Burden Of Pediatric Asthma Research Articles

Disparities in prevalence and outcomes of respiratory disease in low- and middle-income countries.

To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.

Communication Between Schools Nurses and Health Care Providers on Students with Asthma: An Integrative Review

School-based asthma programs have been proven to lessen the burden of pediatric asthma. There is a lack of successful care coordination between school nurses and primary care providers. This review examined strategies to increase communication and identified gaps in the literature. Databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and The Cochrane Library, were searched to identify relevant articles. This review included 12 articles consisting of randomized controlled trials, quasi-experimental studies, mixed method studies, qualitative studies, and other non-research articles. Four key findings emerged, including limited availability of asthma action plans, inclusion of parents in the communication triad, school nurse outreach to providers, and improved communication leads to positive outcomes for students with asthma including decreased use of emergency medication and increased self-management of asthma. Further research is needed to develop evidence-based interventions that can be implemented to improve communication between school nurses and primary care providers.

Prescription Patterns and Burden of Pediatric Asthma in Korea.

PurposeThis study aimed to estimate the prevalence, prescription pattern and burden of pediatric asthma in Korea by analyzing the National Health Insurance (NHI) claims data.MethodsWe retrospectively analyzed the insurance claim records from the Korean NHI claims database from January 2010 to December 2014. Asthmatic patients were defined as children younger than 18 years, with appropriate 10th Revision of the International Classification of Diseases codes (J45 or J46) and a prescription for 1 or more asthma maintenance medications at the same date. Hospitalization and emergency department visits for asthma were defined as use of short-acting beta2-agonists during hospital visits among asthmatic patients.ResultsThere were 1,172,807 asthmatic children in 2010, which increased steadily to 1,590,228 in 2014 in Korea. The prevalence showed an increasing trend annually for all ages. The mean prevalence by age in those older than 2 years decreased during the study period (from 39.4% in the 2–3 year age group to 2.6% in the 15–18 year age group). In an outpatient prescription, leukotriene receptor antagonists were the most commonly prescribed medication for all ages. Patients older than 6 years for whom inhaled corticosteroids were prescribed comprised less than 15% of asthmatic patients. The total direct medical cost for asthma between 2010 and 2014 ranged from $376 to $483 million. Asthma-related medical cost per person reached its peak in $366 in 2011 and decreased to $275 in 2014.ConclusionsThe prevalence of pediatric asthma increased annually and decreased with age. Individual cost of asthma showed a decreasing trend in Korean children.

The Burden of Pediatric Asthma.

Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle Income Countries (LMICs). Host (genetics, atopy) and environmental factors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.

Using Community-Based Participatory Research to Assess the Asthma Needs of Vietnamese American Children

Using Community-Based Participatory Research to Assess the Asthma Needs of Vietnamese American Children Gilda Ngo, MD, David B. Kilgore, MD, Jacqueline H. Tran, DrPH MPH, and Stanley P. Galant, MD What Is the Purpose of This Study? • To assess the perceived burden of asthma in Vietnamese American children and related health needs of those with asthma • To assess the health beliefs and practices of the Vietnamese American community regarding childhood asthma • To assess the Vietnamese American community’s willingness to participate in further research about childhood asthma • To learn and develop culturally acceptable methods that will facilitate further research, outreach, and intervention that are specific to the Vietnamese American community • To establish and build relationships among stakeholders who will be affected by this study What Is the Problem? • Little has been studied about the true prevalence and burden of pediatric asthma in the Vietnamese American community, as well as parental health behaviors pertaining to their children’s asthma • Despite the fact that prior studies have shown that Vietnamese children may have significantly higher rates of both undiagnosed asthma and diagnosed asthma compared to their counterparts, families seem to underutilize Western healthcare for unclear reasons. • Prior studies have suggested that parental traditional beliefs affect their management of their children’s asthma. What Are the Findings? • The members of the Vietnamese American community and the healthcare professionals and school administrators who work with the Vietnamese American community describe asthma as a significant problem for Vietnamese American children. • Academic achievement is a priority for Vietnamese parents. • Barriers to healthcare assess for Vietnamese American children with asthma include language and limited access to specialty asthma care. • Healthcare professionals believe parental traditional health beliefs and practices contribute to non-adherence to Western therapies; however, Vietnamese American parents report that although they may use traditional therapies, they actually prefer Western therapies to treat their children’s asthma. • Vietnamese American parents prefer educational materials be in Vietnamese and report that the best way to communicate with their community is via Vietnamese television or radio. • The Vietnamese American community welcomes further research and interventions regarding childhood asthma in their community. [End Page 419] Who Should Care Most? • Members of the healthcare field who provide care for Vietnamese American children • Community-based organizations • Schools administrators • Health care policymakers • Parents of children with asthma Recommendations for Action • Recommendation #1: Provide more funding and support for studies about the prevalence, morbidity, mortality and traditional health beliefs and practices related to childhood asthma in the Vietnamese American community. • Recommendation #2: Consider involving schools and associating academic achievement with positive health outcomes when providing health outreach, education, or interventions for Vietnamese American children. • Recommendation #3: Consider using Vietnamese television and/or Vietnamese radio when promoting health outreach, education or interventions for Vietnamese Americans. • Recommendation #4: Consider using a mobile asthma care clinic at school sites with providers who speak Vietnamese to provide specialized asthma care for Vietnamese American children. [End Page 420] Gilda Ngo University of California, Irvine, Department of Family Medicine David B. Kilgore University of California, Irvine, Department of Family Medicine Jacqueline H. Tran Orange County Asian and Pacific Islander Community Alliance (OCAPICA) Stanley P. Galant Children’s Hospital of Orange County (CHOC)–Children’s Breathmobile™ Program Copyright © 2014 The Johns Hopkins University Press

Medication Use in Children with Asthma: Not a Child Size Problem

Objective. The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma—in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. Methods. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical s (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms “asthma,” “children,” and “medicines” (and derivatives of these keywords) was conducted. Results. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child’s self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, “off-label” prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. Conclusion. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

An employer perspective on annual employee and dependent costs for pediatric asthma

The burden of pediatric asthma on parents' health care costs is not well described. To evaluate direct and indirect health care costs of employees with children with asthma (asthma cohort) compared with employees with children without asthma (control cohort). Retrospective analysis of 2001-2007 employer data including employee medical and pharmacy claims, payroll, work absence, demographics, and dependent medical and pharmacy claims. Asthma diagnosis or pharmacy claims for asthma controller medications were used to identify employees with dependents younger than 12 years for the asthma cohort. Controls were identified based on dependent age and lack of an asthma diagnosis or pharmacy claim for a controller medication. All costs were calculated using 2-part regression models that controlled for demographics, job information, Charlson Comorbidity Index, and region. Costs were calculated for employee health care, prescriptions, sick leave, short- and long-term disability, and workers' compensation and dependent health care and prescriptions. Costs were compared for employees with children aged 0 through 3 years, 4 through 7 years, 8 through 11 years, and younger than 12 years. Data were available for 11,794 asthma cohort employees and 64,812 controls. Statistically significant annual cost differences were identified for employee health care ($154, P < .001), prescriptions ($95, P < .001), sick leave (-$41, P < .001), short-term disability (-$41, P = .008), dependent health care ($862, P < .001), and prescriptions ($534, P < .001). Pediatric asthma is associated with significant additional health care and prescription costs for both employees and dependents.

The Emergency Department as an Asthma Surveillance Tool at the Community Level: A Decline in the Burden of Pediatric Asthma in Halifax, Canada

We report pediatric emergency department (PED) asthma visit and inpatient asthma (AS) admission data in our area over a 5-year period. AS visits decreased by 33.9%, AS admissions by 24.6%, both significant compared with the decline in elementary school enrollment. The decrease in asthma visits was due to a decrease in the number of asthmatic patients, not a decline in repeat visits, or use of alternate venues of care. Explanations include a decrease in the burden of disease or an improvement in ambulatory care, but not alternate treatment venues or improvement in acute (PED) care. Readily available, emergency department data are useful in the community surveillance of asthma.

The burden of paediatric asthma is higher than health professionals think: results from the Asthma in Real Life (AIR) study.

To assess perceptions of children with asthma, parents of children with asthma and Health Care Professionals (HCPs) of asthma symptoms, lifestyle impairment, perceived control and treatment effects using the dataset provided within the AIR study.1 Method: Questionnaire based survey of 687 parents of children aged 0-14 with asthma, 579 children aged 9-14 with asthma and HCPs treating asthma (401 practice nurses and 809 GPs). Symptom frequency in patients was higher than expected by HCPs, as was reliever use - with 45% of patients using reliever three times per day. 65% described their asthma as "well controlled" yet of these: 37% had difficulty breathing, 34% nocturnal waking, 29% dry cough and 29 % ability to talk adversely affected by asthma at least weekly. HCPs underestimate asthma symptom prevalence and lifestyle limitation. Many children with asthma and parents appear to perceive significant levels of symptoms, lifestyle restriction and reliance on reliever medication as good control. This perception needs to be challenged if progress is to be made in improving patient outcomes.

The changing picture of childhood asthma

Although the last four decades have seen substantial progress in the understanding of the pathophysiology of asthma, the working clinician's main tool in establishing the diagnosis of asthma is a good and accurate clinical history. In the older child, the history is complemented by pulmonary function tests, including measures of bronchial lability. After nearly three decades of increasing hospital admissions for childhood asthma, the 1990s have seen a small reduction in overall admissions. The increase in hospital admissions is explained only partly by the rising prevalence of asthma. The associated morbidity due to the disease has increased quite considerably over the last three decades. International studies assessing asthma prevalence across different parts of the globe using identical methodologies has shown considerable differences in asthma prevalence between the East and the West as well as within countries. The burden of paediatric asthma on the child, the family and society is increasing as we move into the new millennium.

The burden of pediatric asthma

The burden of pediatric asthma

The burden of pediatric asthma

Childhood asthma is common and its prevalence is increasing in most countries of the world. Large-scale studies indicate that approximately one-third of children with asthma have had five or more episodes of wheezing in the previous 12 months. Such frequency of symptoms leads to a significant number of days lost from school, interference with physical exercise, and underfunctioning at school because of interrupted sleep. In cases of more severe asthma, the more frequent school absences may affect the individual's education and, possibly, choice of career. In addition to the extensive individual burden of asthma, the burden on the family is substantial. Additional housework may be required to reduce the child's exposure to potential environmental triggers. Time "off work" may be required to take care of a sick child. In cases of severe asthma, children regularly wake at night, and 50% of parents indicate limitation of their social life. Sibling studies show that sometimes siblings who do not have asthma are neglected and that parents may have insufficient time to devote to them. Mortality in pediatric asthma is low, but there has been little reduction in recent years. When viewed as potential life-years lost, the burden is considerable in social and economic terms. In the United States, the mean annual cost per patient has been estimated at in excess of US$1,000. In Australia, the cost ranges from A$85 to A$884 per patient, depending on asthma severity. In the United Kingdom the estimated annual costs of childhood asthma to the Health Service are between Pounds 100 million and Pounds 150 million. To reduce the burden to patients, their families, and health care services, improved understanding of the basic pathophysiology of asthma is necessary. Environmental issues need to be addressed as does delivery of care using appropriate devices and effective therapeutic medications.

Issues in treating paediatric asthma

What is the burden of paediatric asthma in real terms? Are genetic influences important, and what are the risk factors associated with asthma? Should corticosteroids be incorporated into the treatment of preschool children? How is quality of life (QOL) best assessed in children with asthma? These issues and other problems associated with treating asthma in children were presented and debated at the 5th International Respiratory Forum [London, UK; November 1996].