Major Finding: The number of symptom-free days increased from an average of 8 days per 2-week period for all children at baseline to 11.9 days with the intervention vs. 11.2 days with usual care.
Data Source: School-Based Asthma Therapy trial in 530 children with asthma.
Disclosures: SBAT was supported by grants from the National Heart, Lung, and Blood Institute and the Halcyon Hill Foundation. Ms. Fagnano and Dr. Halterman disclosed no financial conflicts.
VANCOUVER, B.C. — A school-based intervention that focused on medication adherence and reducing exposure to tobacco smoke significantly improved outcomes among inner-city children with asthma in a randomized trial.
Children receiving the intervention had almost 1 additional symptom-free day per 2-week period during the peak winter asthma season of November to February.
The number of symptom-free days increased from an average of 8 days for all children at baseline to 11.9 days per 2-week period with the intervention vs. 11.2 days with usual care. “This difference is larger than what has been seen with more intensive and costly interventions,” said Maria Fagnano, M.P.H., of the University of Rochester (N.Y.) Medical Center.
The children receiving the intervention were significantly more likely than controls to have fewer nights with symptoms (mean 1.5 nights vs. 2.0 nights), fewer days with limited activity (1.2 vs. 1.6), and fewer days with rescue medication use (1.59 vs. 2.61), Ms. Fagnano reported at the annual meeting of the Pediatric Academic Societies.
The intervention group also was significantly less likely than controls to have any acute visit for asthma (12% vs. 18%). In addition, the intervention group had fewer days absent from school due to asthma (0.3 days vs. 0.4 days).
Although additional efforts are needed to evaluate costs of the intervention and to develop dissemination strategies, collaborations with schools provide a unique opportunity to reach high-risk children and target those at greatest need for assistance, Ms. Fagnano said.
“This type of intervention is widely applicable for asthma care in the community nationwide, as well as for management of other chronic diseases, and could potentially reduce disparities between poor and nonpoor children,” she said.
The School-Based Asthma Therapy (SBAT) trial, led by colleague Dr. Jill Halterman, was implemented in 2006 in 54 schools and preschools in Rochester, N.Y., to reduce morbidity in poor children aged 3–10 years with physician-diagnosed asthma.
The school nurse was given a canister of preventive medication (fluticasone propionate or fluticasone propionate with salmeterol), with a spacer and mask as appropriate, and asked to give one dose to the child each school day. A supply of preventive asthma medications also was delivered to parents, who were instructed to use the medications on days the child did not attend school.
The intervention also used motivational interviewing to counsel the primary caregiver about how to reduce environmental tobacco smoke (ETS) in the home for smoke-exposed children, Ms. Fagnano said. Overall, 54% of children lived with one or more smokers at baseline. A home-based counseling session was delivered by a trained nurse, with two follow-up telephone calls made at 1 and 3 months after the 30-minute session.
In the usual care group, parents and physicians were notified of the child's asthma severity and encouraged to start on appropriate preventive treatments, but no medication was provided, she said.
At baseline, 69% of children were on preventive medications, 73% received Medicaid, 58% were male, 63% were black, and 28% were Hispanic. Their mean age was 7 years. There were 265 children in each arm.
In a regression analysis, the intervention was associated with 0.92 days per 2 weeks more symptom-free days (P less than .001), Ms. Fagnano said.
A stratified analysis showed a significant intervention effect on the primary outcome of symptom-free days for children with and without ETS exposure in the home. The mean number of symptom-free days among non-ETS exposed children was 11.6 days in the treatment group vs. 10.9 days in the control group; and was 11.6 days vs. 10.0 days, respectively, in smoke-exposed children, she said.
An audience member remarked on the improvement observed, even among controls. Ms. Fagnano said that monthly follow-up calls could have “clued parents in to what the child was experiencing,” and that asthma calendars given to these families may have helped them notice more symptoms.