Parent’s perceptions and concerns about inhaled asthma therapy

Aim: To determine parent´s perceptions and concerns about inhaled therapy and their relation to disease control. Methods: A questionnaire was applied by interviewing parents of 119 asthmatic children attending the Pediatric Allergy or Pneumology outpatient clinic. Results: Eighty-one (68%) parents expressed concerns and worries about the use of inhaled therapy in their children, either with controlled or partially/uncontrolled asthma (65% Vs 78% p=0.22). Regarding their beliefs about inhaled therapy, 11% (n=13) stated that they considered pMDI’s/DPI’s less effective than nebulizers. When questioned about the knowledge of their child's acute exacerbation therapy, 91.5% (n=109) reported knowing it, albeit only 40% (n=44) did answer it correctly. Nine parents said they were unaware of their children’s reliever treatment. Discussion: We expected to find parental concerns about inhaled therapy, but such a high percentage wasn´t expected. A substantial number of parents believe that their children can become addicted or dependent on the use of the inhaler. This finding reinforces the misconceptions parents do have regarding inhaled therapy. There is a higher proportion of parents with concerns in the group with partially/uncontrolled asthma, although it was not statistically significant. The majority of patients/parents reported knowing the reliever plan in an exacerbation, although most of them could not explain the plan correctly. These results are worrying, as they show parents have an inappropriate knowledge of reliever measures. Therefore, we suggest that improvements in education about inhaled therapy should be made, including the regular review of the inhalation technique and the reliever plan in every consultation.

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Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2013.546 ◽

2013 ◽

Vol 8 ◽

Author(s):

Daniele Rapino ◽

Marina Attanasi ◽

Nicola P. Consilvio ◽

Alessandra Scaparrotta ◽

Anna Cingolani ◽

...

Keyword(s):

Logistic Regression ◽

Asthma Control ◽

Asthma Therapy ◽

Control Test ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Therapy Assessment ◽

Asthmatic Children ◽

Exercise Induced ◽

Assessment Questionnaire

Background: Achieving asthma control is a major challenge in children, otherwise symptoms perception remain poor especially at this age. The aim of this study is to evaluate the relationship between Asthma Control Test (ACTTM), Asthma Therapy Assessment Questionnaire (ATAQTM) and exercise-induced bronchospasm (EIB). Methods: We studied 80 asthmatic children. Airways hyperresponsiveness (AHR) was assessed by exercise-induced bronchospasm (Balke Protocol). Asthma control was evaluated using two questionnaires in all subjects: ACT (composed by Childhood-ACT and ACT) and ATAQ. In addition the use of short acting beta 2 agonist agents (SABAs) was assessed for each patient. Non-parametric variables were compared by Chi Square Test. Binomial logistic regression was performed to estimate the two questionnaires Odds Ratio (OR) in finding AHR. Results: We have found that ATAQ has a sensitivity and a specificity of 0.72 and 0.45 respectively; instead, ACT has a sensitivity and a specificity of 0.5 and 0.39 respectively in evaluating AHR. Patients with uncontrolled asthma according to ATAQ revealed a significant higher percentage of AHR compared with ACT (72% vs 50%, p < 0.01). Confirming this finding, patients declaring uncontrolled asthma to ATAQ have a significantly higher percentage (34%) of frequent SABAs use than the group with uncontrolled asthma to ACT (21%) (p <0.01). Binomial logistic regression shows how a test revealing uncontrolled asthma is associated with the increasing odds of having AHR according to ATAQ (OR = 3.8, p = 0.05), not to ACT (OR = 0.2, p = 0.1). Conclusions: Our results show that ATAQ reflects AHR and asthma control better than ACT. Children with uncontrolled asthma according to ATAQ have higher odds of having AHR and use of rescue medications (SABAs) compared to patients declaring uncontrolled asthma according to ACT. However both questionnaires are not sufficient alone to fully evaluate asthma control in children and it is always necessary to perform functional tests and investigate patients lifestyle, drug use and other important data that a simple questionnaire is not able to point out

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Comparison of inhalation technique with the Diskus® and Autohaler® in asthmatic children at home

ERJ Open Research ◽

10.1183/23120541.00215-2019 ◽

2021 ◽

pp. 00215-2019

Author(s):

A. van der Kolk ◽

N. Lammers ◽

M. Brusse-Keizer ◽

J. van der Palen ◽

J. Faber ◽

...

Keyword(s):

Chronic Disease ◽

Outpatient Clinic ◽

Daily Life ◽

The Other ◽

Inhalation Technique ◽

Randomised Study ◽

Common Chronic Disease ◽

Asthmatic Children ◽

Critical Error ◽

At Home

ObjectiveAsthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to: 1) Compare daily inhalation technique with the Diskus® and Autohaler® in asthmatic children by filming inhalations at home; 2) Compare daily inhalation technique with technique demonstrated in the hospital.MethodsWe performed a randomised study in asthmatic children (6–18 years) from the outpatient clinic of MST hospital from July 2014 to April 2016. Children received inhalation instructions for the Diskus® and Autohaler® and were randomised to use one device in the morning and the other in the evening. During the 28-days study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for 7 critical errors per device.ResultsA total of 636 videos with the Diskus® and 663 with the Autohaler® were provided by 27 children. The most common critical error in daily-life was an incorrect device position during preparation of the Diskus® (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler®. Percentage of correct days using the Diskus® was 44%, compared to 96% with the Autohaler® (p<0.001). The two most common errors with the Diskus® were made at least twice as often at home than in the hospital.ConclusionInhalation technique at home was markedly better with the Autohaler® than with the Diskus®. Pediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus®.

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Does immediate smart feedback on therapy adherence and inhalation technique improve asthma control in children with uncontrolled asthma? A study protocol of the IMAGINE I study

Trials ◽

10.1186/s13063-020-04694-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Esther T. Sportel ◽

Martijn J. Oude Wolcherink ◽

Job van der Palen ◽

Anke Lenferink ◽

Boony J. Thio ◽

...

Keyword(s):

Asthma Control ◽

Mobile Application ◽

Treatment Plan ◽

Current Therapy ◽

Inhalation Technique ◽

Control Group ◽

Phase 2 ◽

Uncontrolled Asthma ◽

Therapy Adherence ◽

Asthmatic Children

Abstract Background Many asthmatic children suffer from uncontrolled asthma with frequent exacerbations, despite an optimal treatment plan using inhalation medication. Studies have shown that therapy adherence and inhalation technique are often suboptimal in asthmatic children, but these have traditionally been hard to measure. A novel device functioning as an add-on to the inhaler has been developed to measure both aspects by recording vibration patterns during inhalation. This data can be converted to smart feedback and provided to patients immediately via a mobile application. The aim of this study is to improve asthma control in children between 6 and 18 years old by providing immediate smart feedback on the intake of inhalation medication. Asthma control will be measured by forced expiratory volume in 1 s, (Childhood) Asthma Control Test ((c-)ACT) score, and lung function variability and reversibility. Methods The study will be performed in Medisch Spectrum Twente (Enschede, The Netherlands). The goal is to include 68 uncontrolled moderate to severe asthmatic children between 6 and 18 years old who receive controller inhalation medication through the Nexthaler®, Ellipta®, or Spiromax®. The study consists of three phases. Phase 1 is observational and will last 4 weeks to observe the baseline adherence and inhalation technique as monitored by the add-on device. A randomised controlled trial lasting 6 weeks will be performed in phase 2. Patients in the intervention group will receive immediate smart feedback about the performed inhalations via a mobile application. In the control group, adherence and inhalation technique will be monitored, but patients will not receive feedback. In phase 3, also lasting 6 weeks, the feedback will be ceased for all children and revision of current therapy may occur, depending on the findings in phase 2. Asthma control can be assessed by means of spirometry (both at home and in the hospital) and (c-)ACT questionnaires. Discussion Immediate smart feedback may improve therapy adherence and inhalation technique, and thus asthma control in children and prevent unnecessary switches to targeted biologics. Performing this study in children is desired, since they are known to react differently to feedback and medication than adults. Trial registration Dutch Trial Register NL7705. Registered on 29 April 2019

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