Focused summary (2021) of updated guidelines for asthma management of children ages 5 to 11 years

Asthma guidelines provide evidenced-based recommendations for clinical management of asthma, and use of current guidelines is associated with better patient outcomes. This brief two-sided printable brochure provides a concise summary of current treatment guidelines by age group, and offers guidance on assessing and managing asthma for clinicians. The summary is based off of EPR3, EPR4 (2020), GINA (2020) updates, and other current asthma literature. Recommendations are current to version date shown on the guide. Guides will be periodically updated to reflect changes to practice. References: National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart Lung and Blood Institues, National Institutes of Health, Publication No. 08-5846; 2007. National Heart Lung and Blood Institues [NHLBI]. Asthma care quick reference. Bethesda, Md.: National Asthma Education and Prevention Program; 2011. National Asthma Education and Prevention Program. Expert Panel Report 4: 2020 Focused Updates to the Asthma Management Guidelines from: https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates 2020 GINA Report, Global Strategy for Asthma Management and Prevention: Pocket Guide for Asthma Management and Prevention. From: https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention

Focused summary (2021) of updated guidelines for asthma management of adults and children ages 12+

Asthma guidelines provide evidenced-based recommendations for clinical management of asthma, and use of current guidelines is associated with better patient outcomes. This brief two-sided printable brochure provides a concise summary of current treatment guidelines by age group, and offers guidance on assessing and managing asthma for clinicians. The summary is based off of EPR3, EPR4 (2020), GINA (2020) updates, and other current asthma literature. Recommendations are current to version date shown on the guide. Guides will be periodically updated to reflect changes to practice. References: National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart Lung and Blood Institues, National Institutes of Health, Publication No. 08-5846; 2007. National Heart Lung and Blood Institues [NHLBI]. Asthma care quick reference. Bethesda, Md.: National Asthma Education and Prevention Program; 2011. National Asthma Education and Prevention Program. Expert Panel Report 4: 2020 Focused Updates to the Asthma Management Guidelines from: https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates 2020 GINA Report, Global Strategy for Asthma Management and Prevention: Pocket Guide for Asthma Management and Prevention. From: https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention

Mapping meaningful symptoms and impacts of early Parkinson\u27s disease to digital outcome measures

Background: Digital health technologies have the potential to capture fine variations in symptoms across a range of diseases. However, it is not clear whether these measures are meaningful to patients, which is critical to guiding the selection of digital endpoints. Objective: This manuscript describes novel methodology for mapping meaningful symptoms and impacts of disease and assessing personal relevance of digital measures from the patient perspective. Methods: Participants with early Parkinson’s from the WATCH-PD study [NCT03681015] completed online surveys (N=65), with a subset recruited for 1:1 online video-interviews (N=40) to explore symptoms, impacts and perceived relevance of selected digital measures. Interviews included: (1) symptom mapping to delineate and rank meaningful symptoms/impacts of Parkinson’s, (2) cognitive interviewing on digital measures administered in the WATCH-PD study, and (3) mapping of these measures back to the personal symptom map to show relevance from the patient perspective. Content coding was used to assess frequencies and bothersomeness of symptoms/impacts, and perceived relevance of the technology. Thematic analysis was performed for narrative transcripts. Copies of maps were shared with participants. Results: This approach was deeply engaging and satisfying to participants, who reported improved ability to describe and discuss their symptom experiences. Maps and interviews provided detailed qualitative data on symptoms/impacts of early Parkinson’s with concurrent ability to quantify symptom frequencies and bothersomeness along with perceived relevance of the digital measures. Conclusion: Combining symptom mapping with cognitive interviewing can improve understanding of meaningful symptoms and impacts of disease and perceived relevance of digital measures from the patient perspective

Relative meaningfulness and impacts of symptoms in people with early-stage Parkinson’s disease

Background: Patient perspectives on meaningful symptoms and impacts in early Parkinson’s disease (PD) is lacking, and is urgently needed to clarify priority areas for monitoring, management, and new therapies. Objective: To examine experiences of people with early-stage PD, systematically describe meaningful symptoms and impacts, and determine which are most bothersome or important. Methods: Forty adults with early PD (≤ 2 years diagnosis) who participated in a study evaluating smartwatch and smartphone digital measures (WATCH-PD study) completed online interviews with symptom mapping to hierarchically delineate symptoms and impacts of disease from “Most bothersome” to “Not present,” and to identify which of these were viewed as most important and why. Individual symptom maps were coded for types, frequencies, and bothersomeness of symptoms and their impacts, with thematic analysis of narratives to explore perceptions. Results: The three most bothersome and important symptoms were tremor, fine motor difficulties, and slow movements. Symptoms most commonly impacted sleep, job functioning, exercise, communication, relationships, and self-concept—expressed as a sense of being limited by PD. Thematically, most bothersome symptoms were those that were personally limiting with broadest negative impact on well-being and activities. However, symptoms could be important to patients even when not present, bothersome, or limiting (e.g., speech, cognition). Conclusion: Meaningful symptoms of early PD can include symptoms that are present or anticipated future symptoms that are important to the individual. Systematic assessment of meaningful symptoms should aim to assess the extent to which symptoms are personally important, present, bothersome, and limiting

Summary of the 2020 focused updates to U.S. Asthma Management Guidelines: What has changed and what hasn\u27t?

Despite the availability of effective medications, the majority of pediatric and adult patients with persistent asthma have uncontrolled symptoms. This has been attributed to patient nonadherence and poor self-management, but clinicians also contribute through inaccurate assessment of asthma and lack of familiarity with best practice guidelines for medication management. Thus, improving patient outcomes will require improving clinical management by health care providers, including utilization of evidence-based practice guidelines. In this report, we briefly summarize key points of the national guidelines for asthma management and delineate important changes enacted by 2020 Expert Panel Report-4 updates. These include revised recommendations on the use of fractional exhaled nitric oxide testing, indoor allergen mitigation, bronchial thermoplasty, adjunctive immunotherapy, and important modifications to medication management that are likely to have widespread impact on prescribing throughout the United States. In particular, for all patients aged five years and older taking stepwise therapy levels 3–4, it is now recommended to use Single Maintenance and Reliever Therapy, whereas the use of intermittent inhaled corticosteroids (ICSs) administered at the same time as short-acting beta agonist is recommended for step 2 to reduce symptom burden, improve control, and minimize total ICS dose

Understanding the genetics of chronic obstructive pulmonary disease, α1-antitrypsin deficiency, and implications for clinical practice

Cigarette smoking and poor air quality are the greatest risk factors for developing chronic obstructive pulmonary disease (COPD), but growing evidence indicates that genetic factors also affect predisposition to and clinical expression of disease. With the exception of α1-antitrypsin deficiency (AATD), a rare autosomal recessive disorder that is present in 1–3% of individuals with COPD, no single gene is associated with the development of obstructive lung disease. Instead, a complex interplay of genetic, epigenetic, and environmental factors is the basis for persistent inflammatory responses, accelerated cell aging, cell death, and fibrosis, leading to the clinical symptoms of COPD and different phenotypic presentations. In this brief review, we discuss current understanding of the genetics of COPD, pathogenetics of AATD, epigenetic influences on the development of obstructive lung disease, and how classifying COPD by phenotype can influence clinical treatment and patient outcomes

Smartphone guide to asthma self-management ages 5 to adult (patient education materials)

This free, colorful, interactive, and evidence-based PDF is designed to support online or in-person education about asthma, with formatting that is smartphone friendly. The patient teaching guide covers key content of asthma self-management education in 15 single-page mini-modules. Help your patients to understand what really asthma is, how uncontrolled asthma scars the lungs, different types of asthma medications, and how to use them correctly. Also includes a customizable action plan and a patient friendly asthma attack algorithm. Text it, email it, fill it in and make it your own! English Version. References: Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. Patient Education & Counseling 2018;101:687-95. Mammen JR, Java JJ, Halterman J, et al. Development and preliminary results of an Electronic Medical Record (EMR)-integrated smartphone telemedicine program to deliver asthma care remotely. J Telemed Telecare 2019;0:1-14 Mammen JR, Schoonmaker JD, Java JJ, et al. Going mobile with primary care: Smartphone-telemedicine for asthma management in young urban adults (TEAMS). . Journal of Asthma 2020;0. PLEASE NOTE: This form does not work in Safari and may be corrupted by Safari download. Please use Google Chrome or other browser to access and download

Health-related internet use among adolescents with uncontrolled persistent asthma

Objectives To describe internet use for health information among adolescents with uncontrolled persistent asthma, and to examine whether health-related internet use is associated with responsibility for home asthma management. Methods We analyzed baseline data from the School-Based Asthma Care for Teens (SB-ACT) Trial, which included adolescents (12–16 years) in an urban school district who had uncontrolled persistent asthma per caregiver report. We asked adolescents whether they had ever used the Internet to look for health or medical information (Y/N). Teens then described family responsibility for 9 asthma management tasks (e.g. full caregiver responsibility, shared responsibility, or full teen responsibility). We examined responsibility sum scores in addition to responsibility for individual management tasks. We used bivariate and multivariate analyses to compare health-related internet use with participant characteristics, teen-reported asthma symptoms, and management responsibility. Results We examined data for 425 adolescents (mean age 13.4 years). Almost half (45%) reported seeking health information on the Internet. In adjusted analyses, health-related internet use was strongly associated with teen responsibility (sum score and tasks relating to carrying and using medications); internet use was also more likely among teens who were older, female, or reported uncontrolled disease. Conclusions Adolescents with persistent asthma who share responsibility for home management or report uncontrolled disease are more likely to seek health information online. Future interventions to support teens who co-manage asthma should work to engage patients in both clinical and digital spaces, and ensure that all patients can access accurate, patient-centered asthma information when needed