Pediatric Asthma Management Research Articles

Attitudes and Perceptions of Providers in Mongolia towards Pediatric Asthma Diagnosis and Management

Purpose In Feb 2018, UNICEF and the Mongolian National Center for Public Health released a report that called for urgent action in treating and preventing the country’s growing number of childhood respiratory illnesses. According to a 2009 study conducted by Arisaka et al, childhood asthma affects roughly 20% of children aged 6-7 years in Ulaanbaatar, Mongolia. The prevalence is higher than estimates previously stated by the ISAAC for both the world and Asia-Pacific countries. No studies have been conducted to evaluate perceptions and attitudes towards asthma and barriers to providing …

Attitudes and Perceptions of Providers in Mongolia towards Pediatric Asthma Diagnosis and Management

Attitudes and Perceptions of Providers in Mongolia towards Pediatric Asthma Diagnosis and Management

Community Health Workers' Role in Supporting Pediatric Asthma Management: A Review.

Community Health Workers (CHWs) have been effective in improving health outcomes in vulnerable communities by providing health education and management services. We review CHW-led asthma education and management interventions for children and their families. Next, we describe the selection and training of CHWs in pediatric asthma management in the Rhode Island Integrated Response Asthma Care Implementation Program (RI-AIR). We queried the MEDLine, Cochrane, PubMed, and EMBASE databases with keywords ("community health worker", "asthma", "health worker", "lay worker", "pediatric", "child", and "childhood") from inception until September 2019. Criteria for study inclusion included: published in English, conducted in the United States, approved with an ethics notification, published in peer-reviewed journal, and involved CHWs as the interventionists. The initial search identified 216 manuscripts. Fifteen studies met criteria for inclusion. CHWs provide asthma management and education services, including home environmental trigger assessments, strategies to reduce environmental trigger exposure, resource linkage, and community referrals. We describe RI-AIR, and its CHW-led asthma education and management interventions. CHWs are effective and vital supports for positive asthma outcomes. More research is needed to guide models of intervention using CHWs, specifically addressing integration in interdisciplinary teams, training, and reimbursement for CHW services. CHWs are effective in helping children with asthma and their families learn to manage asthma. It is important to develop programs that prepare CHWs to work with other medical professionals and health care models to pay for their services.

Clinical guidelines on pediatric asthma exacerbation in emergency department, a narrative review.

Asthma has been known as a prevalent chronic-type inflammatory disease in children, because of their narrower respiratory airways. The present study aimed to identify guidelines for children asthma treatments. Extensive research was conducted on biomedical and pharmacological bibliographic database PubMed, EMBASE, MEDLINE, LILACS database, global independent network of Cochrane, Science Direct and global health library of Global Index Medicus. A comprehensive literature review was carried out using the terms Pediatric Asthma, epidemiology, management, and related clinical guidelines published from 2000 to 2019. After the primary assessment, quick diagnosis, clinical practice guidelines are useful tools for proper management of pediatric Asthma. By setting proper guidelines for this particular population, a higher improvement in quality of management of of pediatric Asthma is expected. Given the differences between the recommendations arisen by BTS/SIGN and NICE guidelines, critical comparison of the evidence-base guidelines provide suggestions that have more in common than what might seems at the first glance. The analysis of the variations presented in the present article will assist clinicians to make accurate decisions regarding their patients.

Probiotics in Paediatric Asthma Management

Probiotics in Paediatric Asthma Management

Oximetry-detected pulsus paradoxus predicts for severity in paediatric asthma

ObjectiveTo evaluate if qualitative visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency...

Acceptability of Inhaler Sensors in Pediatric Asthma Management among Parents

Acceptability of Inhaler Sensors in Pediatric Asthma Management among Parents

Music therapy in pediatric asthma improves pulmonary function while reducing hospitalizations

Objective: The aim of this study was to evaluate music therapy (MT), in conjunction with standard care, as a complementary option for asthma management in pediatric patients.Methods: 173 children were randomly assigned to one of three groups: 1) Music: a single individualized MT session along with a recorder and journal with instructions for home use; 2) Music Plus: weekly group MT sessions along with a recorder and journal for home use; or 3) Control: standard of care. Primary endpoints included pulmonary function tests (FEV1, FVC, FEF25-75, PEF), hospitalizations, ER visits, missed school days, and quality of life (Juniper).Results: Significant intergroup differences relative to Controls were observed for FEV1/FVC (Music and Music Plus, p < 0.05) and FEF25-75 (Music Plus; p < 0.01). Music Plus participants experienced fewer hospitalizations compared to Controls (p < 0.001), corresponding to 1.16 fewer hospitalizations per patient-year. Caregivers’ perception of their children's QOL significantly increased in the Music (p = 0.011) and Music Plus (p < 0.001) groups compared to Controls.Conclusion: These results reflect MT’s potential to favorably impact pediatric asthma management as a child-friendly, low-risk intervention. Further research is needed to substantiate the possible benefits of incorporating MT into standard treatment regimens.

The use of biologic therapies for the management of pediatric asthma.

With better understanding of the role of type 2 inflammation in allergic asthma, there has been progress made in the development of new biologic therapies targeting these specific pathways. This review will consider diagnostic criteria for using biologic therapies for pediatric asthma with special emphasis on populations that are likely to benefit the most from particular therapies. With the exception of the anti-immunoglobulin E, omalizumab, very few studies have been published on the efficacy and safety of biologic therapies in children, particularly anti-interleukin-5 (IL5) and anti-IL4/IL13 therapies. The review will highlight the scarcity of published data in pediatric-specific populations. In addition, we will consider the cost-effectiveness as well as potential long-term consequences of biologic therapies in pediatric asthma.

Pulmonary rehabilitation for children with asthma

Asthma is the most common chronic airway disease in childhood.Recent studies have shown that pulmonary rehabilitation can alleviate dyspnea, improve lung function and quality of life.However, there are few studies on pulmonary rehabilitation for children with asthma.This article will expound the application of pulmonary rehabilitation in the management of pediatric asthma. Key words: Pulmonary rehabilitation; Asthma; Children

Systematic Review of Digital Interventions for Pediatric Asthma Management

Pediatric patients with asthma take only approximately half of their prescribed medication. Digital interventions to improve adherence for youth with asthma exist and have the potential to improve accessibility, cost-effectiveness, and customizability. To systematically review published research examining digital interventions to promote adherence to the treatment of pediatric asthma. A systematic search of the PubMed, Scopus, CINAHL, PsycINFO, and reference review databases was conducted. Articles were included if adherence was an outcome in a randomized controlled trial of a digital intervention for children with asthma. We compared samples, intervention characteristics, adherence measurement and outcomes, as well as additional health outcomes across studies. Of the 264 articles reviewed, 15 studies met inclusion criteria and were included in the review. Overall, 87% of the digital interventions demonstrated improved adherence and 53% demonstrated improved health outcomes. All the promising interventions included a behavioral component and most were 3 to 6 months in length, delivered through a digital stand-alone medium (eg, automated personalized texts, mobile health apps, and website), and assessed adherence to controller medication. Overall, digital interventions aimed at improving adherence are promising and also improve health outcomes in addition to medication adherence. Although future studies using evidence-based adherence assessment and multifactorial design should be conducted, the current literature suggests that both digital stand-alone interventions and interventions combining digital technology with support from a health care team member result in improved adherence and asthma outcomes. Recommendations for digital interventions for pediatric patients with asthma with adherence concerns are provided.

A primary care learning collaborative to improve office systems and clinical management of pediatric asthma

Objective Pediatric asthma is a common, relapsing-remitting, chronic inflammatory airway disease that when uncontrolled often leads to substantial patient and health care system burden. Improving management of asthma in primary care can help patients stay well controlled. Methods The Vermont Child Health Improvement Program (VCHIP) developed a quality improvement (QI) learning collaborative with a primary objective to improve clinical asthma management measures through improvement in primary care office systems to support asthma care. Seven months of medical record review data were evaluated for improvements on eight clinical asthma management measures. Pre and post office systems inventory (OSI) self-assessments detailing adherence to improvement strategies were analyzed for improvement. Logistic regressions were used to test for associations between OSI strategy post scores and the corresponding clinical asthma management measures by month seven. Results This study found significant improvement from baseline to month seven on seven of the eight clinical asthma management measures and between pre and post OSI for seven of the nine strategies assessed (N = 19 practices). Additionally, one point higher average OSI scores on the assessment and monitoring of asthma severity, asthma control, asthma action plans, and asthma education strategies were associated with significantly greater odds of improvement in their respective clinical asthma management measures. Conclusions A QI learning collaborative approach in primary care can improve office systems and corresponding clinical management measures for pediatric patients with asthma. This suggests that linking specific office systems strategies to clinical measures may be a helpful tactic within the learning collaborative model.

Addressing the risk domain in the long-term management of pediatric asthma.

There is growing concern regarding the long‐term outcomes of early and poorly controlled childhood asthma, either of which can potentially lead to the development of severe asthma in adults and irrecoverable loss of lung function leading to chronic obstructive pulmonary disease. These outcomes of inadequately controlled asthma should prompt a change in practice to better and/or earlier identify children at risk of adverse respiratory outcomes of asthma, to monitor disease progression, and to design intervention strategies that could either prevent or reverse asthma progression in children. The careful follow‐up of spirometry over time—in the form of lung function trajectories, the application of biomarkers to assist in the diagnosis of early asthma and medication selection for these patients, as well as methods to identify patients at risk of asthma attacks—can be used to develop individualized management strategies for children with asthma. It is now time for asthma specialists to communicate this information to patients, parents, and primary care physicians and to incorporate them into routine clinical assessments of children with asthma. In time, these concepts of risk management and prevention can be refined to provide a more comprehensive approach to asthma care so as to prevent adverse respiratory outcomes from poorly controlled childhood asthma.

Paediatric Asthma Management in the Kingdom of Saudi Arabia: The need for Culturally Sensitive Research and Practice

Paediatric Asthma Management in the Kingdom of Saudi Arabia: The need for Culturally Sensitive Research and Practice

Asthma.

Asthma is the most common chronic respiratory disease of childhood, a leading cause of emergency department visits, and 1 of the top 3 indications for hospitalization in children. Despite advances in the management of pediatric asthma, significant disparities in care and outcomes persist. To bridge these gaps, we must embrace the concept of asthma care across the continuum and extend our reach beyond the immediate patient-provider visit.After completing this article, readers should be able to:Asthma is defined by episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.Despite novel treatments and guideline-based care, asthma remains a significant public health problem. Medical care, missed school, and missed work related to asthma continue to burden our communities, costing more than $80 billion each year. (1) Furthermore, asthma disproportionately affects minorities and socioeconomically disadvantaged children. (2) Black children have the highest asthma morbidity and mortality rates of any US group, with twice the emergency department (ED) visit/hospitalization rate and 9 times the mortality rate as white children. (3)(4)(5)In 2012, the President’s Task Force on Environmental Health Risks and Safety Risks to Children commissioned a cabinet-level, multiagency group to address overall asthma morbidity and its racial and ethnic disparities. (6) The group chose 4 integrated strategies.Asthma affects 1 in 12 US children aged 0 through 17 years. (3) After decades of increases, the prevalence of asthma in this group plateaued between 2010 and 2012, (2) decreased in 2013 from 9.3% in 2012 to 8.3%, and remained stable through 2016. (2)(3) In contrast, pediatric asthma prevalence in black children increased between 2001 and 2009, leveling off by 2013. (2) In 2016, asthma prevalence in black children rose sharply to 15.7% (a 2.3% increase from 2014 and 2015), twice that of white children. (3) This rate surpassed that of Puerto Rican children, who previously had the highest prevalence of asthma of all US children. (3) The prevalence of asthma in children in poverty did not decrease between 2001 and 2013 and remained high in 2016 (10.5%). (2)(3)Asthma exacerbation is a leading cause of (ED) visits (7) and 1 of the top 3 indications for hospitalization in children. (8) Comparing asthma outcomes between subgroups, an at-risk rate (ARR) is preferred over the traditional population-based rate (PBR). (9) An ARR is the number of children with the outcome (eg, asthma hospitalization or death) divided by the total number of children at risk for that outcome (those with asthma). Conversely, a PBR is the number of children with the asthma outcome divided by the total population. PBRs measure the overall burden of disease in a particular population or subgroup, whereas an ARR accounts for differences in prevalence between subgroups to describe disparities.(4) Between 2001 and 2010, ARRs for black and white children revealed a decrease in racial disparities for ED visit and hospitalization rates and no change in death rate due to asthma. (4) It is important to note, however, that ARRs do not account for differences in underlying asthma severity. A 2013 analysis of hospitalizations for chronic conditions in the Pediatric Health Information System database found that black children had the highest asthma readmission rate (21.4%) of any race or ethnicity. (10) Finally, because ARRs rely on prevalence estimates, any undercounting of

Smart devices for the management of pediatric asthma: a scoping review protocol.

The objective of this scoping review is to identify the scope of literature published on the use of smart devices for interventions in pediatric asthma, including low income and culturally diverse populations. Childhood asthma results in substantial morbidity and costs that pose a significant burden to families and healthcare systems. Low-income and culturally diverse pediatric populations have increased rates of morbidity and mortality compared to higher income families. Smart devices have the potential to improve pediatric asthma health outcomes and reduce health disparities. This scoping review will consider studies with participants who are children, adolescents and young adults with the diagnosis of asthma (ages zero to 26 years). Studies of children and adolescents and young adults with asthma may include adult participants who manage and/or supervise asthma care or provide asthma instruction. This scoping review will be conducted using the Ovid MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, ERIC, and both Compendex and Inspec through Engineering Village databases. Gray literature searches will also be conducted. Studies will be reviewed independently by two reviewers, with any conflicts adjudicated by a third member. Data extracted will be presented in a tabular format with an accompanying narrative.

What Is the Impact of Innovative Electronic Health Interventions in Improving Treatment Adherence in Asthma? The Pediatric Perspective

Suboptimal adherence to treatment is a significant issue in the management of pediatric asthma and is a major cause of uncontrolled disease, life-threatening attacks, and increased use of health care resources. Electronic health solutions have the potential to positively impact asthma self-management in children and adolescents and their families, thereby improving treatment adherence and asthma outcomes. However, there is a lack of sufficient data to support widespread adoption of electronic health tools in pediatric asthma practice. A critical evaluation of the impact of these new interventions on treatment adherence in childhood asthma must consider unmet needs, heterogeneity of trials, safety and data security issues, long-term effects, and cost-effectiveness. This article explores the most relevant issues facing the role of electronic health and its subcategory-mobile health-in promoting treatment adherence in childhood asthma, focusing on current evidence gaps and limitations, and future research perspectives.

A3 thinking Applied: a Real World Process of Implementing An Asthma Home-Based Management Project(AMP)

Background A3 Lean Methodology/Thinking is a foundational management process and methodological structure for transforming health. Along with PDSA methodology it is a vital tool in problem solving and sustainable QI initiatives/intervention. Delivery System Reform Incentive Payment (DSRIP) is a NY State program aimed at transforming health care delivery and decreasing hospitalizations while transitioning to a more socially and community based system of care. When asked to launch a pediatric asthma management program (AMP) by DSRIP the A3 Lean Methodology was used from the outset. …

Why Is It Difficult to Diagnose My Child's Asthma? A Patient Physician Perspective of Asthma Management.

This article is co-authored by the mother of a patient living with asthma, and two consultants in respiratory medicine from Birmingham Women’s and Children’s Hospital. The commentary article describes the mother’s experience of the diagnosis and treatment process of her son’s asthma. The consultants then discuss paediatric asthma diagnosis and management in the context of the patient’s experiences.

Assessing appropriateness of paediatric asthma management: A population-based sample survey.

We conducted a comprehensive assessment of guideline adherence in paediatric asthma care, including inpatient and ambulatory services, in Australia. National and international clinical practice guidelines (CPG) relating to asthma in children were searched and 39 medical record audit indicator questions were developed. Retrospective medical record review was conducted across hospital inpatient admissions, emergency department (ED) presentations, general practice (GP) and paediatrician consultations in three Australian states for children aged ≤15 years receiving care in 2012 and 2013. Eligibility of, and adherence to, indicators was assessed from medical records by nine experienced and purpose-trained paediatric nurses (surveyors). Surveyors conducted 18 453 asthma indicator assessments across 1600 visits for 881 children in 129 locations. Overall, the adherence for asthma care across the 39 indicators was 58.1%, with 54.4% adherence at GP (95% CI: 46.0-62.5), 77.7% by paediatricians (95% CI: 40.5-97.0), 79.9% in ED (95% CI: 70.6-87.3) and 85.1% for inpatient care (95% CI: 76.7-91.5). For 14 acute asthma indicators, overall adherence was 56.3% (95% CI: 47.6-64.7). Lowest adherences were for recording all four types of vital signs in children aged >2 years presenting with asthma attack (15.1%, 95% CI: 8.7-23.7), and reviewing patients' compliance, inhaler technique and triggers prior to commencing a new drug therapy (20.5%, 95% CI: 10.1-34.8). The study demonstrated differences between existing care and CPG recommendations for paediatric asthma care in Australia. Evidence-based interventions to improve adherence to CPG may help to standardize quality of paediatric asthma care and reduce variation of care.