Asthma Self-management Research Articles

The Effectiveness of a Family-Based Asthma Self-Management Program in Enhancing the Asthma Health Outcomes in School-Age Children

ABSTRACT This quasi-experimental study aimed to evaluate a family-based asthma self-management program, based on the individual and family self-management theory and the McMaster model of family functioning. Children aged 7 to 12 with uncontrolled asthma and their families were recruited from an outpatient pulmonary department of a university hospital in Thailand. Thirty-seven child-parent pairs were randomly assigned to three sessions for a period of two months of the family-based asthma self-management program, while 37 child-parent pairs were assigned to the control group. Data were collected at baseline and after implementation at two months by using the Childhood Asthma Control Questionnaire and the Pediatric Asthma Quality of Life Questionnaire, and the measurement of pulmonary function was performed using peak flow meters. Multivariate analysis of covariance (MANCOVA) was employed to analyze the mean difference between the experimental and control groups. The results indicated significant increased asthma control status, pulmonary function, and quality of life in the children from baseline to after implementation in the experimental group that participated in the family-based asthma self-management program. Significant improvement in these three asthma health outcomes was also seen in the experimental group when compared to the control group. It was seen that the family-based asthma self-management program is useful for promoting the self-management of school-age children, enabling the control of symptoms, and enhancing health outcomes regarding asthma.

Sociodemographic Differences in Asthma Self-Management Knowledge of Parents Seeking Asthma Care for their Children in Pediatric Emergency Departments.

To effectively support asthma self-management among children most at risk for poor outcomes, it is important to examine potential disparities in parents' asthma-related knowledge. This study draws on baseline data collected from a randomized controlled trial to analyze how knowledge of asthma self-management varies by sociodemographic characteristics in a racially and economically diverse sample of Medicaid-insured children seeking emergency asthma care (N=221). Multivariable linear regression revealed that parent race/ethnicity, preferred language, and education were independently associated with scores on the Asthma Self Management Knowledge Questionnaire, and there was a significant interaction between parent race/ethnicity and education. In analyses stratified by parent education level, Latinx race/ethnicity was associated with lower-self-management knowledge among parents with higher education level, but not among those with a lower level of education. Our findings call for further research to understand and address the unique barriers to improving asthma self-management knowledge among Latinx parents and parents with limited English proficiency.

Survival of asthma patients attended at Chitungwiza Central Hospital in Zimbabwe

INTRODUCTION: Asthma is a leading global public health problem. Itis estimated that 300 thousand people die annually from asthma worldwide. In Zimbabwe 9/100 000 population died from asthma in 2014, accounting for 1.02% of total deaths. The association between asthma survival and socio-demographic and pathologic factors has not been evaluated in Zimbabwe. The purpose of our study was to determine the survival of patients with asthma at Chitungwiza Central Hospital, Zimbabwe over a period of 20 years (1997 to 2017). METHODS: records for 158 asthma patients were analysed in this retrospective cohort study. The patient records were sampled from the computerised health information department at the hospital. Data were collected using a patient record checklist that was divided into four sections: (i) demographic information, (ii) clinical characteristics of asthma patients, (iii) health service utilization and (iv) asthma self-management. Descriptive data analysis was performed using the Kaplan Meier survival function curves. The Kaplan Meier survival curves were differentiated by the log-rank test, median survival times and mortality rates. Significant hazard ratios were used for multivariate cox regression model and a test on proportional hazards assumption based on Schoenfeld residuals were conducted. RESULTS: the total follow-up time was 2208 person years. The study showed that 94/153(61.4%) had since died. The median age at death was 25.5 years (IQR; 21-34). Smoking history [p=

Qualitative Study Protocol: Augmented Reality Technology to Deliver Asthma Inhaler Technique Training for Children and Adolescents With Asthma

Asthma is a chronic inflammatory condition of the airways with a heterogenous symptom profile. When symptoms are poorly controlled and frequent, asthma sufferers are impacted regularly, with limitations on physical activities and sleep disturbances, significantly impairing quality of life. Asthma is highly prevalent and the leading cause of disease burden in young people. Those aged 0–14 contribute to over half of the asthma hospitalisations within Australia. Asthma education and self-management remains a key component of care; however, challenges remain in the paediatric population with difficulties of engagement. Augmented reality (AR) may provide a novel and effective solution with its ability to superimpose virtual objects into a real-world setting. Using a smartphone or tablet to deliver AR makes this modality accessible to much of the population. AR is a growing field in technology and has already established uses in education and training. The ability to increase motivation, enhance enjoyment and encourage faster concept understanding in the educational setting is encouraging and supports our proposal that AR technology can provide a generation appropriate education delivery modality for young people with asthma. To ensure successful implementation of an AR asthma educational resource on a large scale, the usability, acceptability, barriers and enablers of its use must be investigated. Using an iterative co-design process, an asthma resource utilising AR to deliver education on inhaler technique will be created. Qualitative research will be undertaken using semi-structured interviews with moderator guides to obtain mixed-method data on the AR resource. Participants will be key members of the asthma community including children and adolescents with asthma (8–17 years old), caregivers of children and adolescents with asthma, and health professionals. Understanding the usability, acceptability, barriers and enablers of the AR resource will enable us to improve our alpha version and test an optimal version in a planned feasibility study.

The effectiveness of the use of video games and software-based programs for asthma education and self-management for children and teenagers

Abstract Introduction: Asthma is a chronic disease of the lower airways characterized by usually reversible airflow obstruction, inflammation, and hyperreactivity to various types of stimuli. It is one of the most common chronic respiratory diseases among children and adults, with an incidence of 300 million people worldwide. Objective: To evaluate the quality of the existent evidence in the literature in order to support the use of videogames and software-based programson asthmatic children and teenager’s knowledge capacity and self-management compared with standard education. Methods: Search, selection and analysis (starting March 2016) of all the original articles on virtual reality (VR) concerning asthmatic children and adolescents (ages 3 to 18), published up to October 2017, in Portuguese, English and Spanish, at the electronic databases Pubmed, Web of Science, MedlLine and LILACS, obtained by using the descriptors: asthma, video game, virtual reality, pulmonary rehabilitation, physical training. Results: Only six original articles were obtained. Of these, five (80%) presented level of evidence A, and one (20%) presented level of evidence B. All authors point out the treatment of asthma from VR as a safe and innovative therapy considering that the motivation and intensity of treatment from the use of VR improves the self-management capacity and aerobic capacity of asthmatic patients. Conclusion: The present study seeks to contribute to the literature by demonstrating that videogames and other software-based systemscan be used to improve knowledge capacity and self-management skills in children and teenagers with asthma diagnosis.

Asthma self-management with regular support reduces health care use and improves QoL at 8 mo.

Hodkinson A, Bower P, Grigoroglou C, et al. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:m2521. 32816816.

Cognition, symptom perception, and medication non-adherence in older adults with asthma

Background Cognitive impairment (CI) is highly prevalent in elderly asthmatics and is associated with worse asthma self-management (SM) and outcomes. CI may also explain why older adults may under-perceive asthma symptoms. We hypothesized that CI would be associated with low medication adherence and asthma symptom under-perception (ASP). We also hypothesized that ASP would mediate the relationship between CI and medication adherence. Methods Participants of this longitudinal cohort study were asthmatics (N = 334) ≥60 years (51% Hispanic, 25% Black). Cognitive measures assessed general cognition, attention, processing speed, executive functioning, memory, and language. Measures of SM were self-reported and electronically measured adherence to controller medications. ASP was assessed for 6 weeks by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter, followed by PEF blows. Participants were blinded to actual PEF values. Percentage of time that participants were in the over-perception zone was calculated as an average. Results In regression analyses, those with impairments in memory and general cognition had lower odds ratios (OR) for self-reported non-adherence (OR: 0.96, 95% CI 0.93 − 0.98 & OR: 0.90, 95% CI 0.83 − 0.96, respectively). CI was not associated with electronically measured non-adherence or ASP. In structural equation modeling, while CI was associated with adherence (β = 0.04, SE = 0.021, p = 0.04), ASP did not mediate this relationship. Conclusions While results confirmed the importance of cognition in asthma SM, these findings were not linked to ASP. Future analyses are needed to understand the role of confounding factors.

Using a Systems Engineering Approach to Design an Interactive Mobile Health Application for Improving Asthma Self-management.

Mobile health applications are in demand. According to the Grand Review Research group, there were US $12.4 billion in mobile health app sales in 2018. Increasingly, providers are seeking new ways to engage their pediatric patients. One approach is through mobile health apps. Nearly 10 000 mobile health apps target youth and teens, especially for children with conditions that require complex treatment and self-management. One such chronic illness is asthma. Children with asthma who lack social support are particularly vulnerable to exacerbations because they often are not focused on self-care. For this reason, successful asthma programs for children engage family members, encouraging them to play an active role on the healthcare team. The Just-in-Time Asthma Self-management Intervention is unique in several ways compared to other asthma management mobile applications. The app uses gold standard, evidence-based asthma care practices and extends the support infrastructure beyond family and healthcare providers to engage the child, their peers, and school personnel. Further, the app was built using a systems engineering approach. This article reviews the basis for developing an asthma care mobile application including the conceptual framework supporting a systems model, how the Just-in-Time Asthma Self-management Intervention is unique, and how it was built using a systems engineering design.

Long-term effects of a peer-led asthma self-management program on asthma outcomes in adolescent peer leaders

ObjectiveTo examine the long-term effects of a peer-led asthma self-management program on urban adolescent peer leaders with asthma. MethodsThis longitudinal study includes 51 adolescents (16−20 years) enrolled in an asthma self-management program implemented at a one-day camp as peer leaders. Study outcomes, including quality of life, asthma control, asthma knowledge, and attitudes toward asthma were collected for 15 months post-intervention. Mixed-effects models were conducted to estimate time effects, and effect sizes were calculated for each model. ResultsOf 51 enrolled, 41 completed the training, of which 35 successfully participated in the camp program. A total of 17 peer leaders withdrew between enrollment and 15-months follow-up. Quality of life, asthma control, and knowledge significantly improved after peer leader training and remained elevated for 15 months, while significant improvement in attitudes emerged immediately after camp, in which they served as leaders, and sustained for 15 months. ConclusionThis study demonstrates the long-term positive effects of a peer-led program on a wide range of asthma outcomes in urban adolescent peer leaders. Practice ImplicationsA peer-led approach to asthma education providing peer leaders with intense training and leadership experience can be effective and sustainable in improving asthma outcomes among urban adolescents.

Nocturnal Cough and Sleep Quality to Assess Asthma Control and Predict Attacks.

IntroductionObjective markers for asthma, that can be measured without extra patient effort, could mitigate current shortcomings in asthma monitoring. We investigated whether smartphone-recorded nocturnal cough and sleep quality can be utilized for the detection of periods with uncontrolled asthma or meaningful changes in asthma control and for the prediction of asthma attacks.MethodsWe analyzed questionnaire and sensor data of 79 adults with asthma. Data were collected in situ for 29 days by means of a smartphone. Sleep quality and nocturnal cough frequencies were measured every night with the Pittsburgh Sleep Quality Index and by manually annotating coughs from smartphone audio recordings. Primary endpoint was asthma control assessed with a weekly version of the Asthma Control Test. Secondary endpoint was self-reported asthma attacks.ResultsMixed-effects regression analyses showed that nocturnal cough and sleep quality were statistically significantly associated with asthma control on a between- and within-patient level (p < 0.05). Decision trees indicated that sleep quality was more useful for detecting weeks with uncontrolled asthma (balanced accuracy (BAC) 68% vs 61%; Δ sensitivity −12%; Δ specificity −2%), while nocturnal cough better detected weeks with asthma control deteriorations (BAC 71% vs 56%; Δ sensitivity 3%; Δ specificity −34%). Cut-offs using both markers predicted asthma attacks up to five days ahead with BACs between 70% and 75% (sensitivities 75 - 88% and specificities 57 - 72%).ConclusionNocturnal cough and sleep quality have useful properties as markers for asthma control and seem to have prognostic value for the early detection of asthma attacks. Due to the limited study duration per patient and the pragmatic nature of the study, future research is needed to comprehensively evaluate and externally validate the performance of both biomarkers and their utility for asthma self-management.

The Use of Technology Acceptance Model to Determine the Approval of Asthma Education Features in The Asthma Self-Management App

The Use of Technology Acceptance Model to Determine the Approval of Asthma Education Features in The Asthma Self-Management App

Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps.

BackgroundThe development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps.ObjectiveThe goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings.MethodsReviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps.ResultsOf the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4% (199/373) received high ratings (average ratings of 4 or 5) and 47.2% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps.ConclusionsOur study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes.

Improving Antenatal Asthma Management: A Complex Journey

Asthma is a highly prevalent comorbidity during pregnancy, which can worsen as gestation progresses and is associated with several adverse perinatal outcomes. The adverse outcomes associated with maternal asthma are preventable with appropriate asthma management in pregnancy. However, the prevalence of adverse outcomes has not changed significantly over the last 20 years, even though knowledge and treatments for managing the disease in pregnancy has improved significantly. This is of concern now in the current climate with the coronavirus disease (COVID-19) pandemic and its potential impact on pregnant individuals with asthma. This article will discuss the treatments available for the management of asthma in pregnancy, the barriers for the translation of current knowledge into obstetric practice, and the importance of asthma education and self-management skills.

Estimating the impact of self-management education, influenza vaccines, nebulizers, and spacers on health utilization and expenditures for Medicaid-enrolled children with asthma

Introduction We quantify the effect of a set of interventions including asthma self-management education, influenza vaccination, spacers, and nebulizers on healthcare utilization and expenditures for Medicaid-enrolled children with asthma in New York and Michigan. Methods We obtained patients’ data from Medicaid Analytic eXtract files and evaluated patients with persistent asthma in 2010 and 2011. We used difference-in-difference regression to quantify the effect of the intervention on the probability of asthma-related healthcare utilization, asthma medication, and utilization costs. We estimated the average change in outcome measures from pre-intervention/intervention (2010) to post-intervention (2011) periods for the intervention group by comparing this with the average change in the control group over the same time horizon. Results All of the interventions reduced both utilization and asthma medication costs. Asthma self-management education, nebulizer, and spacer interventions reduced the probability of emergency department (20.8–1.5%, 95%CI 19.7–21.9% vs. 0.5–2.5%, respectively) and inpatient (3.5–0.8%, 95%CI 2.1–4.9% vs. 0.4–1.2%, respectively) utilizations. Influenza vaccine decreased the probability of primary care physician (6–3.5%, 95%CI 4.4–7.6% vs. 1.5–5.5%, respectively) visit. The reductions varied by state and intervention. Conclusions Promoting asthma self-management education, influenza vaccinations, nebulizers, and spacers can decrease the frequency of healthcare utilization and asthma-related expenditures while improving medication adherence.

Association between inhaler technique and confidence among hospitalized children with asthma

ObjectiveProper 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. MethodsChildren 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. ResultsNone 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. ConclusionsChildren 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.

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.

What Is the Best Way to Help Patients Self-Manage Asthma?

Guidelines recommend use of self-management interventions for people with asthma; however, interventions can involve varying types of support by

Systematic Review of mHealth Applications That Interface with Inhaler Sensors in Asthma

A better understanding of outcomes associated with mobile health (mHealth) applications (apps) for asthma self-management that pair with inhaler sensor technology is needed for clinicians to practice evidence-based medicine. To evaluate the effects of mHealth apps that integrate with an inhaler-based sensor on outcomes of patients with asthma. We performed a systematic review in GooglePlay and Apple App stores for consumer-facing mHealth apps for asthma management that pair with an inhaler-based sensor. We then searched for evidence evaluating these apps via PubMed and Cochrane Central (January 2007-May 2020), bibliographies on product websites, and www.clinicaltrials.gov. We included studies in patients with asthma evaluating apps discovered in the app stores on adherence or a health outcome of interest, and qualitatively summarized evidence. We identified 6 mHealth apps and screened 2594 citations for evidence on these apps; 7 studies of 2 apps were included. Interventions modestly improved maintenance inhaler adherence and reduced rescue inhaler use but did not impact Asthma Control Test scores. Effects on exacerbations, quality of life, and pulmonary function were not evaluated in these studies. The current literature evaluating mHealth apps paired with inhaler-based sensors focuses on a small number of available products and has limitations in quality. Positive effects on rescue inhaler use, inhaler adherence, and patient satisfaction were found. However, more comprehensive evaluation of products and their impact on health outcomes is needed before clinicians and patients can weigh the benefits against resources needed to adopt these technologies.

Methodological insights from pre-pilot phases of two complex respiratory interventions (IMP2ART; TANDEM)

Introduction: Complex behavioural interventions, often encounter implementation issues in real-world application. Enhancing the MRC framework for developing and evaluating complex interventions, we included a real-world pre-pilot before formal piloting of two complex interventions: IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) which is developing a whole-systems implementation strategy to improve supported asthma self-management in primary care, and Tailored intervention for ANxiety and DEpression Management in COPD (TANDEM), which uses a cognitive behavioural approach to manage anxiety and depression before attendance at pulmonary rehabilitation in COPD. Methods: Following extensive development, feasibility testing and refining, each study tested the multi-level components of their interventions with up to 4 ‘real-world sites’ to optimise design for the trial. Qualitative feedback from key stakeholders was reviewed by the development groups and integrated into the final design. Results: There were many lessons learnt. In IMP2ART we changed delivery of professional education from facilitated use of a team e-learning module to a more open facilitated team session and individual access to the module. In TANDEM, training of respiratory professionals was made less threatening by replacing role-play with actors to an individual video-recorded session. Conclusion: Real-world pre-pilots resulted in significant changes to the delivery of IMP2ART and TANDEM and should be considered before formal piloting of complex interventions. Method: IMP2ART NIHR PGfAR (RP-PG-1016-20008); TANDEM: M+NIHR HTA (13/146/02)

Developing a theory-based multimedia intervention for schools to improve young people\u2019s asthma: my asthma in school (MAIS)

BackgroundAsthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents.MethodsThe intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation–Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13.ResultsThe complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7–8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma.ConclusionThis study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.