Effects of a written asthma action plan on caregivers’ management of children with asthma

Effects of a written asthma action plan on caregivers’ management of children with asthma: a cross-sectional questionnaire survey

Pages 188-194
^*Ngiap Chuan Tan¹, Zhaojin Chen², Wern Fern Soo³, Agnes Soh Heng Ngoh³, Bee Choo Tai<sup>4

1</sup> SingHealth Polyclinics; DUKE-NUS Graduate Medical School; Yong Loo Lin School of Medicine, National University of Singapore, Singapore

² Investigational Medicine Unit, National University Health System, Singapore

³ SingHealth Polyclinics, Singapore

⁴ Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Received 6 September 2012 • Accepted 8 February 2013 • Online 25 April 2013


Abstract
Background: Caregivers of children with asthma provided with a written asthma action plan (WAAP) are reported to be more confident in their ability to provide care for their child during an asthma exacerbation. However, little is known about how a WAAP impacts on their care processes that contributed to this increased confidence. 

Aims: To determine the effects of a WAAP on caregivers’ understanding of asthma symptoms, their use of asthma medications for their children, and acute care visits to consult their physicians. 

Methods: A questionnaire survey to caregivers of children with a WAAP (CW) and without a WAAP (CNW) who were followed up at nine public primary care clinics in Singapore. χ2 test was used to determine the differences in outcomes between the CW and CNW groups, followed by logistic regression to adjust for potential covariates. 

Results: A total of 169 caregivers were surveyed (75 CNW, 94 CW). Caregivers in the CW group were more likely to understand bronchoconstriction (adjusted odds ratio (AOR) 4.51, p=0.025), to feel capable (AOR 2.77, p=0.004), safe (AOR 2.63, p=0.004), and had increased confidence (AOR 2.8, p=0.003) to change doses of inhaled medications during an asthma exacerbation. The CW group perceived inhaled asthma medication to be safe (AOR 3.42, p=0.015) and understood the use of controller medication (AOR 3.28, p=0.006). No difference was noted between caregivers in their likelihood to stop medications without consulting their physician, seek acute care consultation, and confidence in self-management of their children’s asthma at home. 

Conclusions: The WAAP improved caregivers’ understanding of the disease and use of inhaled asthma medications during asthma exacerbations but did not affect their decision regarding acute visits to their physician.


Cite as: Tan NC, Chen Z, Soo WF, Ngoh ASH, Tai BC. Effects of a written asthma action plan on caregivers’ management of children with asthma: a cross-sectional questionnaire survey.Prim Care Respir J 2013;22(2):188-194. DOI: http://dx.doi.org/10.4104/pcrj.2013.00040

Keywords
asthma action plan, caregiver, asthma

* Corresponding author. Ngiap Chuan Tan Tel: +65-63777136 Fax: +65-62749901 Email:Tan.Ngiap.Chuan@singhealth.com.sg

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Homeostatic T Cell Proliferation after Islet Transplantation

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 217934, 8 pages
http://dx.doi.org/10.1155/2013/217934

Review Article

Homeostatic T Cell Proliferation after Islet Transplantation

Paolo Monti and Lorenzo Piemonti

San Raffaele Diabetes Research Institute, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy

Received 4 June 2013; Accepted 1 July 2013

Academic Editor: Camillo Ricordi

Copyright © 2013 Paolo Monti and Lorenzo Piemonti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pancreatic islet transplantation in patients with type 1 diabetes mellitus is performed under immunosuppression to avoid alloreactive T cell responses and to control the reactivation of autoreactive memory T cells. However, lymphopenia associated with immunosuppression and T cell depletion can induce a paradoxical expansion of lymphocyte subsets under the influence of homeostatic proliferation. Homeostatic T cell proliferation is mainly driven by the IL-7/IL-7 receptor axis, a molecular pathway which is not affected by standard immune-suppressive drugs and, consequently, represents a novel potential target for immuno-modulatory strategies. In this review, we will discuss how homeostatic T cell proliferation can support autoimmunity recurrence after islet transplantation and how it can be targeted by new therapeutic approaches.

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New diagnostic criteria for Common Variable Immune Deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous Immunoglobulin

Review

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1. 
   

1. Rohan Ameratunga^1,2,3,*, 
2. See-Tarn Woon^1,2, 
3. David Gillis⁴, 
4. Wikke Koopmans^1,2,
5. Richard Steele^1,5

DOI: 10.1111/cei.12178

This article is protected by copyright. All rights reserved.

Issue

Clinical & Experimental Immunology

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

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Author InformationPublication History

1. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/cei.12178

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Abstract

Common Variable Immune Deficiency (CVID) is the most frequent symptomatic primary immune deficiency in adults. The standard of care is life-long Intravenous Immunoglobulin (IVIG) or subcutaneous immunoglobulin (scIG) therapy. The cause of CVID is currently unknown and there is no universally accepted definition of CVID. This creates problems in determining which patients will benefit from IVIG/scIG treatment. In this article, we review the difficulties with the commonly used European Society of Immune Deficiencies (ESID) and the Pan American Group for Immune Deficiency (PAGID) definition of CVID. We propose new criteria for the diagnosis of CVID, which are based on recent scientific discoveries. Improved diagnostic precision will assist with treatment decisions including IVIG/scIG replacement. We suggest that asymptomatic patients with mild hypogammaglobulinemia are termed hypogammaglobulinemia of uncertain significance (HGUS). These patients require long-term follow up as some will evolve into CVID.

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International Journal of Chronic Obstructive Pulmonary Disease

The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease

Original Research

(39) Total Article Views

Authors: Takeda K, Kawasaki Y, Yoshida K, Nishida Y, Harada T, Yamaguchi K, Ito S, Hashimoto K, Matsumoto S, Yamasaki A, Igishi T, Shimizu E

Published Date July 2013 Volume 2013:8 Pages 347 - 351

DOI: http://dx.doi.org/10.2147/COPD.S45081

Received:	11 March 2013
Accepted:	24 May 2013
Published:	23 July 2013

Kenichi Takeda,¹ Yuji Kawasaki,² Kazumasa Yoshida,³ Yoji Nishida,³ Tomoya Harada,¹ Kosuke Yamaguchi,² Shizuka Ito,¹ Kiyoshi Hashimoto,¹ Shingo Matsumoto,¹ Akira Yamasaki,¹ Tadashi Igishi,¹ Eiji Shimizu<sup>1

1</sup>Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan; ²Department of Regional Medicine, Faculty of Medicine, Tottori University, Yonago, Japan; ³Department of Rehabilitation Medicine, Yoka Hospital, Yabu, Japan

Background: Upper-extremity exercise is for pulmonary rehabilitation. The 6-minute pegboard and ring test (6PBRT) was developed to evaluate arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients.
Methods: Twenty outpatients with mild to very severe COPD underwent the 6PBRT and spirometry, and their maximal inspiratory and expiratory pressures and grip strength were measured. For the 6PBRT, subjects were asked to move as many rings as possible in 6 minutes, and the score was the number of moved rings during the 6-minute period. Upper-extremity ADLs were evaluated with the upper extremity activities subdomain of the modified Pulmonary Functional Status and Dyspnea Questionnaire. Upper-extremity ADLs were also measured objectively by using a wrist accelerometer every day for 1 week.
Results: There was a positive correlation between 6PBRT score and inspiratory capacity (r = 0.71,P < 0.001), inspiratory capacity/total lung capacity predicted (r = 0.68, P < 0.01), and forced vial capacity (r = 0.57, P < 0.01). There was also a positive correlation between 6PBRT score and accelerometer count (r = 0.54, P < 0.05) and a negative correlation between 6PBRT score and arm activity score (ρ = -0.49, P < 0.05).
Conclusion: The 6PBRT may be a predictive test to maintain and improve upper-extremity ADL during pulmonary rehabilitation in patients with COPD.

Keywords: pulmonary rehabilitation, inspiratory capacity, COPD, wrist accelerometer, modified Pulmonary Functional Status and Dyspnea Questionnaire



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Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

Vol 15, No 7 (2013) > Mulvaney

Original Paper

Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

Shelagh A Mulvaney^1,2,3, PhD; Yun-Xian Ho², PhD; Cather M Cala⁴; Qingxia Chen^2,5, PhD; Hui Nian⁵, MS; Barron L Patterson³, MD; Kevin B Johnson^2,3, MD, MS

¹School of Nursing, Vanderbilt University School of Medicine, Nashville, TN, United States
²Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States
³Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
⁴School of Medicine, University of Alabama, Birmingham, AL, United States
⁵Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States

Corresponding Author:

Shelagh A Mulvaney, PhD

School of Nursing
Vanderbilt University School of Medicine
461 21st Ave
Nashville, TN, 37240
United States
Phone: 1 615 322 1198
Fax: 1 615 343 5898
Email: shelagh.mulvaney [at] vanderbilt.edu

---

ABSTRACT

Background: Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving.
Objective: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making.
Methods: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline.
Results: The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P-.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034).
Conclusions: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system.

(J Med Internet Res 2013;15(7):e141)
doi:10.2196/jmir.2413

KEYWORDS

asthma; adherence; mobile technology; adolescent; assessment

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• PLoS One
• v.8(7); 2013
• PMC3701578

PLoS One. 2013; 8(7): e67768.

Published online 2013 July 4. doi:  10.1371/journal.pone.0067768

PMCID: PMC3701578

ADAM33 Gene Polymorphisms and Mortality. A Prospective Cohort Study

Sylwia M. Figarska,1,4 Judith M. Vonk,1,4 Cleo C. van Diemen,2 Dirkje S. Postma,3,4 and H. Marike Boezen1,4,*

Dennis O’Rourke, Editor

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Abstract

The ADAM33 gene is associated with the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD) and atherosclerosis. In this study we investigated all-cause, COPD and cardiovascular mortality, in relation to single nucleotide polymorphisms (SNPs) in ADAM33 (Q_1, S_1, S_2, T_1 and T_2) that were genotyped in 1,390 subjects from the Vlagtwedde/Vlaardingen cohort. Participants were examined at entry in 1989/1990 and followed up till evaluation of the vital status on December 31st, 2008. Using Cox proportional hazards regression we estimated the risk of the SNPs in relation to mortality, adjusting for gender, age, FEV1, height, place of residence and packyears of smoking. Additionally, we performed stratified analyses according to gender and smoking habits. After 18 years, 284 (20.4%) subjects had died (107 due to cardiovascular disease and 20 due to COPD). Individuals homozygous for the minor allele of SNP T_2 had an increased risk of all-cause and cardiovascular mortality compared to wild types: hazard ratio 3.6 (95% confidence interval 2.0 to 6.7) and 3.4 (1.2 to 9.5) respectively. Individuals homozygous for the minor allele of S_1, S_2, T_2 or Q_1 had a significantly increased risk of COPD mortality. In stratified analyses the risk of all-cause mortality associated with SNP T_2 did not change: females 3.5 (1.5 to 8.3), males 3.1 (1.2 to 7.6), never smokers 3.8 (0.9 to 16.3), ever smokers 3.6 (1.8 to 7.2). This study shows for the first time that ADAM33 is a pleiotropic gene that is associated with all-cause, COPD and cardiovascular mortality, independent of potential confounders.

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Impact of Adiponectin Overexpression on Allergic Airways Responses in Mice

Journal of Allergy
Volume 2013 (2013), Article ID 349520, 13 pages
http://dx.doi.org/10.1155/2013/349520

Research Article

Impact of Adiponectin Overexpression on Allergic Airways Responses in Mice

Norah G. Verbout,¹ Leandro Benedito,¹ Alison S. Williams,¹ David I. Kasahara,¹ Allison P. Wurmbrand,¹ Huiqing Si,¹ Andrew J. Halayko,²Christopher Hug,³ and Stephanie A. Shore¹

¹Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
²Departments of Physiology and Internal Medicine, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
³Children’s Hospital, Boston, MA 02115, USA

Received 21 March 2013; Accepted 7 May 2013

Academic Editor: Akshay Sood

Copyright © 2013 Norah G. Verbout et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Obesity is an important risk factor for asthma. Obese individuals have decreased circulating adiponectin, an adipose-derived hormone with anti-inflammatory properties. We hypothesized that transgenic overexpression of adiponectin would attenuate allergic airways inflammation and mucous hyperplasia in mice. To test this hypothesis, we used mice overexpressing adiponectin (Adipo Tg). Adipo Tg mice had marked increases in both serum adiponectin and bronchoalveolar lavage (BAL) fluid adiponectin. Both acute and chronic ovalbumin (OVA) sensitization and challenge protocols were used. In both protocols, OVA-induced increases in total BAL cells were attenuated in Adipo Tg versus WT mice. In the acute protocol, OVA-induced increases in several IL-13 dependent genes were attenuated in Adipo Tg versus WT mice, even though IL-13 per se was not affected. With chronic exposure, though OVA-induced increases in goblet cells numbers per millimeter of basement membrane were greater in Adipo Tg versus WT mice, mRNA abundance of mucous genes in lungs was not different. Also, adiponectin overexpression did not induce M2 polarization in alveolar macrophages. Our results indicate that adiponectin protects against allergen-induced inflammatory cell recruitment to the airspaces, but not development of goblet cell hyperplasia.

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Total IgE, mosquito saliva specific IgE and CD4+ count in HIV-infected patients with and without pruritic papular eruptions

 

Vol. 32, No. 1, March 2014 (Ahead of print) > Jiamton

AP0317 Total IgE, mosquito saliva specific IgE and CD4+ count in HIV-infected patients with and without pruritic papular eruptions

Sukhum Jiamton, Taniya Kaewarpai, Pattama Ekapo, Kanokvalai Kulthanan, Saowalak Hunnangkul, John JJ Boitano, Sirichit Wongkamchai

Abstract

Background: Pruritic Papular Eruption (PPE) is a skin disorders found in HIV infected patients. However, the exact etiology of PPE is not documented. It has been suggested that PPE might result from arthropod bites.

Objective: The aim of this study was to investigate those factors in the HIV patient contributing to the occurrence of PPE, including specific IgE against mosquito saliva allergens, total IgE, CD4 cell counts and their associations. 

Methods: Specific IgE against saliva allergens of Cx. quinquefasciatus mosquito was measured in 25 HIV patients with PPE and in 60 HIV without PPE by a time-resolved fluorescence immunoassay (TRIFA). The total IgE levels and CD4cell counts were also determined.

Conclusions: It may be concluded that the etiology of PPE in the HIV patient may be heterogeneous or multi-causal with allergic responses to the mosquito saliva allergen being only partially responsible.Results: Among the HIV patients with PPE, 84% (21/25) had CD4 cell counts less than 200 cells/µl in contrast to 30% (18/60) of the HIV without PPE patients. These differences were statistically significant (p =0.0005, χ² test). The total IgE scores for the HIV patients with PPE were
significantly higher than for those without PPE. A comparison of the mean arbitrary scores of the specific IgE in HIV patients, with and without PPE, was non-significant (p = 0.152). However, 44% (11/25) of the HIV patients with PPE had an arbitrary score above the mean score of mosquito bite allergic subjects, as compared to only 3.3% (2/60) of HIV patients without PPE.

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