Scott Burgess

Assessing adherence and factors associated with adherence in young children with asthma

Background and objective:  Adherence with preventive asthma medication by young children is an important factor when evaluating a suboptimal response to treatment. However, few data exist regarding the accuracy of subjective measures of adherence and factors associated with adherence in young children.

Providing feedback on adherence increases use of preventive medication by asthmatic children

This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%, p <.01). There were significant improvements in clinical measures of disease control compared with baseline in both groups. The change in forced expiratory volume in 1 s (FEV1) (% predicted) was greater in those subjects receiving feedback (13.8% versus 9.8%). However, lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance. Measuring adherence and providing feedback increases the use of preventive medication. A larger study is required to explore implications for disease control.

Breastfeeding does not increase the risk of asthma at 14 years.

OBJECTIVES. There are conflicting data regarding the impact of breastfeeding on the development of asthma in late childhood. Our aim with this study was to investigate the relationship between breastfeeding and the prevalence of asthma in children at 14 years. METHODS. The Mater-University of Queensland Study of Pregnancy is a birth cohort of 7223 women and their infants recruited from a public antenatal clinic in Brisbane, Australia, between 1981 and 1984. Data regarding breastfeeding and the duration of breastfeeding were collected through the use of a questionnaire completed by the mother 6 months postdelivery, and the prevalence of asthma was determined through the use of a questionnaire completed by the mother 14 years postdelivery. RESULTS. Data regarding both breastfeeding and asthma were available for 4964 children. The prevalence of asthma in children at 14 years was 28.4%. Breastfeeding for ≥4 months was not found to have a significant effect on the prevalence of asthma in 14-year-olds. The unadjusted odds ratio of developing asthma at 14 years if the child was breastfed for ≥4 months was 1.03. The odds ratio of developing asthma did not change appreciably when allowance was made for potential confounding factors. CONCLUSION. Data from this study indicate that breastfeeding neither increases nor decreases the prevalence of asthma in children at 14 years.

Parenting asthmatic children: identification of parenting challenges.

Asthma is the most common chronic illness of childhood, affecting up to 14% of children. Poor asthma management and non-adherence to treatment regimens are a pervasive problem in this population and are related to exacerbation of symptoms. Effective management of pediatric asthma involves a complex set of interactions between the parent and child, yet there is a paucity of literature examining these interactions. The main purpose of this study was to identify the child behavior and asthma management tasks parents experience difficulty with. It was hypothesized that the more asthma behavior problems reported, the more problems parents experience in asthma management tasks. Participants in this study were 255 parents of 2-to 10-year-old asthmatic children, recruited via an advertisement placed in school newsletters throughout Australia. Results indicated that the most problematic child asthma behaviors were oppositional behavior, hyperactivity, and aggression, and anxiety was also identified by parents as a concern. The main problematic asthma parenting tasks were entrusting the school, entrusting caregivers, identifying unique symptoms, and identifying and avoiding triggers. More problem asthma behaviors were associated with higher levels of parenting difficulty and more general levels of behavior problems. Parents who reported more dysfunctional parenting styles reported more difficulties with their childs asthma behavior. Based on the results it is suggested that an appropriate parenting intervention program would target basic behavioral management skills, in addition to applying these behavior management principles to asthma management.

Adherence with Preventive Medication in Childhood Asthma

Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physicians estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

Successful management of lymphangiomatosis and chylothorax in a 7‐month‐old infant

Abstract:  A 7‐month old infant presented with an effusion and multiple lesions in his spleen. A diagnosis of lymphangiomatosis was made based on chylous effusion and an MRI demonstrating numerous enhancing lesions within the spleen on T2‐weighed images. Conservative measures, including the withdrawal of feeds and octreotide, did not significantly reduce the rate of chyle production and increasing requirement for respiratory support. Resection of the patient’s spleen and partial pleurectomy were associated with a dramatic improvement in his condition. At 27 months the patient was well with no evidence of further lymphangiomas or a recurrence of his chylothoraces.

Parental beliefs about behaviour problems of their asthmatic children and interventions to support parenting

The aim of this study was to explore parents’ attributions for their children’s behaviour and their beliefs about treatment efficacy, and to investigate the specific topics and strategies parents believe would be most beneficial in a parenting intervention. A survey of 165 parents and qualitative interviews with 13 parents were conducted, assessing child behaviour, parental attributions and intervention characteristics. The findings indicated that parents were confident in their ability to manage the challenges of asthma, and in general, believed that five key asthma treatment recommendations were at least moderately helpful in managing their child’s asthma. Many parents believed that asthma medications were related to behavioural difficulties including hyperactivity, disruptiveness, and disobedience. Nearly half of the parents were concerned about how to best manage their child’s asthma, and a number of themes were identified as important intervention elements. The implications of these findings for intervention development are discussed.

Randomized controlled trial of Triple P for parents of children with asthma or eczema: Effects on parenting and child behavior.

Objective: Parents play an important role in children’s illness management, in promoting child adjustment and reducing behavior problems. Little research has focused on the evaluation of parenting interventions in the context of childhood chronic illness. The aim of this study was to test the efficacy of a brief, group parenting intervention (Healthy Living Triple P) in improving parenting skills and parent adjustment, and reducing child behavioral and emotional difficulties in the context of childhood asthma and eczema. Method: One hundred seven parents of children with a diagnosis of asthma and/or eczema were randomly assigned to intervention (n = 52) or care as usual (CAU; n = 55). Parents completed self-report measures of their child’s behavioral and emotional adjustment, their own parenting, and their own level of adjustment at pre- and postintervention and at 6-month follow-up. Parent–child interactions were observed and coded at each time point. The intervention consisted of 2 group sessions of 2 hr each delivered by trained, accredited practitioners. Results: Attrition was low, with T2 and T3 assessment completed by 84.6% and 80.8% of intervention families and 92.7% and 81.8% of CAU families, respectively. Intention-to-treat analyses indicated that overall parent-reported ineffective parenting as well as parental overreactivity reduced as a result of intervention. Parent report of child behavior problems also decreased, but there were no changes in children’s emotional adjustment. No changes in observed parent or child behavior were found. Stress reduced for parents in the intervention group compared to the CAU group, but there were no changes in parental anxiety or depression. Effects showed evidence of reliable and clinical change and were maintained at 6-month follow-up. Conclusions: The intervention shows promise as an addition to clinical services for children with asthma and eczema and may have broader application to other chronic health conditions.

Pulse oximetry plethysmogram analysis could help identify infants with possible apnoeas requiring full investigation.

Non-invasive monitoring of breathing is a holy grail in paediatric respiratory, neonatal and sleep medicine. Respiratory rate is a key marker for the surveillance of sick infants and children (1-3), while repeated infant apnoeic episodes are associated with an increased risk of apparent life-threatening events (4). In clinical pulse oximetry, the photoplethysmographic (pleth) signal is assessed mainly to infer the validity of measured arterial oxygen saturation. This article is protected by copyright. All rights reserved.

Corrigendum to "Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial" [Behav. Res. Ther. 83 (2016) 35-44].

The authors regret for the error at the following sentence. 1 Sentence ‘The modified Parents’ Self-Efficacy with Eczema Care Index (PASECI; α = 0.96 Charman, Venn, & Williams, 2004)’ needs to be corrected to ‘The modified Parents’ Self-Efficacy with Eczema Care Index (PASECI; alpha = 0.96; Mitchell & Fraser (2011) adapted from the original version of PASECI (see Ersser et al., [2015])).’2 Sentence ‘Weekly scores were averaged to calculate mean eczema severity (Patient-Oriented Eczema Measure; POEM; Mitchell & Fraser, 2011),…’ needs to be corrected to ‘Weekly scores were averaged to calculate mean eczema severity (Patient-Oriented Eczema Measure; POEM; Charman, Venn, & Williams, 2004) ….3 An additional reference needs to be added to the reference listErsser, S.J., Farasat, H., Jackson, K., Gardiner, E., Shepperd, Z.A., Cowdell, F. (2015). Parental self-efficacy and the management of childhood atopic eczemadevelopment and testing of a new clinical outcome measure. British Journal of Dermatology, 173(6), 1479–1485 http://dx.doi.org/10.1111/bjd.14175.The authors would like to apologise for any inconvenience caused.