Lin Nancy Y.Ramsey Rachelle R.Miller James L.McDowell Karen M....
8页
查看更多>>摘要：Abstract Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low‐income families in inner‐city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high‐quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school‐based care delivery model that incorporates video‐based telehealth (VBT) medical and self‐management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6‐month period, children from inner‐city, low‐income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self‐management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI?≥?4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI?<?4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school‐based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.
Sossa‐Brice?o Monica P.Castro‐Rodriguez Jose A.Rodriguez‐Martinez Carlos E.
8页
查看更多>>摘要：Abstract Objectives Although the benefits of albuterol delivered via metered‐dose inhalers with a spacer (MDI+S) have been increasingly recognized, the evidence regarding the cost‐effectiveness of MDI+S compared to nebulization (NEB) is not sufficient, especially in less‐affluent countries, where the clinical and economic burden of the disease is the greatest. The aim of the present study was to evaluate the cost‐effectiveness of MDI+S vs NEB for delivering albuterol for the treatment of pediatric asthma exacerbations. Methods A decision‐analysis model was developed to estimate the cost‐effectiveness of MDI+S vs NEB for delivering albuterol for the treatment of pediatric asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national healthcare system in Colombia, a middle‐income country (MIC). The main outcome of the model was the avoidance of hospital admission. Results For the base‐case analysis, the model showed that compared to NEB, using MDI+S for the delivery of albuterol was associated with lower total costs (US$96.68 vs US$121.41 average cost per patient) and a higher probability of hospital admission avoided (0.9219 vs 0.8900), thus leading to dominance. Conclusions This study shows that in Colombia, an MIC, compared with NEB, the use of MDI+S for delivering albuterol for the treatment of pediatric asthma exacerbations is the preferred strategy?because it is associated with a lower probability of hospital admission at lower total treatment costs.
查看更多>>摘要：Abstract Objective Although there are more studies showing higher asthma prevalence in urban rather than rural zones, few assessed asthma mortality by zone in children. The objective of this study is to compare asthma mortality rates (AMR) by zone of residence of Mexican children. Design Using national death certificate and population projections data, AMR were compared in children aged 0 to 14 years by gender, age group, and zone of residence from 1999 to 2016. AMR trends were calculated using Joinpoint regression. Results Of the 680?823 deaths, 2464 (0.36%) were due to asthma. Asthma mortality was higher in rural (0.65%) than urban (0.26%) zones, P ?<?.0001. Whole period AMR median was also higher in rural vs urban zones (0.6 vs 0.3, respectively), P ?<?.05. The average annual percent change (AAPC) of AMR for the whole period was ?5.1 in all children with a higher percent decrease in rural vs urban zones (girls' AAPC?=??6.3 vs ?4.1, respectively and boys' AAPC?=??4.8 vs ?4.2, respectively). AMR decreased in children aged 0 to 4 from both zones (rural's AAPC: girls?=??7.9, boys?=??5.2; urban's AAPC: girls?=??5.1, boys?=??5.4), P ?<?.05. No trend was found in children aged 5 to 14. Conclusions Asthma mortality in Mexican children is higher in rural than urban zones. The decrease of mortality over time in early childhood is reassuring. More research is needed to determine reasons for higher mortality in rural Mexico and for the lack of a favorable decreasing trend in children aged 5 to 14 from both zones.
Weinstein Cindy L. J.Gates DavisZhang XiaoliVarnell Tracey...
8页
查看更多>>摘要：Abstract Objectives Asthma affects over 6 million children in the United States alone. This study investigated the efficacy and long‐term safety of mometasone furoate‐formoterol (MF/F) and MF monotherapy in children with asthma. Materials and Methods This phase 3, multicenter, randomized controlled trial evaluated metered‐dose inhaler twice daily (BID) dosing with MF/F 100/10?μg or MF 100?μg in children, aged 5 to 11 years, with a history of asthma for greater than or equal to 6 months and confirmed bronchodilator reversibility, who were adequately controlled on inhaled corticosteroid/long‐acting beta‐agonist combination therapy for greater than or equal to 4 weeks. After a 2‐week run‐in on MF 100?μg BID, eligible patients received 24 weeks of double‐blind treatment and were followed for safety up to 26 weeks. The primary efficacy endpoint was the change from baseline in AM postdose 60‐minute AUC %predicted FEV1% across 12 weeks of treatment. Results A total of 181 participants received at least one dose of MF/F (n?=?91) or MF (n?=?90). MF/F was superior to MF across the 12‐week evaluation period, with a treatment advantage of 5.21 percentage points ( P ?<?.001). Superior onset of action with MF/F over MF was achieved as early as 5?minutes postdose on day 1. Overall, approximately 50% of participants experienced one or more treatment‐emergent adverse events, with fewer occurring in the MF/F group. Conclusions In children 5 to 11 years of age with persistent asthma, the addition of F to MF was well tolerated and provided significant, rapid, and sustained improvement in lung function compared with MF alone.
NSTL
Wiley