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Effectiveness of nebulizer use-targeted asthma education on underserved children with asthma
Arlene M Butz1, Mona G Tsoukleris, Michele Donithan
1Division of General Pediatrics, Department of Pulmonary and Critical Care, The Johns Hopkins University Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, USA. abutz@jhmi.edu
Insights
A home-based asthma education program did not improve nebulizer use or reduce emergency visits for children with persistent asthma. The study highlighted concerning trends in medication use for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Health Education
Background:
- Persistent asthma in children requires effective management strategies.
- Home-based interventions can potentially improve adherence and outcomes.
- Nebulizer use and appropriate medication are crucial for controlling pediatric asthma.
Purpose of the Study:
- To evaluate a home-based asthma education intervention.
- To assess the intervention's impact on nebulizer use, symptom frequency, and healthcare utilization.
- To determine the intervention's effectiveness over a 12-month period in children aged 2-9 years.
Main Methods:
- Randomized clinical trial involving pediatric primary care, pulmonary/allergy, and emergency departments.
- Participants: Children aged 2-9 years with persistent asthma and recent healthcare utilization.
- Intervention: Home-based education on symptom recognition, home treatment, medication use, and nebulizer practice.
Main Results:
- No significant differences were observed in nebulizer practice, asthma morbidity, emergency department visits, or hospitalizations between the intervention and control groups.
- Over one-third of all children received at least 6 quick-relief medication prescriptions within 12 months, irrespective of the group.
- Most children received appropriate nonurgent asthma care, with an average of 2 visits per 6 months.
Conclusions:
- The home-based nebulizer education intervention demonstrated no significant effect on asthma severity or healthcare utilization.
- A concerning pattern of high quick-relief medication use and low controller medication use was noted in young children with asthma.
- Regular nonurgent care visits (every 3 months) did not mitigate inappropriate medication prescribing patterns.
Objective:
To determine the effectiveness of a home-based asthma education intervention in increasing appropriate nebulizer use and reducing symptom frequency, emergency department (ED) visits, and hospitalizations over 12 months.
Design:
A randomized clinical trial. Settings Pediatric primary care, pulmonary/allergy, and ED practices associated with the University of Maryland Medical System and The Johns Hopkins Hospital, Baltimore.
Participants:
Children with persistent asthma, aged 2 to 9 years, with regular nebulizer use and an ED visit or hospitalization within the past 12 months. Children were randomized into the intervention (n = 110) or control (n = 111) group. Follow-up data were available for 95 intervention and 86 control children.
Intervention:
Home-based asthma education, including symptom recognition, home treatment of acute symptoms, appropriate asthma medication, and nebulizer practice.
Main Outcome Measures:
Estimates of mean differences in asthma symptom frequency, number of ED visits and hospitalizations and appropriate quick relief, controller medication, and nebulizer practice over 12 months.
Results:
Of the 221 children, 181 (81.9%) completed the study. There were no significant differences in home nebulizer practice, asthma morbidity, ED visits, or hospitalizations between groups (P range, .11-.79). Although most children received appropriate nonurgent asthma care (mean, 2 visits per 6 months), more than one third of all children received at least 6 quick-relief medication prescriptions during 12 months, with no difference by group.
Conclusions:
A nebulizer education intervention had no effect on asthma severity or health care use. Of concern is the high quick-relief and low controller medication use in young children with asthma seen nearly every 3 months for nonurgent care.
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