The role of trait mindfulness in quality of life and asthma control among adolescents with asthma

The current study focused on the role of trait mindfulness in asthma-related quality of life (QoL) and asthma control in adolescent asthma patients | Journal of Psychosomatic Research

In this cross-sectional study, questionnaire data of 94 adolescents with asthma that were prescribed daily asthma medication were included. Two Structural Equation Models (SEMs), a direct model and an indirect model, were tested.

We found that trait mindfulness was directly related to asthma-related QoL, but not to asthma control. The relationship between trait mindfulness and asthma-related QoL was explained by asthma-specific, but not by general stress. Furthermore, an indirect relation from mindfulness to asthma control via asthma-specific stress was found.

Cross-sectional evidence for a relation between mindfulness and asthma-related QoL is found. These findings may point to the possibility that an intervention aimed at increasing mindfulness could be a promising tool to improve asthma-related QoL in adolescents via a decrease in asthma-specific stress.

Full reference: Cillessen, L. et al. (2017) The role of trait mindfulness in quality of life and asthma control among adolescents with asthma. Journal of Psychosomatic Research. Vol. 99 (August) pp. 143–148.

Does inhaled steroid therapy help emerging asthma in early childhood?

Elissa M Abrams, Stanley J Szefler, Allan B Becker. The Lancet Respiratory Medicine. Online first 3 August 2017.

Although early childhood wheeze is common, persistent asthma is less common. However, of those children who do progress to persistent asthma, lung function abnormalities and airway remodelling can already be seen early in life and can increase in magnitude with time. There has been a general expectation that early use of inhaled corticosteroid (ICS) could change the natural history of asthma if started in the young child with wheeze. Despite this expectation, the role of ICS therapy in altering the natural course of disease in children with emerging asthma is not well defined. Here we discuss the potential use of ICS therapy to alter the natural disease course in children at risk of persistent asthma (defined as wheeze and presence of airflow limitation or airway hyper-reactivity, or both). We present new information suggesting a more personalised treatment approach in which children might benefit from daily or intermittent ICS therapy. We also provide an overview of other emerging therapies that might be useful in disease modification for the wheezing young child at risk of persistent asthma.

Mindfulness and asthma symptoms

Shi, L. et al. Journal of Asthma | Published online: 1 May 2017

Introduction: Given the known link between asthma and stress as well as the link between mindfulness and stress, we explore the possible association between trait mindfulness and asthma-related diagnosis and symptoms with a cross-sectional study.

Discussion: This is the first study to suggest a link between trait mindfulness and asthma. Our finding provides evidence that people with higher level of mindfulness are less likely to have had an asthma diagnosis and less likely to have the symptoms of persistent dry cough and wheezing.

Read the full abstract here

STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma

Morton RW, Elphick HE, Rigby AS, et al. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma. Thorax 2017;72:347-354

Background Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not demonstrated a significant impact on clinical outcomes. The aim of this study was to determine whether introduction of this approach into routine practice would result in improved clinical outcomes.

Methods Children with asthma aged 6–16 years were randomised to the active intervention consisting of electronic adherence monitoring with daily reminder alarms together with feedback in the clinic regarding their inhaled corticosteroid (ICS) use or to the usual care arm with adherence monitoring alone. All children had poorly controlled asthma at baseline, taking ICS and long-acting β-agonists. Subjects were seen in routine clinics every 3 months for 1 year. The primary outcome was the Asthma Control Questionnaire (ACQ) score. Secondary outcomes included adherence and markers of asthma morbidity.

Results 77 of 90 children completed the study (39 interventions, 38 controls). Adherence in the intervention group was 70% vs 49% in the control group (p≤0.001). There was no significant difference in the change in ACQ, but children in the intervention group required significantly fewer courses of oral steroids (p=0.008) and fewer hospital admissions (p≤0.001).

Conclusions The results indicate that electronic adherence monitoring with feedback is likely to be of significant benefit in the routine management of poorly controlled asthmatic subjects

Associations between allergic diseases and ADHD/ODD in children

Lin, Y-T. et al. (2016) Pediatric Research. 80. pp. 480–485

Background:We aim to investigate the detailed associations between allergic diseases with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) among children.

Methods: Clinical information from 2,896 children enrolled in the Taiwan Children Health Study was obtained for analyses. Allergic diseases, including atopic dermatitis, asthma, and allergic rhinitis, have been evaluated based on the questions adjusted from International Study of Asthma and Allergies in Childhood. The Swanson, Nolan, and Pelham questionnaire was used to assess symptoms of ADHD and ODD. Symptoms of depression, stress, and poor sleep quality were evaluated as the interactive risk factors.

Results: Children having symptoms of allergic diseases within the past 1 y were associated with having all dimensions of symptoms of ADHD and ODD. Children with ever having a physician-diagnosed atopic dermatitis were associated with inattentive and hyperactive–impulsive symptoms of ADHD. Ever diagnosed asthma was associated with ADHD and ODD. Ever diagnosed allergic rhinitis was associated with inattentive and combined symptoms of ADHD and ODD.

Conclusion: Children with allergic diseases, such as atopic dermatitis, asthma, and allergic rhinitis, were associated with exhibiting ADHD and ODD.

Read the abstract here

Telemedicine is as effective as in-person visits for patients with asthma

Portnoy, J.M. et al. (2016) Annals of Allergy, Asthma & Immunology, 117(3), pp. 241-245

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Background: Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine.

Objective: To compare asthma outcomes during 6 months in children managed by telemedicine vs in-person visits.

Methods: Children with asthma residing in 2 remote locations were offered the choice of an in-person visit or a telemedicine session at a local clinic. The telemedicine process involved real-time use of a Remote Presence Solution (RPS) equipped with a digital stethoscope, otoscope, and high-resolution camera. A telefacilitator operated the RPS and performed diagnostic and educational procedures, such as spirometry and asthma education. Children in both groups were assessed initially, after 30 days, and at 6 months. Asthma outcome measures included asthma control using validated tools (Asthma Control Test, Childhood Asthma Control Test, and Test for Respiratory and Asthma Control in Kids) and patient satisfaction (telemedicine group only). Noninferiority analysis of asthma control was performed using the minimally important difference of an adjusted asthma control test that combined the 3 age groups.

Results: Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits. All had a small, although statistically insignificant, improvement in asthma control over time. Telemedicine was noninferior to in-person visits. Most of the telemedicine group subjects were satisfied with their experience.

Conclusion: Children with asthma seen by telemedicine or in-person visits can achieve comparable degrees of asthma control. Telemedicine can be a viable alternative to traditional in-person physician-based care for the treatment and management of asthma.

Read the abstract here

Vitamin D – Can the sunshine vitamin help reduce asthma attacks?

Ware, L. Evidently Cochrane. Published online: 6 September 2016

What’s the story?

It seems to me that vitamin D – also known as the ‘sunshine vitamin’ – is very much in the limelight (or should that be sunlight?) right now. Its role in maintaining a healthy skeleton is well known but it may have other important actions. Low levels of vitamin D have been linked to an increased risk of asthma attacks in children and adults with asthma. It is thought that vitamin D has anti-inflammatory and antimicrobial functions in the lungs, which may explain why it could be beneficial.

What did the Cochrane review find with regard to vitamin D andasthma?

The recent systematic review from the Cochrane Airways Group found nine double-blind randomised placebo-controlled trials of vitamin D in children and adults with asthma, which evaluated the risk of having an asthma attack and/or the level of symptom control. Two studies were in adults and involved 658 participants; seven studies were in children with 435 participants. The studies were conducted in Canada, India, Japan, Poland, UK and USA. Most of the participants had mild to moderate asthma and continued their regular asthma medication for the duration of the trial. The studies lasted from six to twelve months.

High quality evidence showed that giving vitamin D reduced the average number of asthma attacks and the risk of Emergency Department attendances and hospital admissions. These results can be represented diagrammatically :

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Image source: Evidently Cochrane

hospitalisations-small-1024x512

Image source: Evidently Cochrane

There was no evidence to indicate that vitamin D brought about an improvement in lung function tests or in day-to-day symptoms. It was safe at the doses given.

Read the full blog post here

Read the full review here