It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study.

BACKGROUND: The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). OBJECTIVE: The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. METHODS: This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. RESULTS: A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. CONCLUSIONS: Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own.

A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control.

eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children via eHealth.

Increase in oxygen consumption after albuterol inhalation in ventilated infants and children.

OBJECTIVE: To determine if inhaled albuterol (salbutamol) increases oxygen consumption (V'O2) in children and, if so, the duration of this effect. DESIGN: Oxygen consumption was measured by indirect calorimetry using the Argon dilution technique with a respiratory mass spectrometer. After measurement of baseline values, albuterol was administered and subsequent measurements were performed at 10 minutes, 1 hour, 2 hours, 3 hours, and 4 hours. SETTING: Multidisciplinary PICU in a university teaching hospital. PATIENTS: Eleven intubated infants and children (five girls, six boys) with a mean age of 20 months (range, 1 mo to 8 yr) and a mean weight of 10.7 kg (range, 3.1-23 kg) who required therapeutic albuterol inhalations. INTERVENTION: Nine hundred micrograms of albuterol (10 puffs) was administered by a metered-dose inhaler into a spacer through the inspiratory arm of the ventilator circuit near to the patient, during 10 mechanically assisted breaths. MEASUREMENTS AND MAIN RESULTS: All children showed an increase in V'O2 within 10 minutes (mean increase 48.6%). The increased V'O2 was still elevated (42.3% above baseline) at 1 hour, but 3 hours after albuterol inhalation, the V'O2 was back to baseline in all patients. Heart rate increased significantly at 10 minutes, 1 hour, and 2 hours after inhalation. CONCLUSION: There is a large increase in V'O2 after albuterol inhalation. This effect lasts up to 3 hours.