A Global Evaluation on Actual, Perceived Optimal Pediatric Asthma Monitoring Practices

Actual and perceived optimal pediatric asthma monitoring practices among children with asthma is performed similarly worldwide, in which most cases follow evidence-based standards, a survey finds.

The study suggests how asthma monitoring practices are perceived and optimized globally and supports a better understanding of ways to improve these practices.

“A surprising, but optimistic, finding was that differences not only in actual monitoring practices but also in aspirations across geography, economic status, or level of care were modest,” wrote the researchers of the study. “Although actual practices may be influenced by international guidelines, it appears that, at least within the survey respondents, the core needs for pediatric asthma monitoring are universal.”

This international survey study is published in JAMA Network Open.

A total 1319 health care professionals and clinical universities from 88 countries with an expertise in childhood asthma completed the survey from April 12, 2021, to September 3, 2021. Participants included primary (n = 305) secondary (n = 401) and tertiary (n = 522) care professionals, as well as 91 researchers.

The survey aimed to examine how monitoring practices differ by country and by what extent these practices fall short of what is the perceived optimal monitoring standard. The survey included a list of questions based on literature searchers, including questions pertaining to the frequency and priority of different monitoring tools, the frequency these tools are used in clinical practices, and the proportion of patients requiring monitoring with each technique.

In children with mild-to-moderate asthma, the median IQR frequency of visits was 5 (range, 2.5-8.0) months of regular monitoring, and a median IQR of 25 (range, 15-25) minutes for the visit duration. Meanwhile, children with severe asthma had a median IQR frequency of visits of 2.5 (range, 1.0-2.5) months, and a median IQR visit duration of 25 (range, 25-35) minutes.

Additionally, 75% of participants responded were of "very high" or "high" priority to monitor were:

• Symptoms and control,
• Adherence,
• Comorbidities,
• Lung function,
• Adverse effects to medication, and
• Allergy.

Furthermore, the researcher identified differential patterns between actual and perceived optimal use of monitoring tools. For some tools, such as spirometry, current and optimal practices did not differ significantly. However, the researchers found discrepancies and significant need for improvement for other tools, including standardized control and adherence tests.

Lastly, the researchers found the largest gaps between actual and perceived optimal monitoring were between-visit monitoring using electronic trackers, apps, and smart devices, while differences across country economies, care settings, and medical specialties were not significant.

The researchers acknowledged some limitations to the study, including a potentially biased sampling of participants who presumed to have expertise and interest in pediatric asthma. Additionally, the researchers believe these results need to be validated in a clinical setting.

Despite these limitations, the study suggests that asthma monitoring is performed generally homogenously worldwide, and that most clinicians share priorities according to areas of importance for monitoring asthma in children with asthma. Furthermore, the study highlights the importance of evidence-based standardization to improve optimal monitoring practices.

“There is an apparent need for additional standardization and increased availability of tools, although the promise of new technologies has already been translated into high expectations in continuous monitoring,” wrote the researchers. “The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.”

Reference

Papadopoulos NG, Mathioudakis AG, Custovic A, et al. Current and optimal practices in childhood asthma monitoring among multiple international stakeholders. JAMA Network Open. 2023;6(5):e2313120. doi:10.1001/jamanetworkopen.2023.13120