in a concurrent asthma education program self-identified or were referred by a teacher, staff, or administrator. Only seven students identified through the combined methods had access to asthma medication (albuterol) at school. ConclusionMissing asthma action plans, medication forms and inhalers emerged as major barriers to intervention even when a child's diagnosis is documented. Practice implicationsThe Asthma School Readiness Process (ASRP) was developed, which describes recommendations for nurses in school and community settings to promote safety and access to asthma medication in schools.

Perspectives on managing asthma and facilitators in asthma self-management among Thai school-age children: a qualitative study

PurposeThis study explored self-management in the context of asthma experiences of school-age children and the factors that facilitate asthma self-management.Design/methodology/approachThis is qualitative research used in-depth interviews. Purposive sampling was employed to select 15 school-age children with asthma attending the outpatient pulmonary department at university hospital in Thailand. Semistructured in-depth individual interviews were conducted. which were audiotaped and transcribed verbatim. Content analysis was used to analyze the data.FindingsTwo major themes emerged from this study: (1) perspectives on managing asthma and (2) facilitators in asthma self-management. Four subthemes emerged from the first major theme related to views on managing asthma: (1) emphasizing use of an inhaler for asthma, (2) self-monitoring for symptom, (3) difficulties with the daily regimens and (4) family support on asthma self-management. Two subthemes emerged from the second major theme related to facilitators in asthma self-management: (1) confidence in performing asthma care behaviors and (2) asthma communication.Originality/valueThis study described strategies that support asthma management of children in Thailand and provided insight into factors that influence asthma self-management. Findings will inform the development of future self-management interventions for school-age children with asthma.

Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey

Little is known about specialist-specific variations in guideline agreement and adoption. To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n= 134) and pulmonologists (n= 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P= .06), asked about nighttime awakening (91.9% vs 76.5%, P= .03) and emergency department visits (92.2% vs 76.5%, P= .03), assessed home triggers (70.5% vs 52.6%, P= .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.