Validation of Asthma Control Assessment Among Urban Adolescents Using the Asthma Control and Communication Instrument

BackgroundThe National Institutes of Health guidelines recommend questionnaires to assess asthma control, but there are few self-reported asthma morbidity surveys validated among urban, African American, Hispanic, and/or poor adolescents. The Asthma Control and Communication Instrument (ACCI) is a 12-item self-reported questionnaire previously validated among a diverse adult population, but not among adolescents.ObjectiveTo assess the ability of the ACCI to accurately describe asthma control in an urban adolescent population.MethodsBetween November 13, 2014, and March 2, 2017, we collected information using the ACCI, the Asthma Control Test, the Pediatric Asthma Quality of Life Questionnaire, and lung function among adolescents enrolled in a school-based asthma intervention study. The ACCI measure of asthma control was validated by evaluating accuracy (on the basis of receiver operating characteristic curve), internal reliability, and concurrent and discriminative validity.ResultsWe collected information on 280 adolescents (mean age, 13.4 years; 56% males; and 51% African American). ACCI control showed good internal reliability and strong concurrent and discriminative validity with the Asthma Control Test and the Pediatric Asthma Quality of Life Questionnaire. The accuracy of the ACCI in classifying adolescents with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88).ConclusionThe ACCI, a clinical tool developed to assist communication about asthma control, has demonstrated strong construct validity as a self-reported questionnaire within an urban, African American, and Hispanic sample of adolescents. It has the potential to assist in the assessment of asthma control in urban, minority, and/or poor adolescents

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Rationale: Hospitalizations for asthma exacerbations are common in the United States, but there are no national estimates of outcomes in this population. It is also not known if race disparities in asthma deaths exist among hospitalized patients

Asthma Treatment Decisions by Pediatric Residents Do Not Consistently Conform to Guidelines or Improve With Level of Training

ObjectiveTo compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training.MethodsWe conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication.ResultsThere were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training.ConclusionsPediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management

Tailored Education May Reduce Health Literacy Disparities in Asthma Self-Management

Rationale: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown

Sex differences in survival of oxygen-dependent patients with chronic obstructive pulmonary disease

Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. the prevalence of COPID is rising among women and is approaching that of men, but it is not known if sex affects survival.Objectives: To measure the survival differences between men and women with oxygen-dependent COPD.Methods: We conducted a 7-yr prospective cohort study of 435 outpatients with COPD (184 women, 251 men) referred for long-term oxygen therapy (LTOT) at two respiratory clinics in São Paulo, Brazil. Baseline data were collected on enrollment into oxygen therapy, when patients were clinically stable.Measurements: We examined the effect of sex on survival using Kaplan-Meier survival curves, and then used Cox proportional hazards models to control for potential confounders.Main Results: in unadjusted analyses, we observed a nonsignificant trend toward increased mortality for women (hazard ratio, 1.28; 95% confidence interval, 0.98-1.68; p = 0.07). After accounting for potential confounders (age, pack-years smoked, Pa-O2, FEV1, body mass index), females were at a significantly higher risk of death (hazard ratio, 1.54, 95% confidence interval, 1.15-2.07; p = 0.004). Other independent predictors of death were lower Pa-O2 (P < 0.001) and lower body mass index (p < 0.05).Conclusions: Among patients with COPD on LTOT, women were more likely to die than men.State Publ Hosp, São Paulo, BrazilUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilJohns Hopkins Univ, Baltimore, MD USAOregon Hlth & Sci Univ, Portland, OR USACtr Hlth Res, Portland, OR USAUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilWeb of Scienc

Validation of Parental Reports of Asthma Trajectory, Burden, and Risk by Using the Pediatric Asthma Control and Communication Instrument

BackgroundDespite a growing interest, few pediatric asthma questionnaires assess multiple dimensions of asthma morbidity, as recommended by national asthma guidelines, or use patient-reported outcomes.ObjectiveTo evaluate a questionnaire that measures multiple dimensions of parent-reported asthma morbidity (Direction, Bother, and Risk).MethodsWe administered the Pediatric Asthma Control and Communication Instrument (PACCI) and assessed asthma control (PACCI Control), quality of life, and lung function among children who presented for routine asthma care. The PACCI was evaluated for discriminative validity.ResultsA total of 317 children participated (mean age, 8.2 years; 58% boys; 44% African American). As parent-reported PACCI Direction changed from "better" to "worse," we observed poorer asthma control (P &lt; .001), mean Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) scores (P &lt; .001), and FEV1% (P&nbsp;= .025). Linear regression showed that, for each change in PACCI Direction, the mean PACQLQ score decreased by&nbsp;-0.6 (95% CI,&nbsp;-0.8 to&nbsp;-0.4). As parent-reported PACCI Bother changed from "not bothered" to "very bothered," we observed poorer asthma control (P &lt; .001) and lower mean PACQLQ scores (P &lt; .001). Linear regression showed that, for each change in PACCI Bother category, the mean PACQLQ score decreased by&nbsp;-1.1 (95% CI,&nbsp;-1.3 to&nbsp;-0.9). Any reported PACCI Risk event (emergency department visit, hospitalization, or use of an oral corticosteroid) was associated with poorer asthma control (P&nbsp;&lt;&nbsp;.05) and PACQLQ scores (P &lt; .01).ConclusionsPACCI Direction, Bother, and Risk are valid measures of parent-reported outcomes and show good discriminative validity. The PACCI is a simple clinical tool to assess multiple dimensions of parent-reported asthma morbidity, in addition to risk and control