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Published on: November 4, 2010
Clinical and lung function outcomes in a cohort of children with severe asthma
Patricia de Gouveia Belinelo1,2, Aleisha Nielsen1,2, Bernadette Goddard2
1Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia.
Insights
Nurse-led severe asthma clinics improved asthma control and lung function in children. However, persistent lung ventilation abnormalities highlight the need for further research into effective management strategies for severe pediatric asthma.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Respiratory Health
Background:
- Uncontrolled severe asthma in children presents significant management challenges.
- Nurse-led severe asthma clinics (SAC) offer a specialized approach to care.
- This study evaluates outcomes in children with severe asthma managed in a nurse-led SAC.
Purpose of the Study:
- To describe the clinical outcomes of children with uncontrolled severe asthma managed in a nurse-led SAC.
- To assess changes in lung function and asthma control over time.
- To identify persistent challenges in managing severe pediatric asthma.
Main Methods:
- Retrospective analysis of data from children referred to a nurse-led SAC (2014-2019).
- Inclusion of home visits for assessing modifiable factors and comprehensive lung function analysis.
- Personalized interventions, including biologic agents, and statistical analysis using Mann-Whitney U-test, Student's t-test, or ANOVA.
Main Results:
- Children with severe asthma (SA) showed lower FEV1 and FVC% predicted, and higher Lung Clearance Index (LCI) compared to non-asthmatic and asthmatic cohorts.
- At the first SAC visit, 80% of SA children had abnormal LCI and 48% had reduced FEV1%.
- Follow-up visits demonstrated significant improvements in asthma control and FEV1%, but LCI remained abnormal in most (83%).
Conclusions:
- Nurse-led SACs can lead to improved clinical outcomes and lung function in children with severe asthma.
- Lung ventilation inhomogeneities, indicated by abnormal LCI, may persist despite clinical improvements.
- Further controlled studies are needed to confirm the benefits of nurse-led multidisciplinary SACs for severe pediatric asthma.
Background:
Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC).
Methods:
This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate.
Results:
Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%).
Conclusion:
Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
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