A dolescents with asthma, particularly those from inner-city minority groups, experience substantial morbidity and occasional mortality. Investigators from NYU and Columbia University in New York City sought to determine if an intervention involving concurrent provider education and school-based patient intervention would lead to better medical management of asthma, fewer days with activity restriction and school absences, and less urgent health care utilization as compared to conventional management. From 2001 to 2004, 9th and 10th graders with moderate to severe persistent asthma from five participating high schools with a high proportion of Latino and African American students were enrolled into a randomized controlled trial.
Of 561 eligible students, 345 were randomly assigned to the program, identified as Asthma Self-Management for Adolescents (ASMA), or a control group. Of 175 assigned to ASMA and 170 assigned to the control group, 139 and 142, respectively, completed the 12-month study period. The ASMA program involved group, personal, and provider interventions. Primary outcomes included symptom frequency during the last two weeks of each semester, quality of life assessment, and asthma self-management. Secondary outcomes included days with activity restriction in the last two weeks of each semester, school absences, asthma medical management, and urgent health care utilization.
Most intervention students (90%) attended three group sessions, 78% attended four to six sessions, and all but seven participated in at least one individual coaching session with a health educator. Most saw their health care provider at least once during the study. A pulmonologist or adolescent medicine specialist involved with the study spoke by phone with most health care providers of students in the intervention group in order to coach appropriate asthma management.
Measures of asthma management improved to a significantly greater extent in the intervention group compared to the control group (11% increase from baseline at 6 and 12 months vs 2% and 4% increases at 6 and 12 months; P<.0001 and .003 at 6 and 12 months, respectively). During the 12-month period, the intervention group reported 31% fewer night awakenings from asthma (P=.001) and a 42% reduction in days with activity restriction from asthma in the last two weeks (P=.003) as compared to controls. Quality of life assessment was significantly better in the treatment than the control group (P=.0045). Compared to controls, the treatment group had a 28% reduction in acute medical visits (P=.0002), a 59% reduction in emergency department visits (P=.001), and a 76% reduction in hospitalizations (P=.0042).
The authors conclude that an educational program targeting both students and their medical providers significantly improves asthma management, reduces asthma morbidity and urgent health care utilization, and improves quality of life.
Dr Weinberger has disclosed no financial...