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. 2023 May 1;6(5):e2313120.
doi: 10.1001/jamanetworkopen.2023.13120.

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

Nikolaos G Papadopoulos  1   2 , Alexander G Mathioudakis  2   3 , Adnan Custovic  4 , Antoine Deschildre  5 , Wanda Phipatanakul  6 , Gary Wong  7 , Paraskevi Xepapadaki  1 ; PeARL Think Tank
Collaborators, Affiliations

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

Nikolaos G Papadopoulos et al. JAMA Netw Open. .

Abstract

Importance: Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority.

Objective: To assess actual and perceived optimal childhood asthma monitoring practices used globally.

Design, setting, and participants: This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies.

Main outcomes and measures: Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains.

Results: A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest.

Conclusions and relevance: These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Papadopoulos reported receiving grants from Capricare, Nestle, Numil, and Vianex and consulting fees from Abbott, AbbVie, AstraZeneca, GlaxoSmithKline, HAL, Medscape, Menarini/Faes Farma, Mylan, Novartis, Nutricia, OM Pharma, and Regeneron/Sanofi outside the submitted work. Dr Mathioudakis reported receiving grants from GlaxoSmithKline and owning shares in ChestPal outside the submitted work. Dr Custovic reported receiving personal fees from AstraZeneca, Worg Pharmaceuticals, Sanofi, Stellargens Greer, and GlaxoSmithKline outside the submitted work. Dr Deschildre reported receiving personal fees from Novartis, AstraZeneca, Sanofi Regeneron, ALK, Stallergenes Greer, DBV Technologies, Aimmune Therapeutics, Nestlé Health Science, and GlaxoSmithKline outside the submitted work. Dr Xepapadaki reported receiving speaker’s fees from Galenica, GlaxoSmithKline, Menarini, Novartis, Uriach, Nestle, and Nutricia outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Actual and Perceived Optimal Monitoring Visit Frequency and Duration in Severe Asthma
Differentiation of responses between actual and optimal conditions is shown as lines connecting the bars.
Figure 2.
Figure 2.. Prioritization of Asthma Monitoring Domains
Figure 3.
Figure 3.. Use of Monitoring Tools During Asthma Monitoring Visits
Actual (blue) and perceived (green) optimal use of monitoring tools during asthma monitoring visits. All outcomes were significant at P < .001 except for history and clinical examination (panel A). Lines represent medians; black bars, IQRs. The thickness of the IQR bars represents the density of data within the range. ACQ indicates asthma control questionnaire; ACT, asthma control test; FeNO, fractional exhaled nitric oxide; PEFR, peak expiratory flow rate; and QoL, quality of life.
Figure 4.
Figure 4.. Use of Monitoring Tools Between Asthma Monitoring Visits
Actual (blue) and perceived (green) optimal use of monitoring tools between asthma monitoring visits. The proportions of patients in which the tool is or should be offered are shown. All outcomes were significant at P < .001. mHealth trackers refer to the use of wearables, mobile phones, tablets, and smartphone applications for collecting health-related information. PEFR indicates peak expiratory flow rate; FeNO, fractional exhaled nitric oxide; PFT, pulmonary function test.
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