Abstract

Introduction

Asthma is the most common respiratory disorder in children. Knowledge about asthma helps in achieving asthma control. Self-management of the disease includes adherence to medication, avoidance of trigger factors, and appropriate response to symptoms Education about asthma is essential to improve the health and reduce the negative impact on daily life.

Materials and Methods

In this study, 62 patients aged 14.04 ± 2.25 years, who had been followed up for at least 6 months at Dokuz Eylül University Pediatric Allergy and Immunology outpatient clinic, were included. A modified Asthma Self-Management Knowledge Questionnaire with 25 true or false questions was administered.

Results

The results of the study included the mean asthma control score of the patients to be 20.08 ± 4.50. Minimum and maximum score patients achieved on the questionnaire were 9 and 23 points, respectively. The effect of general asthma knowledge, asthma medication knowledge, and environmental factors knowledge on asthma control were found to be statistically significant. On the other hand, asthma exacerbation knowledge was not statistically significant. The findings of this study reveal that knowledge of environmental factors is the most influential factor on asthma control, whereas, the second most effective variable was the asthma medication knowledge.

Conclusion

Hence, asthma education programs must be tailored specifically to this age group, so that they can self-manage properly, avoid exposure to triggering factors appropriately, and hopefully live symptom free.

Introduction

Asthma is the most common chronic disease among children and adolescents worldwide (1). Education is one of the cornerstones in achieving asthma control and is recommended in national and international guidelines (2). Self-management includes adherence to medication, avoidance of triggers, and appropriate response to symptoms, all of which are crucial for the well-being and asthma control of patients with chronic diseases (3). Lack of information about the disease among asthmatic patients and their family members may lead to inadequate treatment and disease control, frequent hospital admissions, high morbidity, and falling behind in school (4, 5, 6).

The primary aim of this study is to evaluate the asthma knowledge levels of children and adolescents over the age of 11 who have been diagnosed with asthma and to determine the impact of this knowledge on asthma control. As asthma is the most common chronic respiratory disease during childhood and adolescence, it is critical for patients and their families to have sufficient knowledge about the disease for its effective management.

In this study, patients’ knowledge levels regarding general asthma information, asthma medications, environmental triggers, and asthma exacerbations were examined, and the contributions of this knowledge to asthma control were analyzed. The results of the study indicate that knowledge of environmental factors and medication use plays a significant role in improving asthma control. Based on these findings, it is aimed to tailor asthma education programs specifically for this age group and to enhance patients’ self-management skills.

Materials and Methods

Patients with asthma who had been followed up for at least 6 months at Dokuz Eylül University Pediatric Allergy and Immunology outpatient clinic were included in the study. Asthma diagnosis was made according to the Global Strategy for Asthma Management and Prevention report by the Global Initiative for Asthma. Patients’ age, sex, time of asthma onset, presence of atopy, presence of atopy in the family, exposure to smoking, asthma control test score, and comorbid allergic diseases were documented. A 25-question questionnaire was administered to the patients. Although the Turkish validation of the Asthma Self-Management Knowledge Questionnaire has been performed for adults, it was modified and administered by three independent pediatric allergists in a language that children over 11 years of age could understand. The questionnaire includes 25 items with “true” or “false” responses about general asthma knowledge, asthma medications, asthma exacerbations, and environmental triggers. One point was given for each correct answer, and the total score indicated the patient’s knowledge of asthma (7).

The asthma control test consists of five items: It evaluates (1) the effect of asthma on daily functioning, (2) the frequency of shortness of breath, (3) night-time/early awakenings due to asthma symptoms, (4) the use of rescue medication, and (5) the overall self-assessment of asthma control. All items refer to the past 4 weeks and are scaled from 1 to 5. The total score indicates asthma control with values of 25, 20–24, and <19 translating to excellent, good, and poor asthma control, respectively (8). An informed consent form was obtained from the patients and their families. For patients with atopy, a positive skin prick test of ≥3 mm was considered significant. The approval for this study was obtained from the Dokuz Eylül University Non-Interventional Research Ethics Committee (date: 27.04.2022, approval number: 2022/16-08).

Statistical Analysis

Descriptive statistics, including mean ± standard deviation (SD), were used to summarize continuous variables such as age, asthma knowledge, medication knowledge, environmental factors knowledge, and exacerbation knowledge. For categorical variables (e.g., sex distribution, smoking exposure, and family history of atopy), frequencies and percentages were calculated.

To evaluate the relationships between level of asthma control and independent variables (general asthma knowledge, medication use knowledge, environmental factors knowledge, and asthma exacerbation knowledge), regression analysis was performed. Regression coefficients, standard errors, and p-values were reported to assess statistical significance. A p-value of <0.05 was considered statistically significant.

Results

The study included 62 patients, 37 of whom were male. The mean age of the patients was 14.04 ± 2.25 years. The time of asthma onset was 5.70 ± 3.27 years. Of the patients, 72.6% had no exposure to smoking, and 69.4% had a family history of atopy (Table 1). Sensitization to at least one allergen on a skin prick test was found in 87.1% of the patients. The main complaints at admission were cough and dyspnea 98.4%, accompanied by nasal congestion in 29% of the cases. Among the patients, 83.9% were using metered-dose inhalers, 30.6% were on montelukast, and 9.7% were on nasal corticosteroids. Additionally, 62.9% of the patients had atopic dermatitis and allergic rhinitis (Table 2). The mean asthma control score of the patients was 20.08 ± 4.50. The questionnaire scores ranged from a minimum of 9 to a maximum of 23, with a mean score of 16.56 ± 2.75. Only 6.5% of the patients responded correctly to all questions related to general asthma knowledge, asthma medication, environmental triggers, and asthma exacerbations (Table 3). Except for the score variable related to asthma exacerbation, other score types positively affected asthma control, increasing the control level. While the effect of general asthma knowledge (p<0.05), asthma medication knowledge (p<0.01), and environmental factors knowledge (p<0.01) on asthma control was statistically significant, asthma exacerbation knowledge was not significant (Table 4). A 1% increase in general asthma knowledge increased asthma control by approximately 0.39%. A 1% increase in asthma medication knowledge increased asthma control by approximately 0.72%. Lastly, a 1% increase in environmental factors knowledge increased asthma control by about 0.77%. The findings show that knowledge of environmental factors is the most influential factor on asthma control, followed by asthma medication knowledge (Figure 1).

Discussion

Although adequate asthma control can be achieved for most patients, the disease is often sub-optimally controlled. The reasons for this are multifactorial, including the patient’s age, age of onset or severity of asthma, patient beliefs and coping strategies leading to decreased adherence to treatment, disease mechanisms, and lack of patient knowledge about management (9). Improving knowledge about asthma among individuals with the disease is an important component of self-management (10). Self-efficacy plays a key role in the prevention of asthma, improvement in asthma conditions, and sustainability of asthma control in children and adolescents (11). Previous data suggest that adolescents and young adults, in particular, are often unable to manage their asthma properly (12, 13). To effectively personalize asthma education, it is necessary to identify gaps in asthma knowledge and self-management skills. An information questionnaire completed by the patient can be a useful tool to identify these gaps. Asthma self-management during adolescence becomes challenging due to poor treatment adherence. Recent studies have observed that digital applications and phone reminders improve treatment compliance in this age group alongside individual education (14).

In this study, patients were asked about their knowledge of asthma, medication use, environmental triggering factors, and asthma exacerbations. General knowledge of asthma, medication use, and environmental triggers was associated with asthma control, whereas knowledge of exacerbations was not. This may be because patients who are well-informed about their disease, take their medication regularly and correctly, and avoid triggers are less likely to experience exacerbations. Hence, their knowledge about exacerbations may be limited. Recent studies have shown that educational programs play a significant role in achieving asthma control. Children who received training on recognizing environmental triggers and proper use of inhaler devices showed a significant reduction in hospital admissions and symptom frequency (15).

Emphasizing the factors that most affect asthma control, as found in this survey, is crucial. It is widely accepted that asthma knowledge is necessary for effective self-management (16). However, managing asthma involves many complex tasks, requiring a vast amount of information (17). For example, patients need to understand the basic pathophysiology to comprehend why triggers can vary and why maintenance medications are necessary even in the absence of symptoms. They also need to learn to monitor lung function, recognize exacerbations early, dose rescue medications, and determine when emergency care is needed. Measuring knowledge in all these areas can be challenging. However, asthma attacks are likely to be less frequent if patients are educated about asthma, how to use medication, and how to avoid triggering factors during every clinical visit. Raising family awareness about recognizing asthma symptoms and taking early action has been shown to significantly reduce the frequency of asthma attacks (18).

A study conducted in Türkiye found a 40% decrease in emergency department visits among children whose families participated in educational programs. A study conducted in Türkiye revealed that indoor cigarette smoke and house dust mites are the most significant environmental risk factors affecting asthma control in children. Therefore, educating families on reducing exposure to environmental triggers is of utmost importance (19).

Study Limitations

Sample size: The study included only 62 patients, which limits the generalizability of the findings to the larger population of children and adolescents with asthma.

Cross-Sectional Design: As a cross-sectional study, it provides a snapshot of the relationship between asthma knowledge and control at a single point in time, without capturing longitudinal changes or causal relationships.

Self-Reported Data: The reliance on self-reported answers may introduce recall bias, particularly regarding adherence to medication and avoidance of triggers.

Unmeasured Confounding Factors: Other factors influencing asthma control, such as socioeconomic status, psychological factors, or detailed environmental exposures, were not included in the analysis.

Limited Scope of Education: The study emphasizes knowledge about asthma medications and environmental triggers but does not thoroughly explore other components of asthma education, such as the psychological impact or family support.

Generalizability to Other Age Groups: The findings are specific to children over 11 years old and may not apply to younger children or adults with asthma.

Conclusion

Education is essential to improve the health of young people with asthma and reduce the negative impact of the disease on their daily lives. The developmental tasks of adolescence require asthma education programs tailored specifically to this age group.