Remote monitoring to predict and prevent asthma attacks in preschool children

研究背景：1至5岁的学龄前儿童是儿童时期哮喘和喘息发作影响最大的年龄段。他们会出现呼吸困难、咳嗽、呼吸困难和呼吸嘈杂(喘息)，因为他们的呼吸管(呼吸道)变得过于狭窄。在大多数儿童中，这发生在简单的感冒引发的孤立发作中。学龄前儿童占所有儿童急性哮喘住院人数的75%。这一录取率15年来一直保持不变。参加全科医生治疗急性喘息的学龄前儿童人数也在增加，这对父母/照顾者的休假时间以及父母和孩子的生活质量都产生了重大影响。虽然已经开发了许多技术，使学龄儿童和患有哮喘的成年人能够监测他们的症状并预测发作，但迄今没有一项技术侧重于预测和预防学龄前儿童的喘息发作。尽管发病率很高，而且学龄前喘息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一个定制的家庭远程监测系统，该系统将能够检测到增加的症状并预测即将发生的喘息发作，提醒父母寻求医疗建议，以防止病情恶化到需要住院的严重发作。我们的目标是：1.开发一款供父母/照顾者使用的应用程序，允许记录喘息症状，或在过去24小时内使用任何抢救吸入剂药物治疗喘息。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，这些设备可以监测儿童在睡眠时呼吸道的开放程度，并确定他们的肺功能的变化是否可以用来预测喘息发作的发生。使用1和2中的数据为每个孩子制定个性化计划，提醒父母/照顾者喘息发作的开始，并寻求医疗建议。潜在的应用和好处：我们的目标是将应用程序的数据和肺功能监测相结合，生成个性化的喘息预测计划，以显著减轻当前的疾病负担。然而，该项目的每个组成部分、APP、肺功能监测和定制计划都是完全新颖的，以前没有进行过调查。因此，我们将在这个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。我们还将确定父母/照顾者对每个组件的接受程度，他们设法记录数据和使用监控设备的程度。我们将确定是否有特定的时间可以最有效地使用这种方法。大多数学龄前磨牙是在每年9月至3月之间入院的，因此可能全年都没有必要进行记录。此外，前一次发作后一个月内发作的可能性特别高，因此可能只需要在最近一次发作后的一段时间内进行肺功能监测，以防止进一步发作。即使该项目的三个分支都不适用，或不适合所有儿童，但每种技术方法也可以单独使用，从而增加更广泛的应用。这一概念验证项目将使我们能够开发一种全新的远程监控解决方案，适用于高度未满足临床需求的患者，但他们的监控和管理是一个挑战，他们的需求经常被忽视。

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.