The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care

London Evening Standard features CLAHRC research on asthma

The London Evening Standard features CLAHRC research in a story on the impact of air pollution on the capital’s younger asthma sufferers.

Our newly published research highlights poor asthma control and knowledge among London secondary school pupils and is referenced in the piece, which also includes contributions from CLAHRC researchers Professor Jonathan Grigg and Kate Harris.

The paper has campaigned extensively on the quality of London’s air, and the health impact on young and developing lungs.  Poor asthma control, as highlighted in our work, can make things worse for those already living with respiratory conditions.

Professor Jonathan Grigg, CLAHRC child health theme and Principal Investigator on the study runs a severe asthma clinic at the Royal London hospital, said: “If you have asthma and it is not well-controlled, you are going to be more likely to suffer from these days of high pollution.If you have poor control, you run a risk of having a severe episode. The number of children who die is very small, but we are not really treating asthma as seriously as we should. In other countries, they say, ‘If you have got asthma, make sure you take your medication on the next few days’. That is what I would do. I would say, ‘There is an air pollution event. Make sure you take it.’ ”

Another researcher on the project Katherine Harris was quoted in the ES story, saying it was the first childhood asthma study carried out in schools: “We know from previous work about asthma in children that there were high levels of hospitalisation and asthma-related deaths were higher than Europe.One reason could be due to poor levels of asthma control in children. What we concluded is that there is a prevalence of poor control in children. There are also low levels of knowledge. A lot of children don’t understand what their medication does or how it was helping them.”

CLAHRC research reveals poor asthma control and knowledge common among London schoolchildren

Newly published CLAHRC research has revealed that nearly half of secondary school pupils living with asthma have sub-optimal control of their condition and gaps in knowledge around symptoms, triggers and treatments.

The findings, published in the Journal of Asthma,  emerged from the results of nearly 800 pupils from across London schools completing questionnaires incorporating the asthma control test (ACT) – a validated tool for assessing control in asthmatic children aged 12 years and older. Using the ACT, we sought to assess asthma control and knowledge in London secondary school children.

Results showed a high prevalence of poor asthma control, poor asthma knowledge, and a high morbidity in London children with asthma.

799 children with doctor-diagnosed asthma completed the questionnaire;

  • suboptimal asthma control was reported by 49.6% of students
  • over a third (42.4%) prescribed a short-acting β2-agonist inhaler felt uncomfortable using it at school, and 29.2% reported not using this inhaler when wheezy
  • 56.4% of those with regular inhaled corticosteroids did not take them as prescribed, and 41.7% did not know what this inhaler was for.
  • suboptimal control was associated with a greater proportion of students reporting that they were “somewhat”, “hardly” or “not at all” comfortable using inhalers at school (52.7% vs 29.1 %) and outside school (22.8% vs. 14.8%)

Since suboptimal control by ACT is a risk factor for future severe exacerbations, and should prompt more intense clinical monitoring, our results suggest a need for interventions aimed at addressing poor asthma control in UK schoolchildren.

Read the full paper below

Asthma control in London secondary school children

Katherine Harris , MSc, Gioia Mosler Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK , PhD, Samson A. Williams , BSc, Abigail Whitehouse , MBChB, Rosalind Raine , MBBS, PhD & Jonathan Grigg , MD

Journal of Asthma

http://dx.doi.org/10.1080/02770903.2017.1299757

Leading the campaign against pollution caused by diesel engines

The Doctors Against Diesel campaign that was launched in December 2016 and has already received widespread media coverage with ongoing interest from the health community, local government and media. The campaign is led by health professionals and is calling for the use of diesel fuels to be banned in urban areas and progressively phased out elsewhere. On February 22nd the CLAHRC’s Professor Jonathan Grigg led a workshop of nurses, doctors and allied health professionals to formulate health messaging and decide next steps in the campaign to reduce diesel use.

CLAHRC Deputy Director and Child Health Theme Lead Professor Jonathan Grigg is a prominent member of the campaign group and co-author of the Royal Colleges Report Every Breath We Take. Professor Grigg is a practising paediatrician with experitse in respiratory health, seeing first hand how pollution damages young and developing lungs. He also leads our School Asthma project which aims to improve management of the condition among children and young people.

Diesel engines are the single biggest source of nitrogen dioxide, which accounts for the vast majority of breaches of legal air pollution limits in the UK. Exposure to pollution can impact children and young people’s current and future health as strong evidence suggest it impairs lung growth in children.

 

 

 

 

Making the Jump….to improved asthma management

Our Asthma Schools project is investigating asthma control among young people in schools and developing interventions to help them manage the condition better.

The project worked with Greenwich and Lewisham Young People’s Theatre (GLYPT) to produce a short film – Breaking the Jump – about the importance of asthma awareness among young people. It carries an important message for all young people living with the condition.

The film was shot at the LEAP Parkour Park in Westminster, London.

 

Prof Jonathan Grigg

Professor Jonathan Grigg is one of the UK’s top paediatricians and an international leader in paediatric respiratory research. Since 2003, he has obtained over £11M in research grants as PI and co-applicant from MRC, NIHR, DH and charities. These funds supported air pollution and asthma research with national and international impact. He is the lead paediatrician for government advice on air pollution and children’s health as a member of the Committee on the Medical Effects of Air Pollution, and provides ad hoc advice on respiratory toxicity to the Committee on Carcinogens. He co-chairs the Royal College of Physicians Committee into “air pollution throughout the life course”. In leading the national paediatric research agenda, he organises all paediatric input into British Thoracic Society’s meetings, and as elected secretary to the Royal College Paediatrics and Child Health’s Academic Board, organises its Annual Meeting. He develops national research priorities in paediatric respiratory medicine as Chair of the British Paediatric Respiratory Society, ex chair and, now member, of the Clinical Study Group (Respiratory) for the Medicines for Children network, NIHR Programme Grant Experts Panel. He leads on paediatric respiratory infection and immunology as elected chair of this group in the European Respiratory Society. Nationally, he evaluates the cost effectiveness of therapies, as the paediatric lead of NICE Appraisal Panel A, and is an RCPCH-appointed expert adviser on asthma therapies to other appraisal panels. Locally, he leads on paediatric non-medicines research in NE London as regional LCRN representative to the national committee, and supports academic training as the RCPCH regional academic advisor.

Prof Stephen Stansfeld

Prof. Stephen Stansfeld is Professor of Psychiatry at QMUL. His research involves longitudinal studies of risk and protective factors for mental health in adolescence, life course studies of social and environmental risk factors and intervention studies on work and mental health. He is Co-Principal Investigator of ORiEL Study, a NIHR-funded cluster randomised trial of the impact of the regeneration surrounding the Olympics on children’s wellbeing and physical activity.

Dr Jordana Peake

Jordana is a research associate at the Louis Dundas Centre for Children’s Palliative Care, Institute of Child Health (ICH). She recently completed her PhD at ICH which looked at the epidemiology and decision making for neural tube defect affected pregnancies within different ethnic communities. She is currently working on a project which aims to improve access and participation in research with children and young people with life-limiting conditions or life-threatening illnesses and their families, including a study of chief investigators and a study of research ethics committees. Jordana is also involved with research on clinical outcomes, including preferred place of death and the evaluation of outpatient clinics for children with life-limiting conditions.