Increasing Adherence to Inhaled Steroid Therapy Among Schoolchildren: Randomized, Controlled Trial of School-Based Supervised Asthma Therapy

University of Alabama at Birmingham, Birmingham, Alabama, Lung Health Center, OHB 138, 619 19th St South, Birmingham, AL 35249-7337, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2009; 123(2):466-74. DOI: 10.1542/peds.2008-0499
Source: PubMed


We aimed to determine the effectiveness of school-based supervised asthma therapy in improving asthma control. The primary hypothesis was that the supervised-therapy group would have a smaller proportion of children experiencing an episode of poor asthma control each month, compared with those in the usual-care group.
Children were eligible if they had physician-diagnosed persistent asthma, the need for daily controller medication, and the ability to use a dry-powder inhaler and a peak flowmeter. The trial used a 2-group, randomized, longitudinal design with a 15-month follow-up period. A total of 290 children from 36 schools were assigned randomly to either school-based, supervised therapy or usual care. Ninety-one percent of the children were black, and 57% were male. The mean age was 11 years (SD: 2.1 years). An episode of poor asthma control was defined as > or =1 of the following each month: (1) an absence from school attributable to respiratory illness/asthma; (2) average use of rescue medication >2 times per week (not including preexercise treatment); or (3) > or =1 red or yellow peak flowmeter reading.
Two hundred forty children completed the study. There were no differences in the likelihood of an episode of poor asthma control between the baseline period and the follow-up period for the usual-care group. For the supervised-therapy group, however, the odds of experiencing an episode of poor asthma control during the baseline period were 1.57 times the odds of experiencing an episode of poor asthma control during the follow-up period. Generalized estimating equation modeling revealed a marginally significant intervention-time period interaction, indicating that children in the supervised-therapy group showed greater improvement in asthma control.
Supervised asthma therapy improves asthma control. Clinicians who have pediatric patients with asthma with poor outcomes that may be attributable to nonadherence should consider supervised therapy.

Download full-text


Available from: Kathleen F Harrington, Sep 30, 2015
14 Reads
  • Source
    • "The primary outcome was the proportion of students who experienced an asthma exacerbation each month defined as one or more of the following: (1) a red (<50% of personal best) or yellow (50–70% of personal best) peak flow meter reading, (2) increased use of quick relief medication from baseline (≥ 4 puffs), or (3) a respiratory-related school absence [29]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Asthma exacerbations are seasonal with the greatest risk in elementary-age students occurring shortly after returning to school following summer break. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections; unfortunately, achieving hand washing recommendations in schools is difficult. Therefore, we designed a study to evaluate the effect of hand sanitizer use in elementary schools on exacerbations among children with asthma. To describe the process of redesigning the trial in response to changes in the safety profile of the hand sanitizer as well as changes in hand hygiene practice in the schools. The original trial was a randomized, longitudinal, subject-blinded, placebo-controlled, community-based crossover trial. The primary aim was to evaluate the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene practices to decrease asthma exacerbations in elementary-age children. Three events occurred that required major modifications to the original study protocol: (1) safety concerns arose regarding the hand sanitizer's active ingredient; (2) no substitute placebo hand sanitizer was available; and (3) community preferences changed regarding hand hygiene practices in the schools. The revised protocol is a randomized, longitudinal, community-based crossover trial. The primary aim is to evaluate the incremental effectiveness of a two-step hand hygiene process (hand hygiene education plus institutionally provided alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations. Enrollment was completed in May 2009 with 527 students from 30 schools. The intervention began in August 2009 and will continue through May 2011. Study results should be available at the end of 2011. The changed design does not allow us to directly measure the effectiveness of hand sanitizer use as a supplement to traditional hand washing practices. The need to balance a rigorous study design with one that is acceptable to the community requires investigators to be actively involved with community collaborators and able to adapt study protocols to fit changing community practices.
    Clinical Trials 07/2011; 8(3):311-9. DOI:10.1177/1740774511403513 · 1.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim This review seeks to identify effective asthma education programs geared toward educating pre- and adolescent youth in ways to manage their asthma. This report examines randomized controlled studies that focus on asthma education and disease management. Subject and methods Studies that met selection guidelines, as outlined in the methods section, were included and coded based on study characteristics, asthma education program design, study outcomes, participant characteristics, and parent involvement. Results Findings from this literature review indicated that asthma education programs demonstrate favorable outcomes, and the majority of the programs were school or clinic-based. Computer/web-based as well as clinic-based programs reported statistically significant outcomes in more outcome areas. In addition, there was limited information provided about the cost-benefits associated with the implementation of asthma education programs. Even though the majority of the programs involved parents, only a few provided a group session specifically for parents. Also, only a few programs were designed specifically for adolescents. Conclusion There appears to be a need for additional research studies that include larger sample sizes and youth from various socioeconomic backgrounds. In addition, more asthma education programs that primarily use a strengths-model, can be obtained through the computer, and focus on the specific needs of adolescent youth need to be developed. Futhermore, more programs need to focus on including a parent component and cost-analysis information.
    Journal of Public Health 06/2011; 20(3). DOI:10.1007/s10389-011-0449-8 · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: School-aged children with chronic conditions (CCC) are increasing in number and bring health needs into classrooms, with implications for learning. Changing technologies and complex care requirements for CCC have left school nurses, the primary health care professional in educational settings, seeking support and further training to provide quality care for CCC. This article describes the development and implementation of a Web-based program, eSchoolCare, designed to extend the expertise of professionals in an academic health care system to school nurses to improve CCC care. The eSchoolCare project serves as an exemplar of an innovative health care delivery support system.
    ANS. Advances in nursing science 10/2013; 36(4):289-303. DOI:10.1097/ANS.0000000000000003 · 0.83 Impact Factor
Show more