How often do you address parental psychology when developing an asthma action plan?
In this month’s Pediatrics, Yuen-yu et. al. (10.1542/peds.2018-1723) offer evidence that doing so may be an important component for improving outcomes
for children with asthma. Parents of children with asthma have greater anxiety- and
depression-related symptoms than those with otherwise healthy children1 and more frequently utilize the emergency department for asthma visits.2 Yuen-yu and colleagues propose that addressing parental psychologic health may improve
child asthma outcomes. In this study, the investigators utilized acceptance and commitment
therapy (ACT) to foster psychological flexibility among parents of children with asthma.
In a nutshell, psychological flexibility combines a state of mindfulness surrounding
stressful or difficult situations with the ability to modify actions according to
an individual’s core values such as dependability, reliability, health, or family
togetherness. The ACT approach empowers parents to acknowledge and accept the difficulty
of caring for their child’s asthma while exploring the values associated with providing
this care. In doing so, parents can shift focus from medication adherence as a task
to identifying how actions such as administering a daily controller medication contribute
to or take away from their core values. Success with using this approach could then
reduce the burden of negative feelings such as anxiety and depression and improve
a parent’s ability to provide asthma related care. Sounds promising, but does it
Yuen-yu and colleagues performed a randomized control trial involving 168 parent-child
dyads aged 3-12 years in Hong Kong, China. One-half of the children were assigned
to the control group and were provided two hours of standard asthma education in an
outpatient clinic. The other half received the same asthma education combined with
four weekly ACT sessions led by a nurse experienced with this therapy modality. These
sessions focused on:
1. Acknowledging the psychological difficulties in caring for a child with asthma
2. Developing awareness and acceptance of these difficulties
3. Identifying a core set of personally-held values as a parent of a child with asthma
4. Creating short- and long-term action plans based on these values to improve the
management of their child’s asthma.
The results are impressive. Children of parents receiving ACT and asthma education
had significantly fewer emergency department visits and visits with a private practitioner
6 months after the intervention in comparison to those who received education alone.
There was no significant difference in general pediatric visits or hospital admissions
due to a child’s asthma exacerbations. However, both control and intervention groups
had fewer hospitalizations at the six-month follow-up period, suggesting at least
some form of educational intervention helped to decrease hospital admissions. Parents
receiving ACT reported fewer negative emotional symptoms of guilt, worry, sorrow,
anger, and anxiety compared to those receiving the standard education. The parents
participating in ACT also reported a better quality of life at 6 months post-intervention
as measured by the Pediatric Asthma Caregiver’s Quality of Life Questionnaire. It’s
important to note that 75% of enrolled patients had never been hospitalized prior
to enrollment and approximately half did not require inhaled corticosteroid use. Thus,
the generalizability of these findings to families of children with more severe asthma
is unknown. Future studies involving parents of children with more severe asthma
are needed, how these results are the first to suggest that addressing the psychologic
needs of families with ACT can improve asthma outcomes. Check out the details in
this month’s Pediatrics!
1. Easter G, Sharpe L, Hunc JC. Systematic review and meta-analysis of anxious and
depressive symptoms in caregivers of children with asthma. J Pediatr Psychol. 2015;40(7):623-632
2. Bartlett SJ, Kolodner K, Butz AM, Eggleston P, Malveaux FJ, Rand CS. Maternal
depressive symptoms and emergency department use among inner-city children with asthma.
Arch Pediatr Adolsc Med. 2001;155(3):347-353.