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

Variability in anesthesiologists’ approach to the preoperative management of asthmatic children

Domany, K.A. et al. Journal of Clinical Anesthesia. December 2016. Volume 35. pp. 62–69

Highlights

  • No preoperative guidelines exist for asthmatic child referred to elective surgery.
  • A national survey showed substantial variability among pediatric anesthesiologists.
  • A relative homogeneity exists for the stable, school-aged asthmatic child.
  • Further studies and implementation of consensus guidelines are needed.

Abstract

Objective: No consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue.

 

Measurement: Twenty-one questions regarding the approach to preoperative management of asthmatic children including 6 case scenarios with a variety of clinical situations and treatments of asthmatic children. The results were compared with the attitude of pediatric pulmonologists recently published using a similar methodology.

Main results: Forty-four pediatric anesthesiologists from all 24 general hospitals in Israel responded. Twenty-five percent of pediatric anesthesiologists answered that, in addition to pediatric anesthesiologists, the primary pediatrician should be consulted, and 70% believed that a pediatric pulmonologists should also be consulted. Overall, results showed a wide variability between responders especially for preschool children and unstable school-aged asthmatic children for both disciplines. The variability referred to the use of any treatment, bronchodilators, inhaled corticosteroids and their combination, addition of systemic corticosteroids, and the length of preoperative treatment. Compared with pediatric pulmonologists, a better within-discipline agreement was observed by the pediatric anesthesiologists for stable school-aged asthmatic children with a lower inclination to augment preoperative treatment (P< .001). No difference was observed for the preschool children with asthma and for the unstable school-aged asthmatic child.

Conclusions: A wide variability exists in pediatric anesthesiologists’ approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.

Read the abstract here

The use of antihistamines in children

Anagnostou, K. et al. Paediatrics and Child Health. Available online 7 April 2016

Antihistamines are commonly used in paediatric medicine mainly for the treatment of allergic conditions. First generation antihistamines have been in use for many years, despite limited research studies supporting their use. Second generation antihistamines have been investigated for both efficacy and safety in paediatrics. An optimal understanding of their effects and pharmacology are required for optimal use in each patient. In this review we discuss the indications for use, as well as efficacy and safety of both old and newer antihistamines for the paediatric population.

View the abstract here