Asthma control in children : what can be done to improve ?
Today JOE is exploring the literature, looking for strategies to improve pediatric asthma control. In fact a group of pediatrician in Colorado did the job for JOE, in a review published in 2015.
The age of asthma diagnosis is decreasing, from 4.7 years in 1993 to 2.6 years in 2000. However, from now on, no improvement has been made concerning the prevention of this chronic disease. In particular, the impact of inhaled corticosteroids (ICSs) has been studied : It has no impact on the prevention of asthma development and progression. Given the lack of resources to cure asthma, focus should be given to asthma control. To achieve asthma control in children, the authors present two solutions : increase medication adherence and continue the research for new therapeutics.
Increase medication adherence
Therapeutic adherence should be addressed first when approaching asthma control in children. Pediatric adherence specifically to ICSs is only 20% to 34% ! Poor adherence in the pediatric population increases the risk of severe exacerbations and hospitalizations. Multiple reasons exist for poor adherence with medications in the pediatric population. Amongst them the autors list : the complexity of treatment regimens, costs of medications, perceived risk of medication-related side effects, lack of parental supervision, poor patient perception of disease severity, and obviously the absence of JOE ! 😉
Developing electronic monitoring device technology (like SmartTouch in NZ or Propeller in USA) with reminders might be a key noninvasive resource to address poor adherence in children and adolescents in a clinical setting. Those tools allow to provide accurate, objective, and detailed information on day-to-day patient adherence without significantly disrupting a patient’s natural medication-taking behavior. However, those technologies are not without their limitations : their cost, the need for patient education, the problem of reliability and the “big brother” feeling.
For the adherence of children, the use of Electronic monitoring devices with an audiovisual reminder function increased adherence about 50 %. Pediatric patients who were provided adherence feedback had overall increased adherence, which continued to increase over the course of the study, compared with those who used an EMD without provider feedback. However the size of the study did not allow to show a significant improvement on the patient health condition.
The research for new therapeutics against pediatric asthma
New therapeutics are under study to increase Asthma control in children.
In patients who have persistently poor control despite optimal medication compliance, newly emerging pharmaceuticals, including inhaled therapies and biologics, might be key to their treatment. However, barriers exist to their development in the pediatric population : longer studies, higher costs ! An insights must be drawn from adult studies, which has its own unique limitations. Biomarkers to direct the use of such potentially expensive therapies to those patients most likely to benefit are imperative.
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