Asthma is characterized by reversible pulmonary symptoms, frequent hospitalizations, poor quality of life, and varied treatment. Parents with low health literacy (HL) is linked to poor asthma ...outcomes in children. Recent practice updates recommended inhaled corticosteroids for the management of persistent asthma, but guideline-concordant care is suboptimal. Our aim was to develop and assess an Asthma Action Plan (AAP) that could serve as an individualized plan for low HL families and facilitate guideline-concordant care for clinicians.
We followed the National Institute of Health 5-step "Clear & Simple" approach to develop the Uniformed Services AAP. Our AAP included symptom pictographs (dyspnea, cough, sleep, activity) and guideline-concordant clinical automation tools. Caregivers assessed the pictograms for validity (transparency of ≥ 85%; translucency score ≥ 5; and ≥ 85% recall). Readability was assessed using 7 formulas. (<6th Grade was acceptable). Comprehensibility, design quality, and usefulness was assessed by caregivers using the Consumer Information Rating Form (CIRF) (>80% was acceptable). Understandability and actionability was assessed by medical librarians using the Patient Education Materials Assessment Tool-Printable (>80% was acceptable). Suitability was assessed by clinicians using the modified Suitability Assessment of Materials (SAM) instrument (>70% was superior).
All 12 pictograms were validated (N = 118 respondents). Readability demonstrated a 4th grade level. Overall CIRF percentile score = 80.4%. Understandability and Actionability = 100%. Suitability score = 75%.
Our AAP was formally endorsed by the Allergy & Asthma Network. The Uniformed Services AAP is a novel tool with embedded clinical automation that can address low HL and enhance guideline-concordant care.
Division of Pulmonary Medicine, Children's Hospital of Philadelphia, and
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
19104
Submitted 27 November 2002
; accepted in final ...form 2 May 2003
Respiratory muscle weakness is common in children with neuromuscular
disease (NMD). We hypothesized that weakness puts them at risk for respiratory
muscle fatigue, a harbinger of chronic respiratory failure. We therefore
measured a noninvasive index of respiratory muscle fatigue, the tension-time
index of the respiratory muscles (TT mus ), in 11 children with NMD
and 13 control subjects. Spirometric flow rates and maximal inspiratory
pressure were significantly lower in the NMD group than in controls (43
± 23 vs. 99 ± 21 cmH 2 O, P < 0.001). The
mean TT mus was significantly higher in the NMD group than in
controls (0.205 ± 0.117 vs. 0.054 ± 0.021, P <
0.001). The increase in TT mus was primarily due to an increase in
the ratio of average mean inspiratory pressure to maximal inspiratory
pressure, indicating decreased respiratory muscle strength reserve. We found a
significant correlation between TT mus and the residual
volume-to-total lung capacity ratio ( r = 0.504, P = 0.03)
and a negative correlation between TT mus and forced expiratory
volume in 1 s ( r = -0.704, P < 0.001). In conclusion,
children with NMD are prone to respiratory muscle fatigue. TT mus
may be useful in assessing tolerance during weaning from mechanical
ventilation, identifying impending respiratory failure, and aiding in the
decision to institute therapies.
respiratory muscles; muscular dystrophy
Address for reprint requests and other correspondence: J. L. Allen, Div. of
Pulmonary Medicine, Children's Hospital of Philadelphia, 34th St. & Civic
Center Blvd., Philadelphia, PA 19104 (E-mail:
allenj{at}email.chop.edu ).
Hospitalization of children with asthma declined at our institution between 1996 and 2000, before stabilizing for the past 5 years. The ages of children hospitalized since 2000 were examined to see ...if the demographics of the hospitalized population have changed to better understand why the hospitalization rate has remained the same despite continued, aggressive screening and education efforts. Data were gathered for our hospital through the Department of Defense Medical Health System Management Analysis and Reporting System (M2). The mean age (± SD) of children hospitalized in 2003 (2.84 ± 2.53) was less than the mean age for 2000 and 2002 (4.85 ± 3.7 and 4.61 ± 4.45), respectively (p < 0.05), and more infants less than 2 years of age were hospitalized in 2003 (33/60, 55% p < 0.01) and 2004 (32/68, 47% p < 0.05) than in 2000 (19/70, 27%). The diagnosis of asthma in hospitalized infants and young children has increased over the past 5 years, suggesting better recognition and providing a new target population for intervention with early asthma controller therapy.
