Open AccessCritical Appraisal on Randomized Controlled Trial to Improve Care for Urban Children with Asthma
Author(s) -
Nadia Mahmoud Ali Abuzied
Publication year - 2019
Publication title -
public health open access
Language(s) - English
Resource type - Journals
ISSN - 2578-5001
DOI - 10.23880/phoa-16000146
Subject(s) - medicine , randomized controlled trial , asthma , confidence interval , exacerbation , pediatrics , relative risk , motivational interviewing , psychological intervention , physical therapy , nursing
Objective-to evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. Design-Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. Setting-Rochester, New York. ParticipantsChildren aged 3 to 10 years with persistent asthma. Interventions-Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. Main Outcome Measure-Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. Results-We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference=0.92 days per 2 weeks;95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P<.01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% Vs 18%, respectively; relative risk=0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n=285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group Vs 10.9 for those in the control group; difference=0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52).Conclusions-The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.