BACKGROUND: Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications. OBJECTIVE: To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity. SUBJECTS/ SETTING: Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. DESIGN: Single group pre-post pilot study during the 2009-2010 school year. INTERVENTION: Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME: Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year. RESULTS: We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again. CONCLUSIONS: This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
BACKGROUND: Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications. OBJECTIVE: To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity. SUBJECTS/ SETTING: Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. DESIGN: Single group pre-post pilot study during the 2009-2010 school year. INTERVENTION: Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME: Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year. RESULTS: We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again. CONCLUSIONS: This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
Authors: Anthony Spirito; Peter M Monti; Nancy P Barnett; Suzanne M Colby; Holly Sindelar; Damaris J Rohsenow; William Lewander; Mark Myers Journal: J Pediatr Date: 2004-09 Impact factor: 4.406
Authors: Noreen M Clark; Randall Brown; Christine L M Joseph; Elizabeth W Anderson; Manlan Liu; Melissa A Valerio Journal: Chest Date: 2004-05 Impact factor: 9.410
Authors: Giselle S Mosnaim; Andrea A Pappalardo; Scott E Resnick; Christopher D Codispoti; Sindhura Bandi; Lisa Nackers; Rabia N Malik; Vimala Vijayaraghavan; Elizabeth B Lynch; Lynda H Powell Journal: J Allergy Clin Immunol Pract Date: 2015-11-07
Authors: Marybeth R Jones; Sean M Frey; Kristin Riekert; Maria Fagnano; Jill S Halterman Journal: J Adolesc Health Date: 2018-10-30 Impact factor: 5.012
Authors: Jill S Halterman; Kristin A Riekert; Maria Fagnano; Paul J Tremblay; Susan W Blaakman; Reynaldo Tajon; Hongyue Wang; Belinda Borrelli Journal: J Asthma Date: 2021-01-08 Impact factor: 2.515