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Correspondence |

Childhood Asthma: A Narrative Approach FREE TO VIEW

Lucy Gibson, MBBS; Jessica Kearney, BSc; Lucy Everson, BSc; Jonny Coppel, MBBS; Rahul Chodhari, MSc
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Rahul Chodhari, MSc, The Royal Free London NHS Foundation Trust, Department of Paediatrics & Child Health, Pond Street, Hempstead, London NW3 2QE, England


Copyright 2016, . All Rights Reserved.


Chest. 2016;149(1):282-283. doi:10.1016/j.chest.2015.09.027
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We read with great interest the study by Owton et al in a recent issue of CHEST (July 2015) and congratulate the authors for highlighting a narrative based approach. We support the article on two fronts.

Firstly, an online survey capturing the subjective patient experience (6,878 participants by Asthma UK—British asthma charity, 2013 and 2014; patient-reported survey of asthma care, 2013 [repeated in 2014]; data received with thanks from Asthma UK), demonstrates that patients feel narrative elements of asthma care are ignored by professionals (Fig 1).

  • 22% of respondents felt that they received a poor standard of care. Nearly half of this group felt that their doctor or carer had not asked sufficiently about their symptoms or their individual response to treatment.

  • A free text response from patients favors a narrative approach, improving their engagement and empowerment.

Figure Jump LinkFigure 1 Respondents were asked to rate their asthma care as excellent, satisfactory, or poor. Within each category, the graph shows if they felt their doctor or care coordinator asked sufficient questions about their asthma symptoms, family history, or response to treatment (yes), if they felt they did not ask sufficient questions (no), or if they did not know (unknown).Grahic Jump Location

Secondly, as referred to in the article, time pressures for doctors impose a barrier to managing asthma with a narrative approach. To alleviate such pressures, community support for asthma care can be augmented in children’s cases through school education programs.

Triple A,” a peer-to-peer narrative-based school learning program in Australia, has shown promising results in improved quality of life and reduced school absenteeism. Coffman et al performed a systematic review that further endorsed that school education could improve self-management behaviors and have some impact on reducing school absences. Indeed, our own collaborative project between the Royal Free Hospital and the University College London has shown that engaging the curiosity of school children is an effective method of improving the understanding of the asthma and its management. Since its inception, our program has educated more than 3,000 school children in London, England. Our results show significant, sustained improvements in asthma knowledge.

References

Owton H. .Allen-Collinson J. .Siriwardena N. . Using a narrative approach to enhance clinical care for patients with asthma. Chest. 2015;148:288-293 [PubMed]journal. [CrossRef] [PubMed]
 
Shah S. .Peat J.K. .Mazurski E.J. .et al Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial. BMJ. 2001;322:583-585 [PubMed]journal. [CrossRef] [PubMed]
 
Coffman J.M. .Cabana M.D. .Halpin H.A. .Yelin E.H. . Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics. 2008;121:575-586 [PubMed]journal. [CrossRef] [PubMed]
 
Coppel J.D.R. .Gibson L.L. .Chodhari R. . P73-Speak Up For Asthma (SUFA) Program for schoolchildren in London—a pilot study. Clin Translat Allergy. 2014;4:128- [PubMed]journal
 

Figures

Figure Jump LinkFigure 1 Respondents were asked to rate their asthma care as excellent, satisfactory, or poor. Within each category, the graph shows if they felt their doctor or care coordinator asked sufficient questions about their asthma symptoms, family history, or response to treatment (yes), if they felt they did not ask sufficient questions (no), or if they did not know (unknown).Grahic Jump Location

Tables

References

Owton H. .Allen-Collinson J. .Siriwardena N. . Using a narrative approach to enhance clinical care for patients with asthma. Chest. 2015;148:288-293 [PubMed]journal. [CrossRef] [PubMed]
 
Shah S. .Peat J.K. .Mazurski E.J. .et al Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial. BMJ. 2001;322:583-585 [PubMed]journal. [CrossRef] [PubMed]
 
Coffman J.M. .Cabana M.D. .Halpin H.A. .Yelin E.H. . Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics. 2008;121:575-586 [PubMed]journal. [CrossRef] [PubMed]
 
Coppel J.D.R. .Gibson L.L. .Chodhari R. . P73-Speak Up For Asthma (SUFA) Program for schoolchildren in London—a pilot study. Clin Translat Allergy. 2014;4:128- [PubMed]journal
 
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