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Objective:To evaluate the effects of smart stethoscope on the monitoring childhood asthma exacerbation, so as to assist family management in childhood asthma.Methods:A prospective randomized controlled study was carried out.A total of 80 children with asthma who were treated at Department of Pediatric Respiratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine and Shanghai Tonxin Pediatric Clinic from November 2020 to May 2021 were enrolled and randomly divided into a test group of 40 cases (used the smart stethoscope) and a control group of 40 cases(not used the smart stethoscope). Medical history data were collected.The control group received monthly routine follow-up, while the test group was followed up both routinely and by smart stethoscope.In the test group, hearing wheezing sound was regarded as asthma exacerbation, and in the control group, the asthma exacerbation was reported by the parents themselves.The frequency of asthma exacerbation, asthma control level and quality of life were compared between the two groups.The recognition, diagnosis, treatment and outcomes of acute asthma exacerbation in two groups of children were described and analyzed.Measurement data were analyzed by t test or Mann- Whitney U test.Numeration data were analyzed by χ2 test. Results:Respiratory sounds collected by smart stethoscope in the test group were assessed by 3 specialist physicians.There were 12 wheezing rales (42.86%), 1 moist rale (3.57%) and 1 rhonchi rale (3.57%). Besides, 12 files (42.86%) were difficult to distinguish, and 2 files (7.14%) induced inconsistent identification.The number of asthma exacerbation was 12 in the test group and 5 in the control group.In the test group, 12 were recognized by the smart stethoscope, and only 6 were recognized by the parents.Comparing the diagnosis and treatment measures between two groups, it was found that there were more children in the test group (38.1%) receiving home treatment through telemedicine than those in the control group (20.0%). Besides, there were less children (61.9%) in the test group receiving unplanned hospital treatment (including unplanned outpatient, emergency and hospitalization) than those in the control group (80.0%). There was no statistically significant difference between the two groups of children during acute asthma exacerbation ( χ2=4.67, P=0.097). Parents were satisfied with the common functions, convenience and stability of smart stethoscope. Conclusions:Smart stethoscope can acquire the respiratory sounds of children with asthma in real time, achieving timely detection, diagnosis and treatment of asthma exacerbation in children.What′s more, smart stethoscope reduces the incidence of unplanned hospital diagnosis and treatment, and assists parents with better family management of children asthma.
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Asthma is one of the most common diseases in childhood which is characterized by chronic airway inflammation.With the increasing incidence, the impact of asthma on children′s quality of life, family income and society economy becomes more and more nonnegligible, and people now pay more attention on the effective treatment of asthma.The aim of asthma treatment is to achieve symptom control and improve prognosis.In order to achieve this aim, the effective managemant of asthma is particularly important.The effective management includes monitoring quality of life, using of spirometry and asthma medications.This review discusses the management of children asthma.
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Objective@#To explore the value of modified Chinese Version of Test for Respiratory and Asthma Control in Kids(TRACK) in the management of asthmatic children aged 0-5 years old by comparing with Global Ini-tiative for Asthma(GINA) guideline.@*Methods@#A total of 157 children aged 0-5 years old were enrolled at the Pedia-tric Asthma Outpatient Department of the Affiliated Hospital of Qingdao University from March to August 2018.All children were treated with individualized anti-asthma treatment for 3 months.After treatment, asthma experts assessed the level of asthma symptom control based on the GINA guideline, while caregivers of all children completed TRACK questionnaire.The optimal threshold of the TRACK questionnaire for asthma control was determined by analyzing receiver operating characteristic curve(ROC curve), and consistency of the 2 evaluation methods was compared.@*Results@#All enrolled children were divided into 3 groups based on GINA guideline: 59 children for the well controlled group, 52 children for the partly controlled group and 46 children for the uncontrolled group.There was a significant difference statistically in TRACK scores among the well controlled group [90(85, 95) scores], the partly controlled group [80(70, 85) scores] and the uncontrolled group [60(55, 65) scores] after treatment (H=101.740, P<0.001). Area under the ROC curve was 0.909 for diagnosing asthma control by the modified Chinese version of TRACK, with 80 scores for optimal threshold, 87.3% for sensitivity and 73.5% for specificity.The Kappa value of the consistency test between the TRACK questionnaire and the GINA guideline was 0.553, and consistency rate of these 2 evaluation methods was 77.1%.@*Conclusions@#The modified Chinese version of TRACK can be used as an effective assessment tool to monitor and manage asthmatic children aged 0-5 years.
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Objective To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. Methods A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test,medication choice of maintenance therapy and asthma education.Results A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%)females and 1 528(39.4%)males. The mean age was(50.7±16.7)years ranging from 14 to 99.Only 10.1%(388/3 837)patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting β2-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities.In this subgroup,17.9%(244/1 360)were tested by PFM and 66.6%(907/1 362)by pulmonary function test during last year.As to the medication,63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians.Compared to the similar survey conducted in 2007-2008,the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher,while the rate of PFM use did not have significant improvement. Conclusion Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve.Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.
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Objective To investigate the pharmaceutical care for the special population with asthma .Methods Clinical pharmacists participated in the process of drug treatment for the patient with acute asthma during pregnancy ,and put forward appropriate medication recommendations in time .Results The patient with acute episode of asthma was well controlled .The importance of asthma management in patients during gestational period was recognized .Conclusion The clinical pharmacists should actively participate in patient education of asthma management for pregnant patient .It will reduce the acute episode and other adverse consequences caused by the lack of asthma awareness during pregnancy .
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El asma es una enfermedad frecuente de fisiopatología compleja. El asma severa constituye aproximadamente el 5% de la población de asmáticos, sin embargo representa un desafío clínico y una carga sanitaria importante. Estudios recientes demuestran la existencia de fenotipos en todo el espectro de gravedad. La eosinofilia en esputo y sangre ha demostrado utilidad como marcador de inflamación Th-2 y de respuesta clínica a esteroides, sin embargo aún no existe mucho conocimiento sobre el asma no-eosinofílica. Los tratamientos actuales en asma se enfocan a estrategias de terapia escalonada según severidad, pero en pacientes con asma severa se requiere también del manejo multidisciplinario de las comorbilidades y la determinación del fenotipo, para aplicar terapias más especificas. El desarrollo acelerado de nuevos tratamientos en asma severa como consecuencia del mejor conocimiento de los distintos fenotipos ha ampliado el arsenal terapéutico para un enfrentamiento personalizado y específico en los pacientes con asma severa.
Asthma is a common disease of complex pathophysiology. Severe asthma accounts about 5% of asthma population, however represents a clinical challenge and a significant health burden. Recent studies show the existence of phenotypes through all the spectrum of severity. Eosinophilia in blood and sputum has proven as a useful marker of Th-2 inflammation and clinical steroid response, however there is still little knowledge about non-eosinophilic asthma. Current treatments for asthma are focused on step-up approaches according to severity, but severe asthma patients also require multidisciplinary management of comorbidities and phenotyping to apply more specific therapies. The fast development of new treatments in severe asthma as a result of better understanding of different phenotypes has broadened the therapeutic arsenal for a personalized and targeted management in severe asthma patients.
Subject(s)
Humans , Adult , Asthma/diagnosis , Asthma/therapy , Phenotype , Asthma/classification , Asthma/drug therapy , Biomarkers , Comorbidity , Patient Compliance , Diagnosis, Differential , Bronchial ThermoplastyABSTRACT
Background & objectives: High prevalence and poor control of asthma make its management a major public health issue worldwide, especially in developing countries. Optimum review of asthma management in the community is essential to improve asthma control. This study was conducted to investigate the quality of asthma management, knowledge about asthma and quality of life of asthma patients referred to a public tertiary care chest hospital in Delhi. Methods: Diagnosis of asthma was confirmed by symptoms and reversible spirometry in 50 referred patients on their first visit. Patients were interviewed using three questionnaires on quality of asthma management before visiting referral hospital, asthma knowledge and asthma quality of life (AQLQ). Correlation amongst quality of treatment, asthma quality of life, and asthma knowledge was also determined. Results: Findings revealed that only 60 per cent of patients were informed about their disease, and 10 per cent had undergone lung function tests previously. Only 44 per cent of patients were prescribed inhalers. None were provided with any educational material. Patients had poor knowledge of aetiology, pathophysiology, medication and how to assess the severity of their asthma. The mean scores in AQLQ indicated a moderate degree of impairment in quality of life. Interpretations & conclusions: This study provides evidence of unsatisfactory asthma management and patient-doctor interaction as patients had limited knowledge of asthma disease, its management and had poor quality of life as measured by a standardized questionnaire. Thus, there is need to implement suitable interventions to improve asthma management according to standard treatment guidelines in the community.
Subject(s)
Adult , Asthma/diagnosis , Asthma/epidemiology , Asthma/therapy , Female , Humans , India , Male , Patients , Quality of Health Care , Quality of Life , Surveys and Questionnaires , Spirometry , Urban Health ServicesABSTRACT
Allergic asthma is a chronic obstructive disease of the airways characterized by airway hyperresponsiveness,inflammation and remodeling.Exhaled nitric oxide (eNO) level is highly correlated with eosinophilic airway inflammation.Since the advantage of noninvasion,convenience,and specificity of eNO measurement,it has been widely used as a biomarker.In this article eNO metabolism and its effects on airway physiology and pathophysiology are described.The usefulness of eNO in asthma diagnosis and management is discussed in detail.
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Establishing the assessment methods of childhood asthma is highlighted in asthmatic prevention and treatment.Due to the factors such as age,genotypic environment,pathogenesis and treatment,the assessment methods existed have some defects and cant objectively reflect the situation of asthma disease and airway inflammation.The assessment methods including symptom scores,pulmonary function test,airway responsiveness detection and fractional concentration of exhaled nitric oxide are described in this review.The principles,advantages,disadvantages,application ways and so on are discussed in detail,to improve the rationality of the application in these methods in order to make them play a greater role in asthmatic diagnosis,disease detection,medication guild and prognosis estimation,and explore a more effective and simple assessment way in children asthma.
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PURPOSE: In spite of the development of asthma management guidelines, there are discrepancies between the guidelines and real management. We surveyed the insights and the real management of asthma to assess the current status of its management in Korea. METHODS: The objects of the survey were 266 parents with asthmatic children, who attended an educational lecture by the Korean World Asthma Day Project Office (KWADPO). Face to face interviews with questionnaires of 11 questions about understanding of asthma maintenance therapy, actual conditions of taking medicine and the impact of asthma on the family life were undertaken. RESULTS: The Median age of the patients was 5.2 years old and their parents' age ranged from those in their twenties to those in their forties. The number of the patients actually taking asthma maintenance medicine (40.6 percent) was a little bit lower than the level of awareness (53.0 percent). As a controller, patients are using short-acting beta2 inhalers (35.3 percent), steroid inhalers (including combination inhaler) (31.6 percent), leukotriene receptor antagonists (24.8 percent), antihistamines (25.6 percent), theophylline (2.3 percent), etc. Regular visits to hospital or clinic were done in 53.0 percent of the patients. As a controllers, oral medications (69.2 percent) was preferred to inhalers (18.0 percent) due to better compliance and easier dosage adjustment. CONCLUSION: According to the survey, asthma had negative effects on the life quality of patients and their families. Remarkable discrepancies were noticed between the guidelines and the real-world status of taking medicine in asthmatic children. It is necessary to have patients participate actively in making asthma management plans to raise their efficacy.