Booklet and Motivational Interviewing to Promote Self-efficacy in Parents/Caregivers of Children with Asthma: A Clinical Trial.

Background: Asthma is the most common chronic disease in childhood which accounts for numerous annual hospitalizations due to a lack of management and proper management of the disease. Thus, this study aimed to evaluate the effect of using an educational booklet with or without combination with motivational interviewing (MI) on the self-efficacy of parents/caregivers in the control and management of childhood asthma. Methods: A clinical trial was carried out with 86 parents/caregivers of children with asthma aged between 2 and 12 years who were followed up in primary health care units from March 2019 to December 2020. Participants were randomly assigned to two groups: one of the groups read the booklet and the other read the booklet combined with the MI. The Brazilian version of the Self-Efficacy and Their Child's Level of Asthma Control scale was applied before and 30 days after the intervention for assessment of self-efficacy. Data were analyzed using SPSS version 20.0 and R 3.6.3 software. P values<0.05 were considered significant. Results: There were 46 participants in the booklet group and 40 in the booklet and MI group. Both groups were effective in increasing total self-efficacy scores after the intervention (P<0.001). No statistically significant difference was found between the scores of the two groups (P=0.257). Conclusion: The educational booklet with or without combination with MI can increase the self-efficacy of parents/caregivers of children with asthma. The findings could be considered by healthcare providers for the empowerment of caregivers of children with asthma in the control and management of their children's asthma.Trial Registration Number: U1111-1254-7256.

Asthma medication adherence, control, and psychological symptoms: a cross-sectional study.

BACKGROUND: Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control. METHODS: We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control. RESULTS: A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted ß: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted ß: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted ß: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted ß: -0.36; 95% CI: - 0.48 to - 0.24; p < 0.001, respectively). CONCLUSIONS: The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes.

Psychometric Properties of the Short Scale Anxiety Sensitivity Index Among Adults with Chronic Respiratory Disease.

Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.

Assessment of lifestyle and coping strategies among asthmatic patients during the Covid-19 crisis.

BACKGROUND: COVID-19 can cause an asthma attack by triggering asthma symptoms, such as wheezing, chest tightness, and difficulty breathing, which are distressing for patients and can cause anxiety. Additionally, it can progress to pneumonia or other severe lung diseases. OBJECTIVES: Therefore, this study aimed to assess the coping strategies and lifestyle modifications among patients with asthma during the COVID-19 crisis. METHODS: A descriptive comparative design was conducted on 300 adult patients with bronchial asthma at the Alexandria Main University Hospital's chest disease outpatient clinic. Three tools were used for data (including biosocio-demographic characteristics of patients with asthma, the effect of the COVID-19 crisis on the lifestyle of patients with asthma, and how patients with asthma cope with COVID-19) collection. RESULTS: This study revealed that more than two-thirds of patients with asthma did not have COVID-19, while more than one-quarter had COVID-19. More than two-thirds had reasonable asthma control, and more than half had neutral coping with their asthma and the COVID-19 crisis. Half of the studied patients had coped neutrally with their asthma during the COVID-19 crisis, and more than half coped neutrally with the COVID-19 crisis. CONCLUSION: These findings indicate that all stressors faced by patients with respiratory diseases during the COVID-19 crisis and psychological, social, and health support that should be provided to these patients during the pandemic require further investigation.

The association of depressive symptoms and medication adherence in asthma patients: The mediation effect of medication beliefs.

BACKGROUND: The significant role of depression in influencing medication beliefs, which are pivotal cognitive factors that strongly influence medication adherence, has been established. Poor adherence to asthma-controlled medication poses an significant barrier to achieving optimal asthma management. OBJECTIVE: To explore the potential mediating effects of medication beliefs on the relationship between depressive symptoms and medication adherence in patients with asthma. METHODS: Demographic and clinical characteristics, depressive symptoms, medication adherence, and medication beliefs were collected using questionnaires. Structural equation modeling, was utilized to model medication beliefs as mediators in the relationship between depressive symptoms and medication adherence. Bootstrapping was performed to analyze the mediation- and contrast-specific indirect effects of the two medication beliefs. RESULTS: Among the patients who participated in the study, 29.6 % with depressive symptoms were more prone to poor adherence and exhibited skepticism toward asthma medications. Depression had a direct effect (direct effect = -0.275, 95%CI: -0.369 to -0.190) and an indirect effect on adherence mediated by medication beliefs (indirect effect = -0.168, 95%CI: -0.224 to -0.121). The specific mediation effect of concern belief was stronger than that of necessity belief (difference = -0.076, 95%CI: -0.132 to -0.029). CONCLUSION: Depressive symptoms have a direct impact on medication adherence as well as an indirect effect mediated by beliefs about medication, particularly concerns belief.

A qualitative study on asthma management experiences of Turkish community pharmacists.

INTRODUCTION: Asthma is seen in more than 4 million people in Turkey. Numerous studies have shown the beneficial effects of pharmacist interventions on medication adherence and therapeutic outcomes. The aim of this study was to gain insight into the current situation by examining the experiences of Turkish community pharmacists in relation to the counseling and referral of asthma patients, the responsibilities of pharmacists and the recommendations made by pharmacists to improve asthma management. METHODS: In this qualitative study, the constructivist-interpretivist paradigm was adopted. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study. RESULTS: A total of 14 pharmacists engaged in semi-structured interviews conducted between June and August 2023. The wealth of information gathered during these interviews facilitated a meticulous thematic analysis, yielding four overarching themes: 1) Patient-related difficulties, 2) Communication with physicians, 3) Desired traits and responsibilities of pharmacists, 4) Pharmacists' expectations. Pharmacists placed significant emphasis on their challenges in allocating time to patients, primarily due to high workloads and limited collaboration with physicians. CONCLUSION: Considering the workload and time limitations faced by pharmacists, a collaborative model involving pharmacists and physicians is seen as essential. Enhancing the collaboration between pharmacists and physicians, especially for chronic diseases, holds the potential to enhance public health outcomes while alleviating the workload of pharmacists.

Maternal stressful life events during pregnancy and childhood asthma and wheeze.

BACKGROUND: Studies have linked prenatal maternal psychosocial stress to childhood wheeze/asthma but have rarely investigated factors that may mitigate risks. OBJECTIVE: To investigate associations between prenatal stress and childhood wheeze/asthma, evaluating factors that may modify stress effects. METHODS: Participants included 2056 mother-child dyads from Environmental influences on Child Health Outcomes (ECHO)-PATHWAYS, a consortium of 3 prospective pregnancy cohorts (the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study, The Infant Development and Environment Study, and a subset of the Global Alliance to Prevent Prematurity and Stillbirth study) from 6 cities. Maternal stressful life events experienced during pregnancy (PSLEs) were reported using the Pregnancy Risk Assessment Monitoring System Stressful Life Events questionnaire. Parents reported child wheeze/asthma outcomes at age 4 to 6 years using standardized questionnaires. We defined outcomes as ever asthma, current wheeze, current asthma, and strict asthma. We used modified Poisson regression with robust standard errors (SEs) to estimate risk ratios (RRs) and 95% CI per 1-unit increase in PSLE, adjusting for confounders. We evaluated effect modification by child sex, maternal history of asthma, maternal childhood traumatic life events, neighborhood-level resources, and breastfeeding. RESULTS: Overall, we observed significantly elevated risk for current wheeze with increasing PSLE (RR, 1.09 [95% CI, 1.03-1.14]), but not for other outcomes. We observed significant effect modification by child sex for strict asthma (P interaction = .03), in which risks were elevated in boys (RR, 1.10 [95% CI, 1.02-1.19]) but not in girls. For all other outcomes, risks were significantly elevated in boys and not in girls, although there was no statistically significant evidence of effect modification. We observed no evidence of effect modification by other factors (P interactions > .05). CONCLUSION: Risk of adverse childhood respiratory outcomes is higher with increasing maternal PSLEs, particularly in boys.

Differences in the health-related quality of life in patients with asthma living in urban and rural areas in the Amur Region of Russian Federation.

BACKGROUND: Asthma usually arises from an interaction between host and environmental factors. Growing attention has been paid to a place of residence as a factor shaping health-related quality of life (QoL). This study investigated the rural-urban disparity in QoL among adult asthma patients in the Amur region of Russian Federation. MATERIALS AND METHODS: This cross-sectional study included 351 randomly selected adults with asthma. We analyzed QoL (SF-36 and AQLQ scores), asthma control (ACT), and anxiety and depression (HADS) depending on the place of residence (urban vs. rural). RESULTS: The scale "Role Emotional" (RE) of SF-36 was significantly lower in patients from rural areas compared to urban residents (59.3±3.1 vs. 70.4±2.3 points; p = 0.0042). In the urban group, the correlation analysis demonstrated a clear influence of RE on patients' own assessment of their physical functioning (PF, r = 0.53; p<0.0001). Both groups demonstrated low "Social Functioning" (SF). In the group of urban residents, correlation analysis revealed the presence of positive correlations of SF-36 domains reflecting physical (PF, RP, BP) and social functioning (SF, VT) with most scales of both QoL questionnaires. The domains of the emotional sphere (RE and MH) positively correlated with all scales of both QoL questionnaires among urban residents. In the group of rural residents, a comparative analysis showed the absence of significant correlations between more of the QoL scales. Although Asthma Control Test did not differ between groups, we noted a significantly higher need for ß2-agonists in rural areas compared to urban areas (4.2±0.6 vs. 2.7±0.3 inh/day, respectively; p = 0.0221). The frequency of urban residents with a clinically significant level of anxiety (56 persons, or 25.2%) turned out to be lower compared to rural residents (45 persons, or 34.8%; χ2 = 34.08; p<0.001). CONCLUSION: The burden of asthma introduces a greater imbalance in the health-related QoL of rural residents compared to urban residents in the Amur region of the Russian Federation. The absence of interrelationships of some QoL domains in rural residents suggested a disunity of the physical, psychological and social aspects of life. The rural residents suppress physical discomfort by the more frequent use of short bronchodilators. They often showed emotional instability with a predominance of anxiety, which affected the decrease in QoL in the psycho-emotional sphere.

Comparison of health-related quality of life measures in asthma-COPD overlap.

OBJECTIVE: The Asthma Quality of Life Questionnaire (AQLQ) and COPD assessment test (CAT) are used to assess the health status of asthma and chronic obstructive pulmonary disease (COPD), respectively. However, whether these questionnaires are appropriate in patients with asthma-COPD overlap (ACO) has not been reported. This study aimed to evaluate the performance of the AQLQ and CAT in subjects with ACO. METHODS: Subjects were enrolled from two previously described observational studies in Beijing, China. ACO was defined by a consensus definition from a roundtable discussion. All subjects completed the AQLQ, CAT, St George's Respiratory Questionnaire (SGRQ), pulmonary function tests, and the Asthma Control Questionnaire (ACQ)-5. Cross-sectional construct validity was evaluated by correlating the AQLQ and CAT with SGRQ score and other measures of asthma and COPD severity. RESULTS: 147 subjects with ACO were recruited. There were floor effects on non-respiratory components of the CAT, and ceiling effects on emotion domains of the AQLQ. Both questionnaires were significantly correlated with ACQ-5 score but were not correlated with FEV1% predicted or FVC% predicted. The AQLQ and CAT were strongly correlated with SGRQ score (r = -0.657 and r = 0.623, respectively). Multivariable linear regression analysis showed that the AQLQ (standardized ß-coefficient = -0.449, p < .001) had a stronger association with SGRQ score compared with CAT (standardized ß-coefficient = 0.211, p = .023). DISCUSSION: The AQLQ and CAT were both valid for assessing the health-related quality of life in subjects with ACO, but the AQLQ performed better than CAT.

Asthma and Rhinitis Through the Lifespan of Nonpregnant Women.

Increasingly, clinical practice guidelines advocate a precision medicine-based approach to care for asthma. This focus requires knowledge of not only different asthma phenotypes and their associated biomarkers but also sex and gender differences through the lifespan. Evidence continues to build in favor of different lifetime prevalence, clinical presentations, responses to management, and long-term prognosis of asthma. Women transition through many biological and psychosocial phases in their lives, all of which may interact with, and influence, their health and well-being. Historically, explanations have focused on hormonal effects on asthma in reproductive life, but a greater understanding of mechanisms starting before birth and changing over a lifetime is now possible, with immunologic, inflammatory, and hormonal factors playing a role. This article describes the evidence for the differences in asthma and rhinitis between men and women at different stages of life, the potential underlying mechanisms that contribute to this, and the implications for management and research. Future research studies should systematically report sex differences in asthma so that this knowledge can be used to develop a personalized approach to care, to achieve best possible outcomes for all.

Parents of asthmatic children knowledge of asthma, anxiety level and quality of life: unveiling important associations

Purpose: Asthma in children affects millions around the world. Parents’ knowledge of asthma and their quality of life (QoL) may affect the management of their asthma child. The study aimed to assess the knowledge of asthma, anxiety, and QoL of parents who have children diagnosed with asthma living in Amman, Jordan. Patients and methods: This cross-sectional study was conducted over five months in Amman, Jordan. Children with asthma were recruited from outpatient respiratory clinics. Parents were interviewed while waiting to see the child’s respiratory specialist. The Consumer Asthma Knowledge Questionnaire (twelve true/false items), Parent Asthma-Related Anxiety Scale (eleven questions), and QoL Questionnaire (thirteen questions) were used. Results: Recruited parents of the children with asthma (n= 150, mean age 5.05±3.5) showed poor asthma knowledge (score= 5.8±1.75 out of 12, and the 11-item mean is 2.42). Screening of anxiety revealed an increased risk of mild anxiety among parents (score= 26.59±7.3 out of 55, and the 13-item mean is 3.55). The QoL screening showed that parents had a median QoL (score= 39.5±12.0). Conclusion: Asthma knowledge among parents of children with asthma living in Jordan is poor. Screening of anxiety and QoL showed that many parents had mild anxiety and poor QoL. These results shed light on an urgent matter that needs to be addressed as quickly as possible in Jordan and for parents of asthma children worldwide. (AU)

Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations.

Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors. Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores. Exposure: Moving to a low-poverty neighborhood. Main Outcomes: Caregiver-reported asthma exacerbations and symptoms. Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations. Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

Changes in caregiver mental health and pediatric asthma control during COVID-19.

OBJECTIVE: This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program. METHODS: The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset. RESULTS: Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms. CONCLUSIONS: Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.

Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior.

People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.

Quality of life in patients with asthma: Medical indicators and psychological variables.

BACKGROUND: Quality of life (QoL) is a widely studied term concerning asthma because it allows the impact of the disease on the patient's life to be assessed through the patient's perception. The study aims to analyze which asthma-related, psychological, and family variables affect the QoL of adolescents with asthma. DESIGN AND METHODS: This cross-sectional design involves 150 patients diagnosed with asthma aged between 12 and 16 years. The patients' emotional symptomatology, the threat of illness, self-esteem, bonds, quality of life, family, and disease variables were assessed. Statistical analyses were performed using QCA models. RESULTS: The results indicate that girls have a poorer QoL, and age is negatively associated. QCA models found that the variables that best explained the quality of life of these patients, in the case of the medical indicators, were control, good compliance, shorter diagnosis times, and improvement. Regarding psychological variables: a lower threat of illness, less emotional distress, and better parental mood explained the high QoL. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Adolescent QoL is affected by variables related to their asthma that are beyond their control and other psychological and family variables that may increase the perception of their QoL.

Association between asthma and work absence in working adults in the United States.

Objectives: The present study aimed to investigate the association between asthma and work absence in a large sample of US working adults, while controlling for several sociodemographic and health characteristics. Methods: This study used data from the 2019 Health and Functional Capacity Survey of the RAND American Life Panel (ALP). Work absence corresponded to the number of days of absence from work for health-related reasons in the past 12 months. Current asthma was self-reported and was included in the analyses as a dichotomous variable. Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, and number of chronic physical or psychiatric conditions. Finally, the association between asthma and work absence was analyzed using logistic regression models. Results: This study included 1,323 adults aged 22-65 years (53.1% males; mean [SD] age 43.1 [11.7] years). Individuals with asthma were more likely to report at least one (81.5% versus 56.8%, p-value<0.001) or three days of absence (56.9% versus 31.3%, p-value=0.003) from work in the past 12 months than those without asthma. These findings were corroborated in the regression analyses, as asthma was positively and significantly associated with work absence after adjusting for all control variables (at least one day of absence: OR=3.24, 95% CI=1.44-7.29; at least three days of absence: OR=2.61, 95% CI=1.26-5.40). Conclusions: This US study of working adults showed that asthma was a risk factor for work absence. Further research is warranted to better understand the factors predisposing to work absence in the asthma population.

Adolescent asthma management self-efficacy and responsibility: impact on asthma control and quality-of-life.

OBJECTIVE: The purpose of this study was to investigate the extent to which adolescent asthma management self-efficacy, outcome expectations, and asthma responsibility were associated with asthma control and quality-of-life. Adolescent self-efficacy and outcome expectations are important components of social cognitive theory, which guided this research. METHODS: English- and Spanish-speaking adolescents ages 11-17 with persistent asthma were recruited at four pediatric clinics. Adolescents were interviewed and parents completed questionnaires. Multiple linear regression was used to analyze the data. RESULTS: Three hundred and fifty-nine adolescents were recruited. Older adolescent age, male gender, and higher adolescent asthma management self-efficacy were significantly associated with higher adolescent responsibility; outcome expectations were not significantly associated with responsibility. Adolescent ratings of their own responsibility were higher than parent ratings of their child's responsibility for almost all asthma management tasks. Adolescents with higher reported asthma management self-efficacy were significantly more likely to have better quality-of-life and controlled asthma. Adolescents with more positive outcome expectations were significantly more likely to have controlled asthma. Being Native American was associated with worse quality-of-life and asthma not being controlled. Being Black was associated with asthma not being controlled. CONCLUSIONS: Parents and providers should work to improve adolescent self-efficacy in managing their asthma because it is associated with asthma responsibility, asthma control, and quality-of-life. Providers need to especially work with Native American and Black adolescents to improve quality-of-life and asthma control.

Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason?

OBJECTIVES: Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID). METHODS: Secondary analyses of 94 children with asthma (ages 10-17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations. RESULTS: Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020. CONCLUSIONS: Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.