Towards Participatory Paediatric Asthma Action Plans

Study Overview
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Brief Summary
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Asthma is the most common chronic disease in children. The management of asthma attacks at home is based on asthma action plans that are very heterogeneous and reflect the diversity of recommendations on this subject. The purpose of this study is to observe using smartinhalers how children and their families use their emergency treatment at home in case of asthma symptoms and asthma attacks, to allow building new recommendations based not only on the literature, but also on real-world data.

Detailed Description
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Asthma is the most common chronic disease in children. Asthma exacerbations are responsible for many unscheduled consultations by paediatricians and general practitioners, numerous emergency room visits and frequent hospitalizations Asthma action plans are documents given to families and schools to give the actions to be taken in the event of an asthma attack occurring in the family or school environment. They are recommended by all learned societies, because, combined with patient education and regular consultations, they reduce the need for unscheduled care. The main drug in the action plan is the emergency treatment, i.e. a short-acting bronchodilator (SABA). However, the doses of SABA to be used vary widely depending on the recommendations. For children up to 5 years of age, the international board of the Global Initiative for Asthma (GINA) suggests limiting the home dose to 2 puffs of 100μg every 20 minutes, to be repeated twice before consulting a physician if there is no improvement. This dose is increased to 4-10 puffs every 20 minutes in children 6 years and older. The British Thoracic Society in the United Kingdom advises administering salbutamol puffs one at a time, 30 to 60 seconds apart, until symptoms improve, with a maximum of 10 puffs. In France, the Groupe de Recherche sur les Avancées en PneumoPédiatrie (GRAPP) recommends to administer higher doses of salbutamol at home, up to one puff per 2 kg of weight, with a maximum of 10 to 15 puffs, to be repeated every 20 minutes for one hour, before giving oral corticosteroids. These very heterogeneous protocols reflect the diversity of doses proposed in the literature, and the paucity of clinical research data that makes it impossible to determine whether one approach is better than another. A study that looked at the goals of parents of children with asthma highlighted that this heterogeneity of practices is a source of stress for families: I would like one plan and not ten explained one parent; I would like a plan that doesn't change all the time reported another. Harmonization of practices is necessary in order to provide families and school physicians nurses with a consistent approach.. The aim of this study is therefore to observe, using inhalers connected to salbutamol inhalers (smart inhalers), how families manage an asthma exacerbation at home, and to integrate these data into the establishment of future recommendations.

Official Title
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Towards Participatory Paediatric Asthma Action Plans

Conditions
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Asthma

Intervention / Treatment
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* Device: Smart inhaler


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parent of 18 years or more Parent with a smartphone compatible with a smart inhaler Parent with child who : is 3 years to 11 years 11 months old has physician-diagnosed asthma diagnosis has a prescription of emergency treatment in case of asthma symptom Non-opposition of the legal guardian Exclusion Criteria: Refuse to participate at the study Difficulty reading and/or understanding French language Technical problem (malfunction) with the smart inhalers and/or the associated mobile application during the initial test with the parent's smartphone

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 11 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Smart inhaler<br>Children with smart inhaler | Device: Smart inhaler<br>* Automatic record (number of actuations and their timing) of the use of the emergency treatment through the smart inhaler Questionnaire sent to the parents at each use of the smart inhaler to get information regarding the reason of use and the efficacy of the treatment given<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean number of actuations of the emergency treatment in the group symptom improvement | Mean number of actuations in asthma attacks asthma attack for which parents think that the emergency treatment has been effective (group symptom improvement), for each symptom or symptom association | 18 months | 
| Mean duration between two actuations of the emergency treatment in the group symptom improvement | Mean duration between two actuations in asthma attacks for which parents think that the emergency treatment has been effective (group symptom improvement), for each symptom or symptom association | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean number of actuations of the emergency treatment between the groups symptom improvement and no improvement | Mean number of actuations for each symptom or symptom association, between asthma attack for which parents think that the emergency treatment has been effective (group symptom improvement), and asthma attacks for which parents think that the emergency treatment has not been effective (group no improvement) | 18 months | 
| Mean duration between two actuations of the emergency treatment between the groups symptom improvement and no improvement | Mean duration between actuations for each symptom or symptom association, between asthma attack for which parents think that the emergency treatment has been effective (group symptom improvement), and asthma attacks for which parents think that the emergency treatment has not been effective (group no improvement) | 18 months | 
| Percentage of asthma attacks treated according to each guideline | Percentage of asthma attacks treated following the GINA guidelines (2 puffs every 10 min), the BTS guidelines (1 puff every 30 seconds with a maximum of 10 puffs), the French guidelines (1 puff/2kg every 20 minutes) | 18 months | 
| Percentage of asthma attacks treated according to the asthma action plan of families | For families with an asthma action plan provided by their physician, the percentage of asthma attacks treated by parents according to their asthma action plan will be presented, providing an evaluation of the adherence of families to their asthma action plan. | 18 months | 
| Overtreatment by families | For families with an asthma action plan provided by their physician, estimate the percentage of asthma attacks treated with ≥ 150% of the number of puffs prescribed by their physician (for example, the physician prescribed 5 puffs, the child was provided 8 puffs or more). | 18 months | 
| Undertreatment by families | For families with an asthma action plan provided by their physician, estimate the percentage of asthma attacks treated with ≤ 50% of the number of puffs prescribed by their physician (for example, the physician prescribed 5 puffs, the child was provided 2 puffs or less | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Action plan, Asthma, Paediatric