Remote monitoring to predict and prevent asthma attacks in preschool children

远程监测预测和预防学龄前儿童哮喘发作

• 批准号: EP/W002280/1
• 负责人: Sejal Saglani
• 金额: $ 63.88万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FW002280%2F1
• 关键词: Remote; monitoring; predict; prevent; asthma

Context of the research: Preschool children aged between 1 and 5 years are the age-group affected most by attacks of asthma and wheezing during childhood. They develop breathlessness, difficulty in breathing with coughing and noisy breathing (wheezing) because their breathing tubes (airways) become excessively narrowed. In most children, this occurs in isolated episodes precipitated by a simple cold. Preschool aged children account for 75% of all childhood hospital admissions for acute asthma. This admission rate has remained unchanged for over 15 years. The number of preschool children attending GPs for acute wheezing is also increasing, and there is a significant impact on parent/caregiver time off work and both parental and their child's quality of life. Although numerous technologies have been developed that allow school-age children and adults with asthma to monitor their symptoms and to predict attacks, none to date have focussed on predicting and preventing wheeze attacks in preschool children. This is despite significant morbidity and the demand on healthcare resources from preschool wheezing. Worryingly, frequent and repeated preschool wheezing attacks are known to have an impact on life-long lung health.Aims and Objectives: The aim of this project is to generate a bespoke home remote monitoring system for preschool children with wheezing which will allow detection of increased symptoms and will predict an impending wheezing attack, to alert parents to seek healthcare advice to prevent progression to a severe attack needing hospitalisation.Our objectives are; 1. to develop an app to be used by parents/caregivers that allows recording of wheeze symptoms, or use of any rescue inhaler medication for wheeze in the previous 24 hours.2. To relate the child's symptoms to how well their lungs are working (lung function) using wearable equipment that can monitor how wide open the child's airways are while they are asleep, and determine whether a change in their lung function can be used to predict the onset of a wheezing attack.3. To use the data from 1 and 2 to develop a personalised plan for each child that alerts parents/caregivers to the onset of a wheezing attack and to seek healthcare advice.Potential applications and benefits: Our aim is to combine data from the app and lung function monitoring to generate a personalised wheeze prediction plan to significantly reduce the current burden of disease. However, each component of the project, the app, the lung function monitoring and the bespoke plan are completely novel and not previously investigated. We will therefore generate preliminary data during this project to work out how effective each aspect is in predicting symptoms and attacks. We will also determine how acceptable each component is to parents/caregivers, how much they manage to record data and use the monitoring equipment. We will determine whether there are specific times when this approach can be used most effectively. The majority of preschool wheezers are admitted between September and March each year, so recording may not be necessary all year round. Also, the likelihood of an attack is especially high within a month of a previous attack, so lung function monitoring may only be needed in the period immediately after a recent attack to prevent a further attack. Even if all three arms of the project are not applicable, or suitable for all children, each technological approach can also be utilised independently, adding to more widespread application. This proof-of-concept project will allow us to develop a completely novel remote monitoring solution for patients with a high unmet clinical need, but who are a challenge to monitor and manage, and whose needs are frequently overlooked.

研究背景：1至5岁的学龄前儿童是儿童期哮喘和喘息发作最多的年龄组。他们会出现呼吸困难，咳嗽和嘈杂的呼吸（喘息），因为他们的呼吸管（气道）变得过于狭窄。在大多数儿童中，这发生在由简单感冒引起的孤立事件中。学龄前儿童占所有儿童急性哮喘住院的75%。这一录取率15年来一直保持不变。因急性喘息而接受全科医生治疗的学龄前儿童数量也在增加，这对父母/照顾者的下班时间以及父母和孩子的生活质量都有重大影响。尽管已经开发了许多技术，使学龄儿童和成人哮喘患者能够监测他们的症状并预测发作，但迄今为止还没有一项技术专注于预测和预防学龄前儿童的喘息发作。尽管学龄前喘息的发病率很高，而且对医疗资源的需求也很大。令人担忧的是，频繁和反复的学龄前喘息发作已知会对终身肺部健康产生影响。目的和目标：该项目的目的是为患有喘息的学龄前儿童生成定制的家庭远程监测系统，该系统将允许检测增加的症状并预测即将发生的喘息发作，提醒家长寻求医护意见，以防止病情恶化至需要入院治疗。开发一款供父母/护理人员使用的应用程序，允许记录喘息症状，或在过去24小时内使用任何急救吸入器药物治疗喘息。使用可穿戴设备将儿童的症状与他们的肺部工作情况（肺功能）联系起来，该设备可以监测儿童睡眠时气道的开放程度，并确定肺功能的变化是否可以用于预测喘息发作。使用1和2中的数据为每个儿童制定个性化的计划，提醒父母/护理人员发生喘息发作并寻求医疗建议。潜在应用和益处：我们的目标是将应用程序和肺功能监测的数据联合收割机结合起来，生成个性化的喘息预测计划，以显著降低当前的疾病负担。然而，该项目的每个组成部分，应用程序，肺功能监测和定制计划都是全新的，以前没有研究过。因此，我们将在该项目期间生成初步数据，以确定每个方面在预测症状和攻击方面的有效性。我们还将确定每个组件对父母/护理人员的可接受程度，他们在多大程度上记录数据和使用监测设备。我们将确定是否有特定的时间，当这种方法可以最有效地使用。大多数学龄前喘息者在每年的9月至3月之间入学，因此可能不需要全年记录。此外，在上次发作后的一个月内，发作的可能性特别高，因此可能只需要在最近的发作后立即进行肺功能监测，以防止进一步的发作。即使该项目的三个分支都不适用，或不适合所有儿童，每种技术方法也可以独立使用，增加更广泛的应用。这个概念验证项目将使我们能够为具有高度未满足的临床需求的患者开发一种全新的远程监护解决方案，但这些患者的监护和管理具有挑战性，并且他们的需求经常被忽视。