School-based intervention improved asthma symptoms

An intervention in which supervised school nurses administered daily medication to children with persistent asthma resulted in more symptom-free days and less rescue medication use compared with a control group, results from the School-Based Asthma Therapy Trial indicate.

Despite National Hearth, Lung and Blood Institute Expert Panel guidelines that recommend that all children with persistent asthma receive daily preventive anti-inflammatory medication, many do not, especially poor and minority children.

Until now, few interventions existed to ensure that these children received appropriate preventive care, Jill S. Halterman, MD, MPH of the University of Rochester School of Medicine and Dentistry in Rochester, N.Y. and colleagues wrote in the Archives of Pediatric and Adolescent Medicine.

Data from the trial, which involved 530 children aged 3 to 10 years who attended preschool or elementary school in the Rochester City School District from 2006 to 2009, indicated that children in the intervention experienced almost one symptom-free day per two weeks more than children in the control group.

“This translates into approximately 2.5 weeks of additional symptom-free days during a school year,” the researchers wrote.

Children in the intervention group received either fluticasone propionate or fluticasone salmeterol xinafoate and a spacer, with doses determined by primary-care providers on an individual patient basis and adjusted as needed throughout the school year. The study team delivered medication to school nurses and family residences for use on days that children did not attend school.

Caregivers of control group children were responsible for filling prescriptions and administering asthma medications on a daily basis. They received no medication counseling and were advised to contact their PCP to discuss persistent asthma symptoms.

Data from family-kept symptom diaries and telephone interviews indicated that although both groups improved during the course of the study, children in the intervention group not only had significantly more symptom-free days compared to those in the control group, they also had fewer nighttime symptoms and fewer days with limited activity (P<.01).

Furthermore, children in the treatment group were less likely to have an exacerbation that required rescue therapy with prednisone (12% vs. 18%; RR=0.64; 95% CI:0.41-1.00).

“Innovative methods of delivering preventive care through schools are being evaluated for many chronic conditions, and because schools already routinely provide daily medications for other conditions such as ADHD, the provision of daily asthma preventive medications potentially represents a simple system change to improve adherence,” the researchers wrote.

They added that additional cost-analysis studies are needed, as well as dissemination strategies. 

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