Search

Introduction: Despite being linked to unfavourable outcomes, short-acting b2-agonists (SABAs) are still overused by a substantial proportion of patients with asthma. Aim: To analyse the prevalence and predictors of SABA overuse and exacerbations in patients with asthma in a nationwide database of prescription purchase records. Material and methods: The prevalence of excessive SABA use (= 12 canisters) and overuse (= 3 canisters) was analysed among patients aged 18-64 years who purchased asthma medications in 2018. Predictors of excessive SABA use and SABA overuse were examined by quasi-Poisson regression. Negative binomial regression was used to study the association of excessive SABA use or overuse to the risk of asthma exacerbation defined as a prescription for oral corticosteroids. Results: Of 91,763 patients with asthma, 42,189 (46%) were SABA users (mean age, 47 years; 58% female). Among them, 34% purchased = 3 SABA canisters, and 6% purchased = 12 canisters. The risk (risk ratio, 95% CI) of excessive SABA use was lower in patients with concomitant prescriptions for inhaled corticosteroids (0.41, 0.34-0.48) or inhaled corticosteroids and long-acting b2-agonists (0.52, 0.47-0.56), women (0.63, 0.58-0.68), and those in secondary care (0.60, 0.44-0.66); older age was associated with a higher risk of excessive SABA use (1.06, 1.03-1.10). Excessive SABA use was the strongest predictor of asthma exacerbations among all patients (3.24, 2.84-3.70) and in those with = 1 exacerbation (1.60, 1.50-1.71). Conclusions: Excessive SABA use is highly prevalent in asthma management, is associated with lack of prescriptions for inhaled corticosteroids, and substantially increases the exacerbation risk. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have indicated the significance of the peripheral airways in asthma control. Methods estimating airway resistance, air trapping, and ventilation inhomogeneity are useful for assessing this area of the lung and have proven utility in the evaluation of asthma; however, it is unclear which method is most effective at characterising uncontrolled asthma. Aim: To evaluate the diagnostic accuracy of various peripheral airway function measurements in the assessment of asthma control in children. Material and methods: Children with controlled (n = 35) and uncontrolled (n = 29) asthma performed a sequence of pulmonary function tests (i.e. spirometry, body plethysmography, oscillometry, nitrogen washout test, and exhaled nitric oxide). The diagnostic accuracy of each peripheral airway measure was evaluated by an area under the receiver operating characteristic curve (AUC). Results: Most peripheral airway parameters were significantly increased in children with uncontrolled asthma compared with children with controlled asthma. The measures with the highest diagnostic accuracy for asthma control were lung clearance index (LCI) (AUC = 0.76), with high specificity (0.97) and modest sensitivity (0.46), acinar ventilation heterogeneity (Sacin) (AUC = 0.73), with high sensitivity (0.85) and modest specificity (0.54), and resonance frequency (Fres) (AUC= 0.74), with perfect specificity (1.0) but low sensitivity (0.38). Conclusions: LCI, Sacin and Fres had the highest discriminative capacity for distinguishing children with controlled and uncontrolled asthma among all evaluated peripheral airways measures. Discrepancies in the performance (i.e. sensitivity and specificity) of each parameter suggest that a combination may be most effective in determining asthma control status. [ABSTRACT FROM AUTHOR]

In recent years, some new concepts have been added to asthma treatment such as "anti-inflammatory reliever" (β2-agonist use associated to an inhaled corticosteroid (ICS) as a reliever treatment) that combines the benefits of both therapies and provides short- and long-term benefits for treatment in asthma patients. Robust evidence has been presented in patients over 12 years, and the main changes in the international guidelines for asthma treatment were originally made in this age group. However, a few suggestions have been added to treatments in younger patients, in part because of the scarce evidence that exists in this group. We aim to analyze the information regarding the utilization of ICS + fast-acting beta-agonist (FABA) combination in children between 6 and 11 years. Although up until today only three published trials exist (two studies use beclomethasone + albuterol and one study uses budesonide + formoterol), they provide significant information on the benefits of ICS + FABA use in this population. [ABSTRACT FROM AUTHOR]

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p < 0.001). In addition, children with poorer asthma control had a higher risk of presenting with SARS-CoV-2 LRTI in a multiple logistic regression analysis. COVID-19 disease course was not associated with regular ICS use and asthma severity. However, patients on regular ICS had better asthma control (p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma. [ABSTRACT FROM AUTHOR]

Aim: Nursing interventions include the preventive care that can support and guide the nurse's effort to provide asthma interventions for children. Hence, this review was done to assess the effectiveness of nursing interventions for management of childhood asthma. Methods: We conducted a search in Medline, the Cochrane library, EMBASE, ScienceDirect and Google Scholar from 1964 until April 2022. Meta‐analysis was done using a random‐effects model and pooled weighted mean difference (WMD) or standardized mean difference (SMD) and/or risk ratio (RR) with 95% confidence intervals (CIs). Results: Fourteen studies were analysed. The pooled RR was 0.49 for emergency visits (95% CI: 0.32 to 0.77) and 0.46 for hospitalizations (95% CI: 0.27 to 0.79). The pooled WMD was −1.20 for number of days with symptoms (95% CI: −3.50 to 1.11), −0.98 for number of nights with symptoms (95% CI: −2.94 to 0.98) and −0.69 for frequency of asthma attacks (95% CI: −1.19 to −0.20). The pooled SMD was 0.39 for quality of life (95% CI: 0.11 to 0.66) and 0.58 for asthma control (95% CI: −0.29 to 1.46). Conclusion: Nursing interventions were relatively effective in improving the quality of life and reducing asthma related emergencies, acute attacks and hospitalization amongst childhood asthma patients. Summary statement: What is already known about this topic? There have been limited reviews on effectiveness of nursing intervention for the management of asthma amongst children including only the randomized controlled trials. What this paper adds? This is the first review that assessed the impact of nursing intervention for childhood asthma including only RCT.Nursing interventions showed significant impact on ED visits and hospital admissions.There was also an impact on reducing the frequency of asthma attacks and improving QoL. The implications of this paper: It is necessary to implement any form of nursing intervention either in hospital setting, school and community or in virtual mode to assist with managing childhood asthma patients. [ABSTRACT FROM AUTHOR]

Objective: Despite stunning advances in drug treatment, the present modern drugs that are used in the treatment of bronchial asthma don't always achieve complete control over the disease. It may be useful to get support from complementary and alternative medicine (CAM) in such cases. CAM is understood as a non-traditional treatment, one of the varieties of which is speleotherapy. With the purpose of studying the therapeutic effect of speleotherapy in children, a treatment of speleotherapy was conducted for 50 children and adolescents suffering from atopic bronchial asthma. Materials and Methods: To evaluate the effectiveness of speleotherapy, the following research methods were used: Spirometry method was used to assess the ventilation function of the lungs, nitric oxide in exhaled air was measured for the assessment of airway inflammation, and laboratory examination of patients were evaluated including Interleukin (IL)-5, IL-13 and Interferon-gamma (IFN-y) in serum by using enzyme-linked immunosorbent assay (ELISA). Results: As a result of the speleotherapy, patients improved their external respiratory function. The study also showed a positive impact with speleotherapy on exhaled nitric oxide and cytokine parameters in children with mild and moderate atopic bronchial asthma. Conclusion: Speleotherapy, as a method of medical rehabilitation for patients with bronchial asthma, leads to a decrease in the number of attacks, reduces the use of bronchodilators, and improves the indicators of the function of external respiration. [ABSTRACT FROM AUTHOR]

In this article, Heather Henry provides a quick overview of what you need to know about children's use of spacers, with reference to the latest evidence [ABSTRACT FROM AUTHOR]

The article comments on a study which described a cohort of children with critical asthma managed with noninvasive respiratory support (NRS). It cites limitations of the study including its failure to report the reasons individuals were started on the different respiratory support modalities, the criteria for escalating respiratory support, and NRS parameters used. Also noted are the conflicts regarding the use of high-flow nasal cannula in pediatric critical asthma, its failure rate and risks.

Severe asthma is a subset of difficult‐to‐treat asthma which requires a systematic and multidimensional approach including the need to manage multiple comorbidities that mimic asthma. Multidisciplinary care is becoming the standard for the assessment of such patients. Multidisciplinary team (MDT) clinics are virtually nonexistent in the private space. We developed an MDT clinic to handle needs in the private space and found it was an invaluable tool for assessment, reflective practice and professional development. [ABSTRACT FROM AUTHOR]

The article focuses on the alarming disparities in asthma outcomes for children and young people in the UK, revealing high hospital admission and mortality rates, significant morbidity, and health inequalities, with factors contributing to poor outcomes including inadequate perceptions of asthma, health disparities, delays or inaccurate diagnosis, and inadequate basic care.

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bronchial asthma is a non-communicable disease demanding long-term adherence to medical treatment and self-management. The effectiveness of a Nurse-Led Clinic for the management of long-term illness is well established. In our setup, we intend to establish a Nurse-Led Clinic. Before establishing one, it is essential to explore stakeholders' perspectives on the feasibility of a Nurse-Led Clinic for the self-management of bronchial asthma. Objective: The study was done to explore stakeholders' opinions on the Nurse-Led Clinic's feasibility for the self-management of bronchial asthma. Methods: Five doctors, six nurses, and 11 patients were taken as stakeholders using the purposive sampling technique. A pre-validated semi-structured opinionnaire having a Content Validity Index (CVI) of 0.82 was used. Face-to-face individual interviews were conducted. The data triangulation and dependability were ensured. Results: After the thematic analysis, themes were categorized into two sections based on the common and different questions for all the stakeholders. The major themes of both sections were as follows: Nurse-Led Clinic-A perceived helpful initiative, strengthening the Nurse-Led Clinic, current obstacles/restorative measures in the management of bronchial asthma, a glance at the current scenario, patient satisfaction with doctors' consultation, and challenges Nurse-Led Clinic may face and related remedial measures. Conclusion: All stakeholders favored the idea of a Nurse-Led Clinic for the self-management of bronchial asthma. [ABSTRACT FROM AUTHOR]

Damp and moisture-damaged building exposure has been linked to adverse health effects, primarily related to respiratory complications from mold spore reactions. This paper describes a case of a previously healthy man who was exposed to a home with hidden mold infestation and remained symptomatic following proper remediation. The patient presented with allergies, allergic bronchopulmonary aspergillosis, and treatment resistant asthma, as well as other non-respiratory symptoms likely related to inhalational mycotoxin exposure from his home. In this case, the addition of systemic and intranasal antifungals improved both respiratory and nonrespiratory symptoms. Antifungals were used for a longer duration than customary and in combination with factors that addressed drug resistance. [ABSTRACT FROM AUTHOR]

Aim: Cat allergen hypersensitivity is a clinical condition that can affect patients across a wide spectrum, ranging from mild allergic rhinitis to severe asthma. Since cat hypersensitivity can occur through indirect exposure, non-cat owners also have the risk of developing cat allergies. The aim of this study was to investigate the effects of direct and indirect exposure patterns on the clinical features of allergic rhinitis and allergic asthma in patients with cat hypersensitivity. Methods: In our study, designed as a retrospective cohort, the demographic and clinical characteristics of 257 patients diagnosed with cat allergy and allergic rhinitis who were followed up and treated between January 2022 and March 2023 were evaluated. Cat and non-cat owner patients were compared in terms of symptoms of allergic rhinitis, treatment steps for allergic rhinitis, and frequency, control and treatment steps for allergic asthma. Results: The median (interquartile range) age of the patients was 29 (23-38), and 182 of them were female (70.8%). The visual analogue scale symptom scores of cat owners were significantly higher than those of non-cat owners (p=0.022 and p=0.023, respectively). The rate of moderate or severe allergic rhinitis that persisted despite treatment was higher in cat owners (31.8%) than in non-cat owners (17.8%). Additionally, allergic asthma frequency in cat owners with moderate or severe allergic rhinitis symptoms despite medical treatment was more common than in cat owners with mild rhinitis (p=0.026). Conclusion: Direct exposure to cat allergens is associated with poor control of allergic rhinitis symptoms. These patients should avoid contact with cats. If avoidance is not possible, the clinical condition of these patients should be closely monitored, as they may have treatment-resistant respiratory allergies. [ABSTRACT FROM AUTHOR]

Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)--driven protocol. METHODS: The protocol established that spirometry and education would be done annually for children ≥ 6 y of age with intermittent asthma and every 6 months for persistent asthma. RTs identified eligible subjects and placed the electronic medical record orders before the clinic visit. Physicians were invited to complete a questionnaire before and after protocol implementation to assess barriers and protocol satisfaction. RESULTS: Nine hundred and thirty-two children were included. Prior to protocol implementation, spirometry and education were completed in 64.9% and 62.6% of eligible children, respectively. Following protocol implementation, spirometry and education were significantly increased to 92.7% (P < .001) and 88.5% (P < .001), respectively. Physicians identified interruption in clinic flow as the primary barrier for ordering spirometry and were satisfied with the protocol. Physicians stated that communication with RT improved through use of this protocol. CONCLUSIONS: Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric outpatient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication. [ABSTRACT FROM AUTHOR]

Air pollutants are known to trigger asthma and wheezing-associated lower respiratory infections in children, but evidence regarding their effect on hospital admissions in India is limited. We conducted a time-series study over a period of five years to assess the role of ambient air pollutants in daily asthma-related hospital admissions in children in Mysore, India. Daily asthma and wheeze (associated with lower respiratory infections) admissions were modelled using a generalised additive model (GAM) to examine the non-linear effects and generalised linear models (GLM) for linear effects, if any. Models were adjusted by day of the week and lag days, with smooth terms for time, maximum temperature, and relative humidity, and they were stratified by sex and age group. Of the 362 children admitted, more than 50% were boys, and the mean age was 5.34 years (±4.66). The GAMs showed non-linear associations between NO2, PM2.5, and NH3. For example, a 10 µgm−3 (or 10%) increase in NO2 increased admissions by 2.42. These non-linear effects were more pronounced in boys. A linear effect was detected for PM10 with a relative risk (95% CI) of 1.028, 1.013, and 1.043 with admission. Further research is needed to explore whether these findings can be replicated in different cities in India. Air pollution needs to be controlled, and policies that focus on lower cut-off levels for vulnerable populations are necessary. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effects of body mass index (BMI), waist circumference (WC), and depression on asthma in older adults Koreans. Methods: Data for 1,388 individuals (> 65 years) were extracted from the Korea National Health and Nutrition Examination Survey (KNHANES w-2, 2020). Complex sampling design data were analyzed using stratification, clustering, and weights. Data were analyzed using unweighted frequencies, weighted percentages, estimated means and standard errors, the Rao-Scott χ² test, and multiple logistic regression analysis, which was performed to identify variables that influenced asthma after adjusting for confounding factors. Results: The factors influencing asthma in the older adults were a depression diagnosis, age at the onset of depression, current depression status, and gender. In contrast, BMI and WC did not affect asthma. A diagnosis of depression had an odds ratio of 3.07 for asthma in the older adults. Furthermore, the odds ratios for asthma in the older adults were 5.08 for depression onset at <49 years and 3.37 for current depression compared to no depression diagnosis. The odds ratio for asthma in female older adults was 1.35. Conclusion: The results of this study suggest that asthma in the older adults could be detected early through depression symptoms. This study also provides evidence that depression-related interventions should be included in asthma prevention and management programs for the older adults in Korea. [ABSTRACT FROM AUTHOR]

This paper discusses the understanding of traditional Chinese medicine, Uyghur medicine, Tibetan medicine and Mongolian medicine on bronchial asthma, and discusses the causes and pathogenesis, syndrome differentiation, treatment principles and treatment drugs, respectively. It compares the similarities and differences of different ethnic groups' traditional medicines on bronchial asthma treatment, so as to help each ethnic group learn from each other and further improve their understanding of asthma. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the signs and symptoms of asthma, as well as how it is treated • To be aware of various frameworks and tools that can be used when assessing, managing and prescribing medicines for patients • To recognise the legal, ethical and professional considerations when prescribing medicines for children Asthma is a chronic condition of varying intensity that is characterised by symptoms including coughing, wheezing, chest tightness and breathlessness. The article details a case study outlining the consultation and prescribing practice for a five-year-old girl who presented with a cough and breathlessness, and who was subsequently diagnosed with asthma. The author assessed and treated this patient while undertaking her non-medical prescribing qualification, and she outlines the diagnostic and prescribing decision-making process. The author also examines the potential drug interactions and adverse drug reactions relevant to the patient's age and comorbidities. [ABSTRACT FROM AUTHOR]

Asthma management consists of a cyclical process based on clinical assessment of the patient, the implementation of therapeutic adjustments, and evaluation of the patient's response. Self-efficacy is the person's confidence in his or her ability to successfully perform a behaviour and guides the patient's decisions for producing healthy behaviours. Studies have shown that asthma management is related to self-efficacy, which in turn can be influenced by various psychosocial factors. A literature search on the relationship between asthma and self-efficacy in paediatric age, has allowed us to hypothesize that adequate levels of self-efficacy might be achieved through a cyclical process, 'the self-efficacy cycle', taking into account assessment, identification of modifiable risk factors and patient's response. This would make it easier to identify the personal and social aspects on which to intervene to promote a proper management of the disease. [ABSTRACT FROM AUTHOR]

While autism spectrum disorder (ASD) has traditionally been diagnosed in specialty care, rising prevalence rates have strained specialist capacity and created significant diagnostic bottlenecks. With long wait times for specialist evaluations, pediatricians are increasingly being asked to play a greater role in identifying, diagnosing, and managing ASD within the medical home. In this commentary we draw parallels between the challenges pediatricians faced two decades ago learning how to manage pediatric asthma in the medical home, to those faced today in the field of primary care ASD management. Reflecting on the lessons learnt in primary care asthma management may help us construct a roadmap towards a higher and more consistent standard of ASD primary care for patients and their families. [ABSTRACT FROM AUTHOR]

Background: Avoidable hospitalisation rates for Indian immigrant children with asthma is high in New Zealand and other Western countries. Understanding how children and their carers manage asthma may lead to a reduction in hospitalisation rates. The topic of asthma and Indian immigrant children's perspectives has not been investigated. Most studies on the topic focus on the experiences of family carers and health professionals. Practice cannot be advanced in the child's best interests unless the child's asthma experiences are explored. The following research addressed this gap by upholding Article 12 of the United Nations Convention on the Rights of the Child, thereby giving Indian immigrant children a voice in describing their asthma experiences. Design: Constructivist grounded theory. Methods: Intensive interviews were conducted with ten family carers and nine children (eight to 17 years old). Child‐sensitive data collection techniques such as drawing, and photography were used to facilitate interviewing children younger than 14 years. The COREQ guidelines guided the reporting of this study. Results: The theory, navigating asthma: the immigrant child in a tug‐of‐war, is the resulting grounded theory with the tug‐of‐war being the basic social process. This theory comprises three main categories: being fearful, seeking support and clashing cultures. The data reflected two types of tug‐of‐war: one between two cultures, the native Indian and the host New Zealand culture and another between family carers' and children's preferences. Conclusion: Acculturation and sociocultural factors may significantly influence the asthma experiences of Indian immigrants. Relevance to clinical practice: The theory may assist healthcare practitioners to better comprehend Indian immigrants' asthma experiences within their wider sociocultural context. Our research indicates the need for healthcare practitioners to work in partnership with Indian immigrant families to implement culturally safe asthma management strategies. [ABSTRACT FROM AUTHOR]

Aims: This study examined the short‐term effect of motivational interviewing on treatment adherence and self‐efficacy of adolescents with asthma. Design: The randomized controlled trial. Method: In this study, 72 adolescents with asthma were recruited and assigned to experimental and control groups randomly. In the experimental group, the motivational interviewing was performed for five weekly sessions lasting 80–90 min. The treatment adherence and self‐efficacy questionnaires were completed before the intervention, 2 weeks and 3 months after the intervention in both groups. Data were analysed by Chi‐Square test, independent samples T‐test, repeated measures of Wilcoxon and generalized estimating equation. Results: The treatment adherence was found to be significantly higher 2 weeks (p = 0.006) and 3 months after the intervention (p = 0.04) in the experimental group than the control group. In addition, the degree of self‐efficacy was significantly more in the experimental group 2 weeks (p < 0.001) and 3 months later (p < 0.001) than the control group. The result of generalized estimating equation showed that the intervention group had an average of 14.44 more self‐efficacy points than the control group (p < 0.001). Also, treatment adherence in the intervention group was significantly higher than the control group (β = 6.14, p = 0.05(. Conclusion: This study adds to the evidence for the effectiveness of motivational interviewing in treatment of adolescents with asthma. [ABSTRACT FROM AUTHOR]

Familial support was essential to the care of asthma patients during the COVID-19 pandemic. It helps clients in making asthma care decisions. The purpose of this study was to explain the experience of families in providing asthma care and the effects of family care on the patient during the COVID-19 pandemic in Indonesia. This qualitative study was conducted using a content analysis approach on three families in East Java Province, Indonesia. Data were collected from the 3 families, using semi-structured interviews between 2020 and 2021. The subjects were all families in which some members had asthma. Sampling was done using the purposeful technique with maximum variation. Immediately after each interview, the content was transcribed using the Word software. The interviews were conducted with one individual at a time in the family's home. Data were analyzed using the conventional content analysis method with simultaneous data collection based on five steps. The data analysis showed three main themes: family burdens and disruption when asthma relapsed, using a mask, keeping up stamina, keeping the mind relaxed, and staying away from crowds as an effort to prevent asthma, and pharmacological and non-pharmacological treatments carried out by families. The burden faced by the family when the disease recurs can be curbed through the family's taking anticipatory measures that involve cooperation between family members. The family also plays a vital role in limiting the patient's activities when the disease relapses. [ABSTRACT FROM AUTHOR]

Asthma imposes a significant social burden on children, their families, and society at large. As a chronic health condition, effective management could greatly benefit from consistent adherence to guidelines. Despite this, minimal effort has been exerted to examine the impact of asthma management guidelines and adherence to treatment on children with asthma and the mothers caring for them. This study was designed to evaluate the influence of asthma management guidelines on the knowledge and treatment adherence among children with asthma and their mothers. A quasi-experimental design was utilized, and the study was conducted at two large hospitals in Jordan: Princess Rahma Hospital and King Hussein Medical Center. A purposive sample of children aged 6–12 years (n = 100) who were accompanied by their mothers (n = 100) were recruited for this study. Data were collected using a structured questionnaire and an observation checklist before and after the implementation of guidelines. Statistical analyses were performed using SPSS. The results revealed a statistically significant improvement in knowledge related to asthma among children and their mothers (p < 0.001). Additionally, a statistically significant difference was observed in the children's adherence to their treatment regimen before and after the implementation of asthma management guidelines (p < 0.001). Moreover, the improvements in knowledge and practice related to asthma were sustained in the follow-up assessments. In conclusion, the guidelines had a beneficial effect on the children's adherence to their treatment regimen both before and after their implementation. Thus, asthma patients should adhere to conventional guidelines at various health services to manage their condition effectively. [ABSTRACT FROM AUTHOR]

Pediatric asthma management in the U.S. is primarily oriented around caregivers. As evident in policy, clinical literature and provider practices, this caregiver-centric approach assumes unidirectional transfer of practices and knowledge within particular relational configurations of physicians, caregivers, and children. Reflecting broader societal values and hierarchies, children are positioned as passive recipients of care, as apprentices for future citizenship, and as the responsibility of parents who will train them in the knowledge and labor of asthma management. These ideas, though sometimes contradictory, contribute to a systemic marginalization of children as participants in their health care, leaving a conceptual gap regarding children's inclusion in chronic illness management: what children's roles in their health care are or should be. We address this conceptual gap by asking, what does pediatric asthma management look like when we center children, rather than caregivers in our lens? We draw data from a study of asthma management in St. Louis, Missouri, and Gainesville, Florida, which included 41 caregivers, 24 children, and 12 health-care providers. By asking children to show us how they manage asthma, we find that children actively co-construct health practices within broader interdependencies of care and the structural constraints of childhoods. [ABSTRACT FROM AUTHOR]

Background: Gaps in the treatment of patients with acute asthma have been repeatedly described in Australia. We conducted a retrospective audit of acute asthma care at a Victorian tertiary institution. Aims: To describe acute asthma care at a large health network in metropolitan Melbourne, and evaluate the extent to which Emergency Department (ED) care was consistent with National Asthma Council guidelines. Methods: A retrospective audit was performed of medical records between July 2017 and June 2019. We included adult patients admitted to campuses within the Western Health network in Melbourne, Victoria, where the length of stay was at least 12 h, and the primary discharge diagnosis was asthma. Results: Four hundred and ninety‐three admissions were included in the analysis, representing 392 individual patients. Seventy‐one percent of patients were female and 27% were current smokers. Ninety‐six percent of patients had a prior asthma diagnosis, 63% had a previous hospital presentation and 75% were prescribed an inhaled preventer. In the ED, systemic corticosteroids and inhaled salbutamol were prescribed in 65% and 82% admissions respectively; adjunctive treatments included ipratropium (67% of admissions), magnesium sulfate (30%), adrenaline (11%) and non‐invasive ventilation (9%). Overall, ED care was guideline concordant in 59% of admissions. On the wards, treatments prescribed within 24 h of admission included corticosteroids (90% of admissions), salbutamol (84%), ipratropium (64%) and inhaled preventers (63%). The proportion of patients prescribed these treatments, as well as documented follow up (e.g. asthma action plans), varied significantly depending on the treating specialty. Conclusion: The emergency treatment of patients with acute asthma frequently deviated from guidelines and there was significant variation in inpatient treatment. Quality improvement initiatives that incorporate structural changes are required to improve asthma care. [ABSTRACT FROM AUTHOR]

Copyright of Enfermeir@s is the property of Colegio Oficial de Enfermeria de Lugo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Overprescription of short-acting beta-agonist (SABA) inhalers and blood eosinophil count have strong associations with exacerbation risk in asthma. However, in the authors' recent publication only a minority of patients overprescribed SABA (=6 inhalers in 12 months) were eosinophilic (=0.3 x 109 cells/l). Aim: To compare the characteristics of eosinophilic and non-eosinophilic patients with asthma overprescribed SABA inhalers, and identify latent classes using clinical variables available in primary care. Design & setting: Cross-sectional analysis of patients with asthma in North East London, England, using primary care electronic health record data. Method: Unadjusted and adjusted multi-variate regression models and latent class analysis. Results: Eosinophilia was significantly less likely in female patients (P = 0.004), those with multiple mental health comorbidities (P<0.001), and those with SABA on repeat prescription (P<0.001). Latent class analysis identified the following three classes of patients overprescribed SABA: class 1, which represents classical uncontrolled asthma (oral steroids required for exacerbations, step 2-3 asthma medications, high probability of being eosinophilic); class 2, which represents mild asthma (low exacerbation frequency, low asthma medication step, low probability of being eosinophilic); and class 3, which represents difficult asthma (high exacerbation frequency despite high-strength preventer inhalers, low probability of being eosinophilic). The mild asthma class was the largest. Conclusion: Many patients being overprescribed SABA were non-eosinophilic with a low exacerbation frequency, suggesting disproportionately high SABA prescription compared with other asthma control markers. Potential reasons for high SABA prescription in these patients included repeat prescription (being dispensed but not taken) and use of SABA for non-asthma breathlessness (for example, breathing pattern disorders with anxiety). Further research is needed into management of SABA overuse in patients without other markers of uncontrolled asthma. [ABSTRACT FROM AUTHOR]

Background: Inhaler therapy plays a crucial role in controlling respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD). Incorrect or partially correct use of inhaler devices causes many chronic obstructive pulmonary disease (COPD) patients to continue to have respiratory symptoms due to poor drug deposition in the airways as a result of poor inhaler technique, leading to increased healthcare costs due to exacerbations and multiple emergency room presentations. Choosing the right inhaler device for each individual patient is a bigger challenge for doctors and chronic obstructive pulmonary disease (COPD) patients. The type of inhaler device and the correct inhaler technique depends on the control of symptoms in chronic obstructive pulmonary disease (COPD). Physicians treating patients with chronic obstructive pulmonary disease (COPD) play a central role in educating patients about the correct use of inhalation devices. The steps for the correct use of inhalation devices should be taught to patients by doctors in the presence of the family so that if the patient has difficulties handling the device correctly, the family can support them. Methods: Our analysis included 200 subjects divided into two groups—recommended group (RG) and chosen group (CG)—and aimed primarily to identify the behaviour of chronic obstructive pulmonary disease (COPD) patients when faced with deciding which type of inhaler device is most suitable for them. The two groups were monitored three times during the 12-month follow-up period. Monitoring required the physical presence of the patient at the investigating physician's office. The study included patients who were smokers, ex-smokers, and/or with significant exposure to occupational pollutants, aged over 40 years diagnosed with chronic obstructive pulmonary disease (COPD), risk group B and C according to the GOLD guideline staging, and on inhaled ICS+LABA treatment, although they had an indication for LAMA+LABA dual bronchodilation treatment. Patients presented for consultation on their own initiative for residual respiratory symptoms under background treatment with ICS+LABA. The investigating pulmonologist who offered consultations to all scheduled patients, on the occasion of the consultation, also checked the inclusion and exclusion criteria. If the patient did not meet the study entry criteria, they were assessed and received the appropriate treatment, and if the study entry criteria were met, the patient signed the consent and followed the steps recommended by the investigating pulmonologist. As a result, patient entry into the study was randomised 1:1, meaning that the first patient was recommended the inhaler device by the doctor and the next patient entered into the study was left to decide for themselves which type of device was most suitable for them. In both groups, the percentage of patients who had a different choice of inhaler device from that of their doctor was statistically significant. Results: Compliance to treatment at T12 was found to be low, but compared to results previously published on compliance, in our analysis, compliance was higher and the only reasons identified as responsible for the better results were related to the selection of the target groups and the regular assessments, where, in addition to reviewing the inhaler technique, patients were encouraged to continue treatment, thus creating a strong bond between patient and doctor. Conclusions: Our analysis revealed that empowering patients by involving them in the inhaler selection process increases adherence to inhaler treatment, reduces the number of mistakes in inhaler use of the inhaler device, and implicitly the number of exacerbations. [ABSTRACT FROM AUTHOR]

The article examines the implementation of the Community Asthma Prevention Program Plus (CAPP+), a unique partnership between a large pediatric health system and community-based organizations to remediate the homes of children with asthma and reduce exposure to environmental asthma allergens. Topics discussed include program design and operation, impact of home repairs on child's asthma, and lessons learned from the program.

Background: Fungal sensitization is usually associated with increased asthmatic severity, morbidity and mortality, including higher rates of hospital and intensive care admission. However, the possible association between fungal airway colonization with regard to sensitization remains controversial. Objectives: to investigate the presence of severe asthma with fungal sensitization among asthmatic patients and to find evidence of Aspergillus fumigatus (A. fumigatus) role in severely asthmatic patients. Methods: this study investigated forty asthmatic patients and twenty controls. Demographic data of all subjects within the study was collected, as well as total serum IgE, A.fumigatus specific IgE and A. fumigatus galactomannan antigen ELISA test. Results: our results showed significant elevation of total IgE, Aspergillus specific IgE and A. fumigatus galactomannan antigen in 75% of severely asthmatic patients, compared to patients with mild asthma and negative values in control. Conclusion: We report a high percent of A. fumigatus colonization among severely asthmatic patients. This supports the hypothesis of the role of fungal elements colonization in the airways of patients with severe asthma. [ABSTRACT FROM AUTHOR]

In pediatric patients with acute respiratory illnesses, the widespread availability of heated humidified high-flow nasal cannula (HHHFNC) devices, ease of use, and increased compliance have increased their use in conditions such as pneumonia, acute respiratory failure, asthma, and acute respiratory distress syndrome. Due to the patient comfort and ease of use of HHHFNC, there are widely used. Similarly, the use of NIV is increasing due to the availability of better interfaces and non-invasive ventilators (NIV) for use in infants The conundrum has been regarding the generation of positive end-expiratory pressure in these open circuits of the HHHFNC devices versus the pressures delivered by the closed circuits in the NIV devices. This article reviewed the latest literature based on the clinical conditions and the rationale for selecting respiratory support in common acute respiratory illnesses. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article examined the sociodemographic and health-related factors associated with the use of complementary and alternative medicine/therapy (CAM) among adults with current asthma in the United States. We used data from 76,802 adults aged 18 years and above from the 2012–2019 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS) cycles. Weighted binary and multinomial logistic regression was used to examine the association of these factors with ever CAM use and the number of CAM use. We found that approximately 45.2% of US adults with asthma ever used CAM. Among adults with asthma, 25.3% and 19.9% endorsed using one CAM and ≥2 CAMs, respectively. CAM use was significantly associated with adults ≤ 35 years, female gender, multiple/other race/ethnicity, higher cost barriers, adults with two or more disease comorbidities, and those with poorly controlled asthma in both binary and multinomial models. CAM use was not associated with insurance and income status. Understanding factors associated with CAM use can provide asthma care professionals valuable insights into the underlying drivers of CAM use behavior in this population, enabling them to offer more informed and effective medical advice and guidance. [ABSTRACT FROM AUTHOR]

Background & Aims: Asthma is a common chronic airway disease that has a dramatic effect on the process of life, group activity and socio-psychological functioning and even the economic progress of patients. There are currently 300 million asthma patients worldwide and it is predicted that by 2025, 100 million asthma patients will be added to the world population (1). Exacerbation of the symptoms of the disease affects the quality of life as well as the cost of treatment. Complications of chronic obstructive pulmonary disease include respiratory failure, pneumonia or other respiratory infections, right heart failure (pulmonary heart), arrhythmias, and depression. Asthma control is determined by the frequency of symptoms during the day, activity limitations, nocturnal symptoms, the need for essential medications, and lung function (4). Studies show that unhealthy lifestyles such as inactivity and obesity are associated with negative health consequences in asthma patients, including poor asthma control (5). Among the measures taken to relieve symptoms and improve the functional status of patients with these diseases are pulmonary rehabilitation and breathing exercise and exercise programs that are part of it are used to improve functional status (6). Numerous clinical studies have shown that exercise, as part of a pulmonary rehabilitation program, improves asthma control and overall physical fitness in people with asthma and reduces hospitalization rates (7). Resistance training and strengthening the muscles of inhaling and exhaling are among the techniques that increase respiratory function in respiratory patients (8). Regarding the beneficial effects of exercise in asthma patients, many studies have shown that physical activity and regular exercise play a beneficial role in reducing respiratory tract inflammation, shortness of breath and improving or maintaining pulmonary capacity such as Forced expiratory volume in the first second (FEV1) and has a Forced vital capacity (FVC) throughout the life of asthma patients (9-12). However, some studies have shown that during the period of sports interventions, patients had emergency conditions and exacerbation of asthma (13,14). Turner et al. Found that some patients had exacerbated asthma during exercise (14). Asthma in adolescents and children can have detrimental effects on their mood and social activities. Over the past decades, a 100% increase in childhood obesity has been implicated in the prevalence of asthma because it affects the physiopathology and mechanics of the lungs. Because maintaining asthma control through medication is at a difficult level, it seems that getting help from lifestyle changes, such as including regular physical activity in the asthma patients' lifestyle, can help control asthma (8). Recent evidence in systematic studies has led to the support of aerobic exercise as an aid to the treatment of asthma, and despite standard treatment, its supply to asthma patients has become essential. However, the role of regular exercise, especially breathing exercises, in very limited asthma control has been investigated. Therefore, the present study investigated the effect of eight weeks of moderate intensity aerobic exercise on FVC and FEV1 in mature and immature girls with asthma in humid environment. Methods: In this semi- experimental trial, 60 girls students with asthma (30 mature and 30 immature girls; with average age of 8-18 years) from Rasht city were randomly selected and randomly divided into two groups include exercise and control. The aerobic exercise program was performed with intensity of 45-75% of maximum heart rate, 3 sessions per week for 8 weeks. Spirometry test was performed to determine pulmonary function before and after the training protocol. Data were analyzed using 2-factor analysis of covariance (ANCOVA) test at the p≤0.05. Results: Aerobic exercise led to significant increase in FEV1 in girls with asthma (P= 0.000). There was no significant difference between the effect of aerobic exercise on FEV1 in mature and immature girls with asthma. Aerobic exercise led to significant increase in FVC in girls with asthma (P= 0.000). There was no significant difference between the mean FVC of mature and immature girls with asthma. Conclusion: The results of the present study showed that after the intervention period, FEV1 levels significantly increases in girls with asthma. Also, the mean FEV1 of adult girls was significantly higher than immature girls with asthma. The results showed that increasing FEV1 had beneficial effect on improving asthma control. The results of the present study are consistent with some previous findings (20-22). Increasing or improving pulmonary function with exercise seems to be related to reducing airway resistance, increasing airway diameter, as well as strengthening the respiratory muscles and the elastic properties of the lungs and chest. On the other hand, the effects of adrenaline and cortisol may be effective. Increased activity of the adrenaline system during exercise reduces the reversibility of the lungs and dilation of the pulmonary arteries. Also, the increase in plasma levels of cortisol as a bronchodilator is a very strong and strong production of surfactant in the lungs (19). Asthma is classified clinically according to the frequency of symptoms, expiratory volume with pressure per second (FEV1) and maximum expiratory flow rate (23). Strengthening the respiratory muscles, increasing the effective tail force due to strengthening the elasticity of the main and auxiliary intercostal muscle fibers, reducing obesity and thus reducing the pressure caused by the accumulation of fat around the chest have been reported as mechanisms of effect of exercise in improving lung function (25). In the present study, moderate-intensity aerobic exercise increased FVC in girls with asthma. The findings of our study also showed that aerobic exercise along with resistance exercise can be associated with an increase in spirometry indices FEV1 and FVC. These results are consistent with the results of previous research (20-22). The value of the FVC index depends on the elasticity of the lungs, the authority of the airways. Studies have shown that the elasticity of the lungs, the position of the ducts between the alveolar region and the location of the stenosis and dilatation of the airway wall are effective physiological mechanisms in determining airflow at this stage. The increase in FVC appears to be due to aerobic exercise due to increased lung volume and elastic reversal of the lungs (11). There were some limitations in the present study; One of the limitations of the present study is the lack of measurement of lung function following ventilation. To determine whether the adjustments we observed are the result of exercise or increased ventilation, future studies should examine the effects of over-ventilation on changes in respiratory muscle strength and respiratory volume. Also, more research is needed to understand the effects of long-term aerobic exercise on respiratory volume. The results of this study showed that regular exercise with increased activity tolerance can facilitate the transfer of oxygen to body tissues. As a result, eight weeks of moderate aerobic exercise can cause a positive and favorable change in FEV1 and FVC indices in mature and immature girls with asthma. [ABSTRACT FROM AUTHOR]

Background: Asthma and COVID-19 have overlapping symptoms. During the 2019–2022 pandemic, pediatric asthma control appears to have improved, with some researchers theorizing that that is due to changes in asthma self-management. This study examined adolescents' views regarding how the pandemic impacted their asthma severity and self-management. Differences by urbanicity, sex, and race/ethnicity were explored. Methods: We utilized baseline data from adolescents with poorly controlled asthma (n = 183) who were participating in 1 of 2 school-based clinical trials—1 in rural schools and 1 in urban schools—testing the impact of interventions to improve asthma control. Adolescents reported if they believed their asthma severity remained the same, improved, or worsened during the pandemic, and if it changed, how it changed. They also reported if and how they modified their asthma management since the pandemic. We used multinomial logistic regression and binary logistic regression to assess the relationship between demographic factors and changes in asthma severity during the pandemic, and if adolescents altered their asthma management. Results: Adolescents' mean age was 15.9 years; most lived in rural communities (65.6%) and identified as female (66.7%). About half (56.2%) self-identified as black, 13.1% as Hispanic, and 10.4% as another race/ethnicity. Most (68.4%) reported that their asthma severity remained unchanged; 26.0% reported it worsened. Nearly 30% reported they altered how they managed their asthma, with most (80%) reporting additional efforts. Compared with asthma remaining the same, females had a higher relative risk than males of reporting that their asthma worsened [adjusted relative risk ratio = 3.65, 95% confidence interval (CI) = 1.34–9.90, P < 0.05]. Urban youth had greater odds (adjusted odds ratio = 5.4, 95% CI = 2.0–14.5, P < 0.001) of reporting they changed their asthma self-management compared with rural peers. Conclusion: This study demonstrates that during the 2019–2022 pandemic, adolescents generally believed their asthma severity stayed consistent and many took additional self-management efforts. [ABSTRACT FROM AUTHOR]

Background: Expressed emotion is the affective attitudes and behaviors of an individual toward another. In this preliminary study, we described expressed emotion among caregivers of children with asthma living in low-income urban area and evaluated its association with child asthma control. Methods: Forty-one children (90.2% African American/Black) and their caregivers participated. Measures included the Childhood Asthma Control Test and the Five-Minute Speech Sample coded for overall expressed emotion, emotional over-involvement, and criticism. Results: Most caregivers were rated borderline (31.7%) or high (48.8%) for expressed emotion, borderline (31.7%) or high (39.0%) for emotional overinvolvement, and low for criticism (73.2%). The association between criticism and asthma control neared statistical significance [U(Nlow = 30, NB/high = 11) = 100, z = −1.922, P = 0.055]. Conclusion: Findings suggest an examination into expressed emotion coding procedures for caregivers in low-income urban areas, and culturally specific adaptations may be necessary. Future research should confirm findings in a larger sample and consider how parental criticism affects children's asthma management. [ABSTRACT FROM AUTHOR]