Feldman Jonathan M, Rastogi Deepa, Warman Karen, Serebrisky Denise, Arcoleo Kimberly
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York.
Division of Academic General Pediatrics, and.
Ann Am Thorac Soc. 2025 Mar;22(3):403-415. doi: 10.1513/AnnalsATS.202406-637OC.
Underperception of asthma symptoms is associated with poor asthma outcomes. We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes. A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling. Latino and Black adolescents with asthma ages 10-17 years old and caregivers were recruited from hospitals in the Bronx, New York. PEF feedback sessions reviewed accuracy of PEF guesses and medication adherence data and targeted behavior change using motivational interviewing and problem-solving skills training. The supportive counseling group received emotional support related to asthma. Both groups received three sessions across 6 weeks. All participants were blinded to PEF while guessing PEF before intervention and at 1, 6, and 12-month follow-up. Children in the PEF feedback group saw actual PEF after guesses were locked in during the 6-week intervention. Participants and assessors were blinded to group assignment. The primary outcome was underperception of airflow limitation (divergence between actual PEF and guesses) on home spirometers. Secondary outcomes included daily PEF and forced expiratory volume in 1 second (FEV), inhaled corticosteroid adherence measured by electronic monitors, Asthma Control Test, and emergency health care use for asthma. The sample comprised 354 children (mean = 13.2 ± 2.2 yr; 62% Latino, 38% Black) and caregivers. The PEF feedback group ( = 153 analyzed) demonstrated greater improvements at 1-month follow-up on underperception of airflow limitation (difference-in-differences, -12.64; 95% confidence interval [CI], -17.54 to -7.74), percent personal best PEF (9.89; 95% CI, 7.13 to 12.65), percent predicted FEV (4.93; 95% CI, 0.95 to 8.90), and inhaled corticosteroid adherence (16.02; 95% CI, 7.15 to 24.89) compared with the supportive counseling group ( = 152 analyzed). At 12-month follow-up, the PEF feedback group maintained improvements on underperception of airflow limitation (-13.87; 95% CI, -19.03 to -8.71), maintained higher percentage personal best PEF (14.23; 95% CI, 11.37 to 17.08) and percent predicted FEV (5.62; 95% CI, 1.56 to 9.67), and had smaller declines in inhaled corticosteroid adherence (17.51; 95% CI, 7.12 to 27.89) versus before intervention than the supportive counseling group. No between-group differences existed for asthma control or health care use. The efficacy and sustainability of PEF feedback was established in improving children's perception of airflow limitation, pulmonary function, and medication adherence. Clinical trial registered with www.clinicaltrials.gov (NCT02702687).
哮喘症状感知不足与哮喘不良预后相关。我们评估了一种行为干预对改善气流受限感知及哮喘预后的效果。一项双臂随机对照试验比较了呼气峰值流速（PEF）反馈与支持性咨询。从纽约布朗克斯区的医院招募了10至17岁患有哮喘的拉丁裔和黑人青少年及其照顾者。PEF反馈环节回顾了PEF猜测的准确性和药物依从性数据，并运用动机访谈和解决问题技能培训来针对性地改变行为。支持性咨询组接受与哮喘相关的情感支持。两组均在6周内接受三次干预。在干预前以及1个月、6个月和12个月随访时，所有参与者在猜测PEF时均对PEF数值不知情。在为期6周的干预期间，当猜测被锁定后，PEF反馈组的儿童会看到实际的PEF数值。参与者和评估者对分组情况不知情。主要结局是家庭肺量计上气流受限感知不足（实际PEF与猜测值之间的差异）。次要结局包括每日PEF和1秒用力呼气容积（FEV）、通过电子监测仪测量的吸入糖皮质激素依从性、哮喘控制测试以及哮喘的紧急医疗使用情况。样本包括354名儿童（平均年龄=13.2±2.2岁；62%为拉丁裔，38%为黑人）及其照顾者。PEF反馈组（153例纳入分析）在1个月随访时，在气流受限感知不足方面（差异差值为-12.64；95%置信区间[CI]，-17.54至-7.74）、个人最佳PEF百分比（9.89；95%CI，7.13至12.65）、预计FEV百分比（4.93；95%CI，0.95至8.90）以及吸入糖皮质激素依从性（16.02；95%CI，7.15至24.89）方面，与支持性咨询组（152例纳入分析）相比有更大改善。在12个月随访时，PEF反馈组在气流受限感知不足方面仍保持改善（-13.87；95%CI，-19.03至-8.71），保持较高的个人最佳PEF百分比（14.23；95%CI，11.37至17.08）和预计FEV百分比（5.62；95%CI，1.56至9.67），并且与支持性咨询组相比，吸入糖皮质激素依从性相对于干预前的下降幅度更小（17.51；95%CI，7.12至27.89）。在哮喘控制或医疗使用方面，两组之间没有差异。PEF反馈在改善儿童对气流受限的感知、肺功能和药物依从性方面的有效性和可持续性得到了证实。该临床试验已在www.clinicaltrials.gov注册（NCT02702687）。
