Where does health communication technology fit into allergy practice? - PowerPoint Presentation

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Where does health communication technology fit into allergy practice?

Bruce G. Bender, PhD

Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Where does health communication technology fit into allergy practice?

Key Messages

Adherence interventions to date have been only moderately successful.

Health communication technology brings new possibilities for improved asthma self-management.

New biosensors, such as smartphone-compatible fractional exhaled nitric oxide and spirometers, could provide additional benefits.

Allergists must exercise caution so that HCTs do not compromise patient confidentiality or safety.Bender BG. Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Timeline of Existing and New Technology Emergence

Bender BG. Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Fluticasone and Salmeterol Refill Rates in

5,500

Patients Over 365 Days

Bender BG. Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Effect Size of Adherence Interventions

Bender BG. Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Translational Sequence for Health

Behavior

Research

Bender BG. Ann Allergy Asthma Immunol. July 2018;121(1):24-30

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Integrated Behavioral Health Care for

Management

of Stress in Allergic Diseases

Alyssa A. Oland, PhD

Genery D. Booster, PhD

Bruce G. Bender, PhD

Ann Allergy Asthma Immunol. July 2018;121(1):31-36

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Integrated Behavioral Health Care for

Management of

Stress in Allergic Diseases

Key Messages

Oland AA

, Booster GD, Bender BG. Ann Allergy Ashma Immunol. July 2018;121(1):31-36

There is an increasing prevalence and severity of allergic disease worldwide.

A bidirectional relationship has been found between allergic disease and stress, particularly for patients with severe, chronic, or multiple allergic diseases; physiological and behavioral pathways contribute to this bidirectional relationship.

Behavioral health interventions are helpful in addressing stress and nonadherence in patients with allergic disease.

Medical providers are encouraged to routinely screen for behavioral health and make referrals as indicated or, ideally, incorporate a behavioral health provider into a multidisciplinary patient care team.

School, workplace, and community-level interventions are

also

indicated

for supporting patients with allergic disease.

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Barriers to Medication Adherence in Asthma:

The Importance of Culture and Context

Elizabeth L. McQuaid, PhD

Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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Barriers to Medication Adherence in Asthma:

The Importance of Culture and Context

Key Messages

McQuaid EL. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

There are racial and ethnic disparities in the use of controller medications for asthma in prescription receipt, prescription initiation, and medication adherence once obtained.

Individual factors such as culturally derived medication concerns and depressive symptoms play a role.Patients with severe asthma or those with financial burdens may consider complementary and alternative medicine (CAM) as a supplemental or alternative strategy to traditional medications.Patient-provider variables, such as limited discussion of CAM use, difficulties communicating with limited English proficiency patients, and cultural stereotypes, likely influence lower levels of adherence.

Office-based interventions (providing education, simplifying regimens, monitoring) may be effective if delivered in a culturally informed manner.

Provider training in communication and cultural competence may increase

patient receptivity to discussing and accepting controller medications.

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Components of Medication Adherence

McQuaid EL. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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Intervention Approaches to Address

Disparities

in Medication Use

McQuaid EL. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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The Burden of Allergic Rhinitis and Allergic Rhinoconjunctivitis on Adolescents:

A Literature Review

Michael S. Blaiss, MD

Eva Hammerby, MSc

Susan Robinson, PhD

Tessa Kennedy-Martin, MSc

Sarah Buchs, MsC

Ann Allergy Asthma Immunol. July 2018;121(1):43-52

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The Burden of Allergic Rhinitis and Allergic Rhinoconjunctivitis on Adolescents: A Literature Review

Key Messages

Blaiss MS,

Hammerby E, Robinson S, et

al. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

Although allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) are sometimes perceived as trivial conditions, this review indicates that their impact on adolescent life is negative and far-reaching. It is important that the disease burden should be examined in adolescents as they represent a unique population with needs that are distinct from adults and younger children.The symptoms associated with AR and ARC can be different in adolescents compared with adults and children.AR/ARC has been shown to have a significant impact on the quality of life (QOL) of adolescents with respect to both physical and mental components, and may limit daily activities and functioning in these individuals.Adolescents with AR/ARC may experience difficulties falling asleep, night waking, and snoring, and generally have poorer sleep.

AR/ARC has a negative impact on school attendance, performance, and academic achievement.

Improved management of AR and ARC could help to reduce the disease burden across a number of important patient-reported outcomes, such as QOL, daily functioning, sleep,

and

academic

performance, in adolescents.

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart of Search Results

Blaiss MS, Hammerby E, Robinson S, et al. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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Association Between Moderate to Severe Seasonal Allergic Rhinitis Symptoms and Poor Rhinoconjunctivitis Quality of Life Questionnaire Score in Adolescents, Children, and Adults

Blaiss MS, Hammerby E, Robinson S, et al. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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Associations Among Allergic Rhinitis (AR), AR medication, and Asthma in Adolescents

(

aged 15–17 years) Taking UK National Examinations

Blaiss MS, Hammerby E, Robinson S, et al. Ann Allergy Asthma Immunol. July 2018;121(1):37-42

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Epinephrine, Auto-injectors, and Anaphylaxis:

Challenges of Dose, Depth, and Device

Julie C. Brown, MDCH, MPH

Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Epinephrine, Auto-injectors, and Anaphylaxis: Challenges of Dose, Depth, and Device

Key Messages

Brown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

Epinephrine is the only first-line medication for the treatment of anaphylaxis, and it must be readily available in the community, with doses and exposed needle lengths that are optimized to best meet the needs of patients of all sizes and weights.

Optimal dosing is based on common practice, but it is not well studied. No pharmacokinetic or pharmacodynamic data involving patients in anaphylaxis are available.

The recently marketed 0.1 mg epinephrine auto-injector (EAI) is the first approved device for patients weighing 7.5 to 15 kg, which allows for dosing closer to the recommended 0.01 mg/kg. It also has a shorter needle that may be more appropriate for this weightrange.The 0.15-mg EAI gives increasingly less than the recommended 0.01 mg/kg dose as the patient weight approaches 30 kg. Data are lacking to determine whether this is clinically important, but switching at 20 or 25 kg may be better than switching at 30 kg.

A higher-dose EAI might better meet the needs of larger patients, but data are lacking.

An EAI with a longer needle might better meet the needs of obese patients, but data are lacking.

Prehospital and hospital providers should review their anaphylaxis preparedness and

consider

using anaphylaxis kits or prefilled syringes when EAIs are not used.

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Epinephrine dose percentage above and below a 0.01 mg/kg ideal, by weight at which the switch between 0.15-mg and

0.3-mg devices is made (20 kg, 25 kg, or 30 kg)

Brown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Epinephrine dosing compared with a 0.01-mg/kg

ideal

, using a 4 epinephrine auto-injector (EAI)

strategy

vs

a 2 EAI strategyBrown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Administration of an epinephrine auto-injector to a well-restrained infant, demonstrating how a single holder can bunch the thigh muscle during administration to increase the skin-to-bone depth

Brown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Epinephrine 1-mg/mL vial and supply kit for anaphylaxis, prepared by the inpatient pharmacy and stocked wherever

1

 mg/mL epinephrine is needed throughout the hospital

Brown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Emergency

Epinephrine

Check-and-Inject

Kit

for

Emergency Medical Service ProvidersBrown JC. Ann Allergy Asthma Immunol. July 2018;121(1):53-60

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Advances in Rhinitis:

Models and Mechanisms

Anne K. Ellis, MD, MSc, FRCPC

Mark W. Tenn, BHSc

Ann Allergy Asthma Immunol. July 2018;121(1):61-64

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Advances in Rhinitis: Models and Mechanisms

Key Messages

Ellis AK, Tenn MW. Ann Allergy Asthma Immunol. July 2018;121(1):61-64

The nasal microbiome is a diverse community of bacteria that can be found throughout the nose and sinuses.

Bacteria in the nose and nasal microbiome profiles can be detected shortly after birth.

Staphylococcus aureus is a key pathogenic bacterium in chronic rhinosinusitis with nasal polyps; however, this may be dependent on the phenotype and severity of disease.Probiotics can potentially improve clinical efficacy of immunotherapies and anti-histamines in treatment plans of allergic rhinitis, but this requires further evidence.