ORLANDO – Adding asthma education to reading, writing, and arithmetic in public schools resulted in significant improvements in asthma control measures among at-risk children, researchers reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Children in the intervention group also had fewer urgent-care visits, suggesting better asthma control, the authors found.
In a pilot study aimed at reducing socioeconomic disparities in asthma control, at-risk children from schools assigned to implement the American Lung Association’s Open Airways for Schools (OAS) program had significantly better activity quality-of-life (QoL) scores and demonstrated significantly greater improvements in the use of metered-dose inhalers (MDI) than did their peers in schools that did not receive the intervention, reported Dr. Summer Monforte, a second-year fellow at National Jewish Health in Denver.
The study’s senior author was Dr. Stanley J. Szefler, head of pediatric clinical pharmacology at National Jewish Health.
The improvement in MDI use is an indicator that such programs can help to improve the health of children who are at risk for poor asthma outcomes, Dr. Monforte said in an interview.
"Every single time a child comes in, you have to make sure that they take their inhaler correctly; so it’s nice when the medicine gets where it’s supposed to go," she said.
The overall asthma prevalence rate in Colorado is 8.5% – but in some inner-city schools, the rate is nearly three times higher (22.8%). School-based asthma-education programs can help children improve their asthma control and avoid or reduce exacerbations, but such programs are not always available in poorer urban districts, the investigators noted.
They conducted a randomized, controlled study to see whether the evidence-based OAS intervention would work in schools where children were at risk for health care disparities. At-risk schools were defined as those in which more than 75% of children qualified for free lunch programs, or those with a greater than 50% Hispanic or African American student population.
Four of the schools (with a total of 49 children with asthma, plus their parents or guardians) were randomized to receive the intervention, and four other schools (total of 43 asthmatic children) were assigned as controls. All participants had a visit at baseline and at 3 months’ follow-up.
The children in the intervention groups attended a 40-minute OAS session once weekly for 6 weeks, while controls received their usual care.
At baseline, children in both groups were evaluated with the Health Risk Assessment instrument. Children in both groups also were assessed at baseline and follow-up with the Asthma Control Test (ACT) or Childhood ACT, asthma history questionnaires, Juniper’s Pediatric Asthma Quality of Life Questionnaire and Caregiver Quality of Life tools, spirometry, and observation and assessment of inhaler technique.
At 3-month follow-up, children in the intervention group had a mean improvement of 0.8 (plus or minus .22) points on the activity subscale of the QoL scale, which is scored from 1 (worst) to 7 (best). In comparison, controls had a mean improvement of only 0.2 (plus or minus 1.7) points (P = .05).
Assessments of MDI technique showed that children in the intervention group improved by a mean of 2.3 points on a 5-point scale, compared with just 0.7 for controls (P less than .0001).
The authors noted that this was a pilot study of short duration, with limited enrollment attributable to insufficient funding.
Nonetheless, the results indicate that a proven intervention "can be implemented with minor modifications in populations, such as the Denver Public Schools, that differ from the population where it was originally developed," the researchers noted in a poster presentation at the meeting.
The Step Up asthma program, a collaboration between National Jewish Health and the Denver Public Schools, was designed based on the needs identified in the pilot study, and is currently in place. The investigators plan to evaluate its ability to improve asthma control over a 5-year period.
GlaxoSmithKline supported the study. Dr. Monforte reported that she had no relevant disclosures.