Thinking Outside the Inhaler: Potential Barriers to Controlled Asthma in Children

2004 ◽  
Vol 17 (3) ◽  
pp. 211-220
Author(s):  
Amy L. Potts ◽  
Carol B. Reagan
Keyword(s):  
Health Care Professionals ◽  
Asthma Management ◽  
The United States ◽  
Communication Education ◽  
National Guidelines ◽  
Parental Concerns ◽  
Childhood Morbidity ◽  
Children With Asthma ◽  
Psychosocial Influences ◽  
Asthma In Children

Asthma has reached epidemic proportions in the United States, increasing in prevalence especially among children. Despite the development of national goals and practice guidelines, childhood morbidity and mortality associated with asthma has continued to rise at astonishing rates. Effective management of asthma in children requires both improvements in following nationally recognized guidelines and addressing barriers associated with poor control. This article identifies barriers leading to uncontrolled asthma in children. Barriers in communication, education, resources, parental concerns, and psychosocial influences have resulted in nonadherence to national guidelines. Health care professionals have the opportunity to affect asthma management by addressing these barriers and improving the quality of care for children with asthma.

Inadequate Therapy for Asthma Among Children in the United States

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 272-276
Author(s):  
Jill S. Halterman ◽  
C. Andrew Aligne ◽  
Peggy Auinger ◽  
John T. McBride ◽  
Peter G. Szilagyi
Keyword(s):  
Severe Asthma ◽  
Asthma Management ◽  
The United States ◽  
Asthma Therapy ◽  
National Guidelines ◽  
Cross Sectional ◽  
Asthma Morbidity ◽  
The Past ◽  
Maintenance Medication ◽  
Inadequate Therapy

Objective. Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy. Methods. The National Health and Nutrition Examination Survey (NHANES) III 1988–1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, ≥2 acute visits for wheezing, or ≥3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design. Results. A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age ≤5 years, Medicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more likely to have taken maintenance medications than children surveyed before 1991. Conclusion. Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.

Management Considerations for Chronic Asthma

2001 ◽  
Vol 14 (2) ◽  
pp. 108-125
Author(s):  
Sharya Vaughan Bourdet ◽  
Dennis Williams
Keyword(s):  
Inhaled Corticosteroids ◽  
Environmental Control ◽  
Management Strategies ◽  
Asthma Management ◽  
The United States ◽  
Control Measures ◽  
Ongoing Research ◽  
Common Chronic Disease ◽  
Children With Asthma

Asthma is a common chronic disease affecting millions of individuals in the United States. Appropriate management and prevention of asthma symptoms is essential in order to maintain quality of life and reduce healthcare costs. Published consensus guidelines provide recommendations for asthma management and emphasize pharmacologic and nonpharmacologic components for long-term management. Major components of asthma management include environmental control measures, patient education and self-management, pharmacotherapy and periodic assessment. Since publication of the guidelines in 1997, there has been additional research and advances in our knowledge and understanding of asthma. Ongoing research focuses on issues such as regular versus as needed use of short-acting bronchodilators, early initiation of inhaled corticosteroids, safety of inhaled corticosteroids in children with asthma, combination therapy with inhaled corticosteroids and other long-term control agents, and reduction of inhaled corticosteroid doses. Advances in therapy and new knowledge about appropriate management strategies should be incorporated into clinical management strategies.

scholarly journals The Role of Patient Navigators in Improving Caregiver Management of Childhood Asthma

2017 ◽  
Author(s):  
Lucia Rojas Smith ◽  
Megan L. Clayton ◽  
Carol Woodell ◽  
Carol Mansfield
Keyword(s):  
Health Care Providers ◽  
Childhood Asthma ◽  
Asthma Management ◽  
The United States ◽  
Care Providers ◽  
Patient Navigators ◽  
Care Plans ◽  
Study Results ◽  
Asthma In Children

Childhood asthma is a significant public health problem in the United States. Barriers to effective asthma management in children include the need for caregivers to identify and manage diverse environmental triggers and promote appropriate use of preventive asthma medications. Although health care providers may introduce asthma treatments and care plans, many providers lack the time and capacity to educate caregivers about asthma in an ongoing, sustained manner. To help address these complexities of asthma care, many providers and caregivers rely on patient navigators (defined as persons who provide patients with a particular set of services and who address barriers to care) (Dohan & Schrag, 2005). Despite growing interest in their value for chronic disease management, researchers and providers know little about how or what benefits patient navigators can provide to caregivers in managing asthma in children. To explore this issue, we conducted a mixed-method evaluation involving focus groups and a survey with caregivers of children with moderate-to-severe asthma who were enrolled in the Merck Childhood Asthma Network Initiative (MCAN). Findings suggest that patient navigators may support children’s asthma management by providing individualized treatment plans and hands-on practice, improving caregivers’ understanding of environmental triggers and their mitigation, and giving clear, accessible instructions for proper medication management. Study results may help to clarify and further develop the role of patient navigators for the effective management of asthma in children.

scholarly journals Monitoring asthma in children

2015 ◽  
Vol 45 (4) ◽  
pp. 906-925 ◽  
Author(s):  
Mariëlle W. Pijnenburg ◽  
Eugenio Baraldi ◽  
Paul L.P. Brand ◽  
Kai-Håkon Carlsen ◽  
Ernst Eber ◽  
...  
Keyword(s):  
Lung Function ◽  
Task Force ◽  
Bronchial Hyperresponsiveness ◽  
Asthma Management ◽  
Modified Delphi ◽  
Optimal Monitoring ◽  
Clinical Control ◽  
Children With Asthma ◽  
Asthma In Children ◽  
Clinical Tools

The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.

The Oxford Handbook of Integrative Health Science

2018 ◽  
Keyword(s):  
Adult Life ◽  
The United States ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Health Science ◽  
National Study ◽  
Integrative Health ◽  
Social Structural ◽  
Research Population ◽  
Psychosocial Influences

This handbook signals a paradigm shift in health research. Population-based disciplines have employed large national samples to examine how sociodemographic factors contour rates of morbidity and mortality. Behavioral and psychosocial disciplines have studied the factors that influence these domains using small, nonrepresentative samples in experimental or longitudinal contexts. Biomedical disciplines, drawing on diverse fields, have examined mechanistic processes implicated in disease outcomes. The collection of chapters in this handbook embraces all such prior approaches and, via targeted questions, illustrates how they can be woven together. Diverse contributions showcase how social structural influences work together with psychosocial influences or experiential factors to impact differing health outcomes, including profiles of biological risk across distinct physiological systems. These varied biopsychosocial advances have grown up around the Midlife in the United States (MIDUS) national study of health, begun over 20 years ago and now encompassing over 12,000 Americans followed through time. The overarching principle behind the MIDUS enterprise is that deeper understanding of why some individuals remain healthy and well as they move across the decades of adult life, while others succumb to differing varieties of disease, dysfunction, or disability, requires a commitment to comprehensiveness that attends to the interplay of multiple interacting influences. Put another way, all of the disciplines mentioned have reliably documented influences on health, but in and of themselves, each is inherently limited because it neglects factors known to matter for health outside the discipline’s purview. Integrative health science is the alternative seeking to overcome these limitations.

Feasibility study of a communication and education asthma intervention for general practitioners in Australia

2010 ◽  
Vol 16 (1) ◽  
pp. 75 ◽  
Author(s):  
Smita Shah ◽  
Brett G. Toelle ◽  
Susan M. Sawyer ◽  
Jessica K. Roydhouse ◽  
Peter Edwards ◽  
...  
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Communication Strategies ◽  
Asthma Management ◽  
Doctor Patient Communication ◽  
Children With Asthma ◽  
The Usa ◽  
Randomised Controlled ◽  
Communication Behaviours ◽  
The Impact

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.

Variability in Pediatric Brain Death Determination Protocols in the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012225
Author(s):  
Conall Francoeur ◽  
Matthew J Weiss ◽  
Jennifer M Macdonald ◽  
Craig Press ◽  
David Matthew Greer ◽  
...  
Keyword(s):  
United States ◽  
Brain Injury ◽  
Organ Procurement ◽  
The United States ◽  
Cross Sectional Study ◽  
Neurologic Examination ◽  
National Guidelines ◽  
Cross Sectional ◽  
Organ Procurement Organizations ◽  
Death By Neurologic Criteria

Objective:To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.Methods:Cross-sectional study of DNC protocols obtained from pediatric institutions in the United States (US) via regional organ procurement organizations. Protocols were evaluated across five domains: general DNC procedures, prerequisites, neurologic examination, apnea testing and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.Results:One hundred and thirty protocols were analyzed with 118 dated after publication of the 2011 guidelines. Of those 118 protocols, identification of a mechanism of irreversible brain injury was required in 97%, while 67% required an observation period after acute brain injury before DNC evaluation. Most protocols required guideline-based prerequisites such as exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%). On neurologic examination, 91% required a lack of responsiveness, 93% no response to noxious stimuli, and 99% loss of brainstem reflexes. 84% of protocols required the guideline-recommened two apnea tests. CO2 targets were consistent with guidelines in 64%. Contrary to guidelines, fifteen percent required ancillary testing for all patients and 15% permitted ancillary studies that are not validated in pediatrics.Conclusionsand Relevance: Variability exists between pediatric institutional DNC protocols in all domains of DNC determination, especially with respect to apnea and ancillary testing. Better alignment of DNC protocols with national guidelines may improve the consistency and accuracy of DNC determination.

INTRODUCTION

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. ii-ii
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Child Development ◽  
Health Services ◽  
Cultural Sensitivity ◽  
Health Care Professionals ◽  
Research Policy ◽  
The United States ◽  
Policy Formulation ◽  
Full Account

In June 1992, 35 health care professionals, child and disability advocates, researchers, clinicians, and parents met at Wingspread Center in Racine, Wisconsin, for an invitational conference on Culture and Chronic Illness in Childhood. The meeting had as its goal the identification of the state of knowledge on the interface between culture, chronic illness, child development, and family functioning so as to lay the foundations for "culturally appropriate" health policy formulation, "culturally sensitive" services, and "culturally competent" clinicians. The purpose of this special supplement is to establish a national agenda for research, policy, service delivery, and training in addressing the needs of all children with chronic illnesses and disabilities that takes the family, ethnicity, socioeconomic status, and culture into full account. To meet this task, five papers were commissioned. The first, by Newacheck et al, addresses the changes in incidence and prevalence of chronic illness and disability among children and youth by ethnic group. The second paper, by McManus et al, focuses on the trends in health services organization, delivery, and financing as they vary among ethnic groups in the United States. What emerges is a rhetoric of cultural sensitivity not paralleled in the organization or financing of health services. Groce and Zola's paper addresses how cultural attitudes and beliefs are the foundations of our perceptions about health and illness. Those perceptions at times are predisposed to conflict with a health care professional who, coming from a different culture, may hold different norms and beliefs. Brookins grounds her discussion within the context of child development and argues that for a child of color or one whose ethnic heritage is other than mainstream, the key to developmental success is bicultural competence—the ability to walk in and between two worlds.

Association of Antenatal Corticosteroid Exposure and Infant Survival at 22 and 23 Weeks

2021 ◽  
Author(s):  
Robert M. Rossi ◽  
Emily A. DeFranco ◽  
Eric S. Hall
Keyword(s):  
United States ◽  
The United States ◽  
Adjusted Relative Risk ◽  
Antenatal Corticosteroid ◽  
National Guidelines ◽  
Antenatal Corticosteroids ◽  
Executive Summary ◽  
Weight Category ◽  
Corticosteroid Administration ◽  
Antenatal Steroid

Objective In 2014, the leading obstetric societies published an executive summary of a joint workshop to establish obstetric interventions to be considered for periviable births. Antenatal corticosteroid administration between 220/7 and 226/7 weeks was not recommended given existing evidence. We sought to evaluate whether antenatal steroid exposure was associated with improved survival among resuscitated newborns delivered between 22 and 23 weeks of gestation. Study Design We conducted a population-based cohort study of all resuscitated livebirths delivered between 220/7 and 236/7 weeks of gestation in the United States during 2009 to 2014 utilizing National Center for Health Statistics data. The primary outcome was rate of survival to 1 year of life (YOL) between infant cohorts based on antenatal steroid exposure. Multivariable logistic regression estimated the association of antenatal steroid exposure on survival outcomes. Results In the United States between 2009 and 2014, there were 2,635 and 7,992 infants who received postnatal resuscitation after delivery between 220/7 to 226/7 and 230/7 to 236/7 weeks of gestation, respectively. Few infants born at 22 (15.9%) and 23 (26.0%) weeks of gestation received antenatal corticosteroids (ANCS). Among resuscitated neonates, survival to 1 YOL was 45.2 versus 27.8% (adjusted relative risk [aRR]: 1.6, 95% confidence interval [CI]: 1.2–2.1) and 57.9 versus 47.7% (aRR: 1.3, 95% CI: 1.1–1.5) for infants exposed to ANCS compared with those not exposed at 22 and 23 weeks of gestation, respectively. When stratified by 100 g birth weight category, ANCS were associated with survival among neonates weighing 500 to 599 g (aRR: 1.9, 95% CI: 1.3–2.9) and 600 to 699 g (aRR: 1.7, 95% CI: 1.1–2.6) at 22 weeks. Conclusion Exposure to ANCS was associated with higher survival rates to 1 YOL among resuscitated infants born at 22 and 23 weeks. National guidelines recommending against ANCS utilization at 22 weeks should be re-evaluated given emerging evidence of benefit. Key Points

scholarly journals The PUFFinCA scale: development of an instrument for evaluating the primary care functions of family physicians in childhood asthma

2018 ◽  
Vol 20 ◽  
Author(s):  
Ayşe Nur Usturali Mut ◽  
Zeliha Aslı Öcek ◽  
Meltem Çiçeklioğlu ◽  
Şafak Taner ◽  
Esen Demir
Keyword(s):  
Primary Care ◽  
Childhood Asthma ◽  
Assessment Tool ◽  
Asthma Management ◽  
Correlation Coefficients ◽  
Family Physicians ◽  
Principal Component ◽  
Care Assessment ◽  
Provision Of Services ◽  
Children With Asthma

AbstractAimTo develop the Primary care fUnctions oF Family physicians in Childhood Asthma (PUFFinCA) scale for evaluating the cardinal process functions of primary care services (accessibility, comprehensiveness, continuity and coordination) provided by family physicians (FPs) in the management of childhood asthma.BackgroundIn the literature on the functions of primary care, there is no assessment tool focusing on children with asthma. Primary care assessment scales adapted to various languages are not suitable to adequately address the needs of special patient groups, such as children with asthma.MethodsIn this methodological study, the instrument development process was completed in four stages: establishing the pool of items, evaluating the content validity, applying the scale and statistical analysis. The scale was applied to 320 children who had asthma and received care in the clinic of the Department of Pediatrics, Division of Allergy and Pulmonology at Ege University School of Medicine, Turkey. The Cronbach’s α and Spearman–Brown coefficient were calculated to determine the reliability of the scale. Principal component analysis was used to determine the construct validity of the scale.FindingsThe PUFFinCA scale was found to have four-factor structure and 25 items. Cronbach’s α coefficient was 0.93. It has been determined that the reliability was excellent and the item-total correlation coefficients were >0.30 each. The factors were titled FP’s ‘functions of accessibility, first contact and continuity’, ‘functions of coordination and comprehensiveness of health services related to asthma management’, ‘provision of preventive care related to asthma’ and ‘provision of services for paid vaccinations’.

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