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Challenges and Recommendations on Digital Health Sources in Pediatric Chronic Suppurative Lung Diseases: Comparison
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Please note this is a comparison between Version 2 by Sirius Huang and Version 1 by Eleni Kortianou.

In the context of digitalizing healthcare systems, digital health sources (DHSs) aim to enhance the efficiency, accessibility, and quality of healthcare services by leveraging technology. Multiple types of DHSs are increasingly established in healthcare, providing direct and wide communication between pediatric patients, parents, and healthcare professionals. Therefore, they are considered promising key tools to improve pediatric disease monitoring and management. At the same time, DHSs have been associated with several issues and risks, such as those related to data sharing, privacy, and the cultural readiness of the users. Yet, discussions in the literature have mostly focused on technical considerations and a user-friendly design. In contrast, the contribution of DHSs to treatment engagement in pediatric populations and data sharing has only partially been discussed. On this basis, we provide an overview of the available digital health technologies and their application in the pediatric population with chronic suppurative lung diseases; we describe the effectiveness in health-related outcomes, discuss possible challenges, and propose some recommendations that may overcome barriers in their everyday use.

  • children
  • chronic suppurative lung disease
  • digital health sources
  • pediatric pulmonary disease
Chronic suppurative lung disease (CSLD) is a clinical syndrome characterized by chronic endobronchial bacterial infection and chronic productive cough. The term has been increasingly used to describe children who exhibit clinical features consistent with bronchiectasis but lack radiographic evidence of the condition [1]. Due to common features, protracted bacterial bronchitis (PBB), primary ciliary dyskinesia (PCD), cystic fibrosis (CF), and non-cystic fibrosis bronchiectasis (NCFB) are included in the CSLD spectrum clinically manifested by prolonged wet or productive cough [2]. The prevalence of pediatric CSLDs varies depending on geographic regions. In European populations, the prevalence ranges from 0.2 to 2.3/100.000, while in non-European populations, it ranges from 13.3 to 15/100.000. Among Indigenous populations in New Zealand, Australia, Alaska, and Canada, the prevalence is higher, ranging from 4.8 to 18.3/100.000. Data from Australia, Alaska, and Canada show that the peak age group prevalence for Indigenous children is around 5 years old, while data from other countries are not available [3]. Managing everyday symptoms and respiratory exacerbations is the key component of CSLD care [4]. Prompt recognition of respiratory exacerbations is crucial, as delayed recognition is linked to heightened psychological stress and a reduced health-related quality of life (HRQoL) [5]. Enhancing education for patients, parents/caregivers, and healthcare professionals (HCPs) on recognizing exacerbations and initiating additional treatments is essential [6].
In the broad context of pediatrics, digital health sources (DHSs) can provide unique opportunities for the management of a chronic disease. Children and adolescents with neurological conditions, muscular dystrophies, cerebral palsy, and behavioral disorders are some of the pediatric populations that have benefitted from the application of DHSs for monitoring symptoms, tracking physical activity, enhancing gross motor skills, and improving social interactions [7].
In pediatric chronic respiratory diseases, the DHSs in the form of digital spirometers, mHealth Apps, web-based platforms, and active video games (AVGs) have been previously applied to children with asthma and CF, mainly for monitoring symptoms, delivering health education information, or exercise programs [8,9,10,11][8][9][10][11].
Except for the possible benefits of DHS use, specific reference has been made to the technical and ethical challenges, including accuracy, privacy, security, and cyber risks [12]. DHSs should safeguard children’s rights, ensure safe use, and address pediatric-specific needs [13]. Still, technical and ethical considerations are treated as separate issues that need much further research and discussion. Thus, the literature on the pediatric CSLD population is scarce. In response to these considerations, in this review, we provide an overview of the available tools, the main functions of DHSs (remote monitoring, support, education, supervised exercise, and entertainment), and the role of these functions on health outcomes and users’ preferences. Furthermore, we discuss the main challenges of DHSs when used on the pediatric CSLD population, the health-related benefits for the users, and the benefits for the HCPs.

References

  1. Redding, G.J.; Carter, E.R. Chronic Suppurative Lung Disease in Children: Definition and Spectrum of Disease. Front. Pediatr. 2017, 5, 30.
  2. Chang, A.B.; Redding, G.J. Bronchiectasis and Chronic Suppurative Lung Disease. Kendig’s Disorders of the Respiratory Tract in Children; Elsevier: Amsterdam, The Netherlands, 2018; pp. 439–459.
  3. McCallum, G.B.; Binks, M.J. The Epidemiology of Chronic Suppurative Lung Disease and Bronchiectasis in Children and Adolescents. Front. Pediatr. 2017, 5, 27.
  4. Chang, A.B.; Bush, A.; Grimwood, K. Bronchiectasis in children: Diagnosis and treatment. Lancet 2018, 392, 866–879.
  5. Kapur, N.; Masters, I.B.; Newcombe, P.; Chang, A.B. The burden of disease in pediatric non-cystic fibrosis bronchiectasis. Chest 2012, 141, 1018–1024.
  6. Chang, A.B.; Grimwood, K.; Boyd, J.; Fortescue, R.; Powell, Z.; Kantar, A. Management of children and adolescents with bronchiectasis: Summary of the ERS clinical practice guideline. Breathe 2021, 17, 210105.
  7. Sacks, L.; Kunkoski, E.; Noone, M. Digital Health Technologies in Pediatric Trials. Ther. Innov. Regul. Sci. 2022, 56, 929–933.
  8. Versteegh, L.A.; Chang, A.B.; Chirgwin, S.; Tenorio, F.P.; Wilson, C.A.; McCallum, G.B. Multi-lingual “Asthma APP” improves health knowledge of asthma among Australian First Nations carers of children with asthma. Front. Pediatr. 2022, 10, 925189.
  9. Vilarinho, T.; Floch, J.; Stav, E. Co-designing a mHealth Application for Self-management of Cystic Fibrosis. In Proceedings of the 16th IFIP TC 13 International Conference Part III, Mumbai, India, 25–29 September 2017; Springer: New York, NY, USA, 2017; pp. 3–22.
  10. Del Corral, T.; Cebria I Iranzo, M.A.; López-de-Uralde-Villanueva, I.; Martinez-Alejos, R.; Blanco, I.; Vilaro, J. Effectiveness of a Home-Based Active Video Game Programme in Young Cystic Fibrosis Patients. Respiration 2018, 95, 87–97.
  11. Kenis-Coskun, O.; Aksoy, A.N.; Kumas, E.N.; Yilmaz, A.; Guven, E.; Ayaz, H.H.; Sozer, T.; Ergenekon, A.P.; Karadag-Saygi, E. The effect of telerehabilitation on quality of life, anxiety, and depression in children with cystic fibrosis and caregivers: A single-blind randomized trial. Pediatr. Pulmonol. 2022, 57, 1262–1271.
  12. Canali, S.; Schiaffonati, V.; Aliverti, A. Challenges and recommendations for wearable devices in digital health: Data quality, interoperability, health equity, fairness. PLoS Digit. Health 2022, 1, e0000104.
  13. Drummond, D.; Gonsard, A.; Robinson, P.D. Digital respiratory medicine for children and young people. In Digital Respiratory Healthcare (ERS Monograph); Pinnock, H., Poberezhets, V., Drummond, D., Eds.; European Respiratory Society: Sheffield, UK, 2023; pp. 122–131.
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