Pediatric Pulmonology & Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Roma, Italy.
Allergology Service Policliclinico Casilino, Rome, Italy.
Ital J Pediatr. 2024 Oct 25;50(1):220. doi: 10.1186/s13052-024-01792-w.
The use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews.
Children with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app.
We enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ''simple and intuitive'' at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21-25) for the control group (42 patients) and 23 (21-24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24-25) and 24 (24-25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable.
The smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.
移动应用程序的使用有助于改善青少年哮喘的自我管理。然而，目前尚无针对学龄前喘息儿童的证据。此外，我们也没有关于就诊时收集的病史可靠性的数据。第一个目的是评估智能手机应用程序在学龄前喘息管理中的可行性；其次，我们旨在评估面对面医疗访谈中收集的病史数据的可靠性。
年龄在 25 至 72 个月之间、反复发作喘息的儿童被随机分配到干预组，为他们提供用于监测症状和治疗哮喘发作的智能手机应用程序，或分配到对照组，为他们提供书面行动计划。在随访时，收集了哮喘控制测试和临床问卷，并探讨了应用程序的可接受性。还收集了呼吸症状、药物使用情况和医疗资源的利用情况。此外，还比较了纸质问卷中获得的医疗信息与应用程序中每日记录的数据。
我们共纳入 85 例反复发作喘息的学龄前儿童：43 例分配到干预组，42 例分配到对照组。电子日记编纂的平均（标准差）依从率为 60（15）%。干预组的接受度和可用性较好，70%和 93%的参与者在就诊 1 时（入组后 3 个月）和就诊 2 时（就诊 1 后 3 个月）分别描述该应用程序“简单直观”，95%和 98%的参与者认为该应用程序在症状管理方面有用。两组在临床结局方面无显著差异。就诊 1 时，对照组（42 例患者）的 cACT 中位数（IQR）评分为 23.5（21-25），干预组（43 例患者）为 23（21-24）。就诊 2 时（对照组 41 例和干预组 42 例）分别为 25（24-25）和 24（24-25）。对干预组数据的二次分析显示，应用程序记录的每日症状发生率高于纸质问卷，这表明回溯性病史的收集可能不完全可靠。
智能手机应用程序可被有学龄前喘息儿童的家庭使用和接受。需要进行未来的对照试验来证明其对临床结局的影响或在远程医疗方案中的疗效。最后，每日问卷可以为医生提供更可靠的临床情况，因为它反映了比就诊时填写的书面回溯问卷更好的每日哮喘症状。
