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Home use of short-acting beta agonists by children with asthma: a multicentre digital prospective study
Apolline Gonsard1, Lisa Giovannini-Chami2, Pierrick Cros3
1Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France.
Insights
Parents of children with asthma often use 2-4 puffs of salbutamol for symptom relief. Asthma action plans should be updated to reflect this common practice for better alignment with real-world asthma management.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Digital Health
Background:
- Asthma is a common chronic respiratory disease in children.
- Written asthma action plans (WAAPs) guide home management of asthma symptoms.
- Understanding real-world medication use is crucial for effective asthma care.
Purpose of the Study:
- To investigate actual salbutamol usage by children with asthma at home.
- To compare children's real-life salbutamol use with their prescribed asthma action plans (WAAPs).
Main Methods:
- A multicentre, observational prospective study was conducted in five French hospitals.
- 120 children (3-11 years) with asthma participated.
- Parents recorded salbutamol use and symptoms via a smartphone app and smart inhaler over 6 months.
Main Results:
- 43 families recorded 124 salbutamol use episodes.
- Median salbutamol use was 3 puffs (IQR 2-4) within 2 hours of symptom onset.
- 49% of families used fewer puffs than prescribed in WAAPs, while 9% used more.
Conclusions:
- Real-world salbutamol use by families typically involves 2-4 puffs for asthma symptoms.
- Current WAAPs may not align with common family practices.
- Adjusting WAAPs to recommend 2-4 puffs initially could better match family behavior and improve asthma management.
Objective:
To investigate real-life salbutamol use by children with asthma at home and compare it with their written asthma action plans (WAAPs).
Design:
Multicentre, observational prospective study.
Setting:
Five tertiary care hospitals in France.
Patients:
120 children aged 3-11 years with asthma.
Interventions:
Parents used a smartphone application connected to a smart inhaler via Bluetooth to record salbutamol use and answer questionnaires about their child's asthma symptoms over 6 months.
Main Outcome Measures:
The primary outcome was the median number of salbutamol puffs used in the first 2 hours after an asthma symptom occurred, depending on symptom type. Secondary outcomes included how families operationalised WAAP instructions and the proportion who administered more or less salbutamol than prescribed.
Results:
43 families used the smart inhaler for asthma symptoms, recording 124 episodes of salbutamol use. The median number of puffs used in the first 2 hours was 3 (IQR 2-4, range 1-26), varying between 2 and 4 depending on the initial symptom type. The number of puffs used did not differ significantly between episodes with and without symptom resolution. 18 (42%) families used a number of salbutamol puffs similar to that in their WAAP, while 21 (49%) used fewer and only 4 (9%) used more.
Conclusions:
Families typically use 2-4 puffs of salbutamol in the first 2 hours after an asthma symptom. Adjusting WAAPs to start with 2-4 puffs of salbutamol, to be repeated if necessary, would be more in line with family practice, and effective in most situations.
Trial Registration Number:
NCT04810169.
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