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Children's adherence to recommended asthma self-management
Patricia V Burkhart1, Jacqueline M Dunbar-Jacob, Philip Fireman
1College of Nursing, University of Kentucky, Lexington, KY, USA.
Insights
Improving adherence to daily asthma monitoring in children is crucial. A behavioral strategy showed promise, though not statistically significant, suggesting potential for better asthma management.
Area of Science:
- Pediatric Pulmonology
- Behavioral Science in Medicine
- Asthma Management
Background:
- Asthma affects millions of children, with adherence to monitoring crucial for management.
- Peak expiratory flow rate (PEFR) monitoring is a key tool for asthma self-management.
- Declining adherence to daily monitoring can lead to poor asthma control and increased morbidity.
Purpose of the Study:
- To evaluate adherence to peak expiratory flow rate (PEFR) monitoring in children with asthma.
- To test a behavioral strategy, contingency management, aimed at enhancing daily PEFR monitoring adherence.
Main Methods:
- A 5-week randomized controlled trial involving 42 children (7-11 years) with persistent asthma.
- Electronic data collection via PeakLog and self-report using the Asthma Diary.
- Comparison of adherence rates between an intervention group and a usual care group.
Main Results:
- Adherence to PEFR monitoring demonstrated a decline over the 5-week study period.
- The intervention group showed higher median adherence (79%) at week 5 compared to the usual care group (64%).
- While not statistically significant, the observed difference and effect size suggest a potential benefit of the behavioral strategy.
Conclusions:
- Even modest improvements in adherence to asthma treatment regimens can be clinically significant.
- Contingency management presents a promising behavioral approach for improving adherence to asthma monitoring.
- Future research should utilize larger sample sizes and more intensive behavioral strategy training to confirm these findings.
Purpose:
Adherence to peak expiratory flow rate monitoring by children with asthma was evaluated, and a behavioral strategy to enhance adherence to daily monitoring was tested.
Design And Methods:
Forty-two 7- through 11-year-old children with persistent asthma were recruited into a 5-week randomized, controlled clinical trial. Adherence data were collected electronically by PeakLog and the self-report Asthma Diary.
Results:
Adherence declined over time. At week 5, intervention group adherence (Median = 79%) was higher than the usual care group adherence (Median = 64%), but the difference was not statistically significant. The effect size did suggest that differences between groups were present.
Conclusions:
Even small improvements in adherence to asthma treatment may be clinically significant in light of the alarming increases in asthma morbidity and mortality. Contingency management shows promise for improving adherence outcomes. Future research should engage larger sample sizes and increase the number and intensity of sessions to teach behavioral strategies.