Background Failure to detect respiratory compromise can lead to emergency healthcare use and fatal asthma attacks. The purpose of this study was to examine the effect of predicting peak expiratory flow (PEF) and receiving feedback on perception of pulmonary function and adherence to inhaled corticosteroids (ICS). Methods The sample consisted of 192 ethnic minority, inner-city children (100 Puerto Rican, 54 AfricanAmerican, 38 Afro-Caribbean) with asthma and their primary caregivers recruited from outpatient clinics in Bronx, New York. Children's PEF predictions were entered into an electronic spirometer and compared with actual PEF across 6 weeks. Children in one study were blinded to PEF (n=88; no feedback) and children in a separate study were able to see PEF (n=104; feedback) after predictions were locked in. Dosers were attached to asthma medications to monitor use. Results Children in the feedback condition displayed greater accuracy ( p<0.001), less under-perception (p<0.001) and greater over-perception (p<0.001) of respiratory compromise than children in the no feedback condition. This between-group difference was evident soon after baseline training and maintained across 6 weeks. The feedback condition displayed greater adherence to ICS ( p<0.01) and greater quick-relief medication use ( p<0.01) than the no feedback condition. Conclusions Feedback on PEF predictions for ethnic minority, inner-city children may decrease underperception of respiratory compromise and increase adherence to controller medications. Children and their families may shift their attention to asthma perception and management as a result of this intervention.

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As a result of advances in curative therapies, more than 80% of children and adolescents diagnosed with cancer are expected to survive into adulthood (Jemal, Siegel, Xu, & Ward, 2010; Noone et al., 2017). This unique population may experience long-term physical and psychosocial sequela including chronic health conditions (CHCs), high levels of distress, poor health-related quality of life, and unmet psychosocial needs (Ness et al., 2008). Late effects of treatment may affect multiple organ systems including reproductive, endocrine, gastrointestinal, urinary tract, musculoskeletal, neurologic, auditory, ocular, oral/dental, dermatologic, cardiovascular, pulmonary, metabolic, immune systems as well as other aspects of life including psychosocial, behavioral, and neurocognitive functioning. This population is also at increased risk for subsequent malignancies (Bhakta, Liu, Ness, Baassiri, & Eissa, 2017; Oeffinger et al., 2006). The Childhood Cancer Survivor Study includes individuals who have survived 5 or more years after a diagnosis of cancer (leukemia, tumor, or similar illness) diagnosed during childhood or adolescence, and reported the cumulative incidence of CHCs in this population was 73.4% (30 years after diagnosis), with 42.4% of those conditions considered severe, disabling, or life threatening (Oeffinger et al., 2006). More recently, the St. Jude Lifetime Cohort Study (SJLIFE) reported the cumulative incidence of CHCs for 819452J POXXX10.

Child anxiety was associated with a subjective pattern of over-perception. Caregiver anxiety and depression were risk factors for lower lung function assessed by objective measurement.