Achieving and maintaining asthma control in an urban pediatric disease management program: The Breathmobile Program

Jones, Craig; Clement, Loran T.; Morphew, Tricia; Kwong, K.; Hanley-Lopez, Jean; Lifson, F.; Opas, Lawrence; Guterman, Jeffrey J.

doi:10.1016/j.jaci.2007.02.031

Cited by 51 publications

(40 citation statements)

References 27 publications

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“…Most parents and children in our study population came from Caucasian middle-class families, and the study was performed in a dedicated, secondary care, specialised asthma clinic. However, previous studies pointed out the importance of ICS adherence in determining good asthma control in inner-city populations from ethnic minorities [11,12]. In addition, the relationship between adherence and asthma control in our study was not influenced by demographic and clinical characteristics of the study population.…”

Section: Strengths and Limitationscontrasting

confidence: 58%

“…Previous studies have also shown a high prevalence of well-controlled asthma during comprehensive guideline-based asthma care [11,12,23]. Because such comprehensive care comprises several components that may promote asthma control, including reduction of allergen and irritant exposure, identification and treatment of relevant comorbidity, and ensuring proper inhalation technique and self-management, the independent role of adherence in determining asthma control remained uncertain in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Thirdly, the focus of guideline-based comprehensive asthma care is not only on adherence, but also on improving inhalation technique, elimination of exposure to relevant allergens and irritants (including environmental tobacco smoke) and treating comorbidities such as allergic rhinitis, all of which may contribute to improved asthma control [10]. Previous studies have shown that such comprehensive asthma care with regular follow-up was associated with achieving and maintaining well-controlled asthma in innercity asthmatic children [11,12]. Although the authors suggested that adherence may explain the relationship between comprehensive asthma care and asthma control, adherence in these studies was assessed by healthcare providers instead of being monitored electronically.…”

Section: Introductionmentioning

confidence: 99%

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It’s the adherence, stupid (that determines asthma control in preschool children)!

et al. 2013

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Although guideline-based asthma care and adherence to inhaled corticosteroids are predictors of asthma control, the role of adherence in maintaining long-term asthma control is largely unknown. This study was designed to explore the relationship between adherence to inhaled corticosteroids and long-term asthma control in young children with asthma.In this observational study, 81 2-6-year-old asthmatic children, using inhaled corticosteroids, closely followed-up in a programme with extensive self-management training, were enrolled. Adherence was measured daily for 12 months using Smartinhaler (Nexus6 Ltd, Auckland, New Zealand) devices. Longterm asthma control was assessed by parents and physicians and included clinical assessment, an asthma control questionnaire and lung function measurement. We examined the association of adherence to asthma control, adjusting for seasonal influences and clinical characteristics.Median (interquartile range) adherence was 87% (70-94%), and 64 (79%) children had well-controlled asthma throughout follow-up. Adherence .80% was associated with better asthma control, and we found no important confounders of this association. Children with persistent mild symptoms had lower adherence rates (p50.028).Guideline-based asthma care was associated with good asthma control in most children. Adherence to inhaled corticosteroids was an independent strong predictor of long-term asthma control, with highest levels of asthma control found in children with adherence .80% of doses prescribed. @ERSpublications Adherence to inhaled corticosteroids strongly predicts long-term asthma control in young children

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Section: Strengths and Limitationscontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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It’s the adherence, stupid (that determines asthma control in preschool children)!

et al. 2013

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“…In a large study, Jones et al (46) showed that almost all children visiting a mobile unit reached control of their asthma within six visits. Ongoing control, however, was not constant and varied significantly across all levels of asthma severity.…”

Section: School-focused Studiesmentioning

confidence: 99%

Community-Based Approaches to Controlling Childhood Asthma

Clark

2012

Annu. Rev. Public Health

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The prevalence and burden of childhood asthma remain high and are increasing. Asthma hot spot neighborhoods around the country face particular challenges in controlling the effects of the condition. Increasing attention is being paid to developing interventions that recognize the child and family as the primary managers of disease and to introducing assistance that reaches beyond the clinical care setting into the places where families live and work. A range of types of community-focused interventions has been assessed in the past decade in schools, homes, and community health clinics, and programs using electronic media and phone links have been evaluated. Stronger evidence for all these approaches is needed. However, school-based programs and community coalitions designed to bring about policy and systems changes show particular promise for achieving sustainable improvements in asthma control. Research is needed that emphasizes comparisons among proven asthma control interventions, translation of effective approaches to new settings and communities, and institutionalization of effective strategies.

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“…With sustained controller treatment, patients may be maintained free of symptoms and other clinical features of asthma for prolonged periods [5]. However, evidence from cross-sectional surveys suggests that a high proportion of patients remain uncontrolled despite controller therapy [6][7][8].…”

mentioning

confidence: 99%

24-h duration of the novel LABA vilanterol trifenatate in asthma patients treated with inhaled corticosteroids

et al. 2012

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Current guidelines recommend adding a long-acting inhaled b 2 -agonist (LABA) to inhaled corticosteroids (ICS) in patients with uncontrolled asthma. This study evaluated the novel, once-daily LABA vilanterol trifenatate (VI) in asthma patients who remained symptomatic despite existing ICS therapy.The study involved a randomised, double-blind, placebo-controlled trial of VI (3, 6.25, 12.5, 25 and 50 mg), administered once daily in the evening by dry powder inhaler for 28 days, in asthma patients aged o12 yrs symptomatic on current ICS therapy. The primary end-point was trough (24 h post-dose) forced expiratory volume in 1 s (FEV1); secondary end-points were weighted mean FEV1, peak expiratory flow (PEF), symptom-/rescue-free 24-h periods, and safety.A significant relationship was observed between VI dose and improvements in trough FEV1 (p50.037). Statistically significant increases in mean trough FEV1, relative to placebo, were documented for VI 12.5-50 mg (121-162 mL; pf0.016). Dose-related effects of VI were observed on weighted mean (0-24 h) FEV1, morning/evening PEF, and symptom-/rescue-free 24-h periods. All doses of VI were well tolerated with low incidences of recognised LABA-related adverse events (tremor 0-2%; palpitations 0-2%; glucose effects 0-1%; potassium effects 0-,1%).Once-daily VI 12.5-50 mg resulted in prolonged bronchodilation of at least 24 h with good tolerability in asthma patients receiving ICS. Based on the overall efficacy and adverse event profile from this study, the optimum dose of VI appears to be 25 mg.

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Achieving and maintaining asthma control in an urban pediatric disease management program: The Breathmobile Program

Cited by 51 publications

References 27 publications

It’s the adherence, stupid (that determines asthma control in preschool children)!

It’s the adherence, stupid (that determines asthma control in preschool children)!

Community-Based Approaches to Controlling Childhood Asthma

24-h duration of the novel LABA vilanterol trifenatate in asthma patients treated with inhaled corticosteroids

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