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Controlled trial of a home and ambulatory program for asthmatic children
D M Hughes1, M McLeod, B Garner
1Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
A comprehensive pediatric asthma management program improved children's lung function and reduced school absenteeism. However, these positive effects on asthma care diminished after the program ended, highlighting the need for sustained interventions.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Public Health
Background:
- Pediatric asthma care is often reactive, focusing on treatment rather than prevention.
- Current management approaches may not adequately address the comprehensive needs of children with asthma.
Purpose of the Study:
- To evaluate the impact of a comprehensive home and ambulatory pediatric asthma management program.
- To assess objective outcome measures in children with asthma receiving an intensive intervention versus standard care.
Main Methods:
- A 2-year randomized controlled trial involving 95 children with asthma.
- Intervention group received regular clinic visits, education, and home visits by a nurse.
- Control group received standard pediatric care.
Main Results:
- Study group showed significantly less school absenteeism (10.7 vs. 16.0 days) and improved small airway function after 1 year.
- Improved asthma severity, better metered aerosol technique, and fewer hospital days were observed in the intervention group.
- More intervention group families reported children taking responsibility for asthma management (72.1% vs. 33.1%).
Conclusions:
- Comprehensive ambulatory asthma programs can enhance objective measures of pediatric asthma severity.
- The benefits of such programs require sustained intervention, as a 'washout' effect was noted after discontinuation.
- Further research is needed to identify strategies for long-term maintenance of improved asthma control in children.
Abstract:
Care of asthmatic children is often episodic and more therapeutic than preventive. A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures. Interventions for the study group during the first year included 3-month clinic visits, education, and home visits by a specially trained research nurse. Control subjects continued to receive regular care from a family physician or pediatrician. Eight-nine subjects (93%) completed the study. Study subjects had less school absenteeism than control subjects (10.7 vs. 16.0 days, P = .04) and showed significantly better small airway function after 1 year. Asthma severity improved in 13 study subjects and worsened in 5. The reverse was true for control subjects. Study subjects exhibited better metered aerosol technique than control subjects (P = .0005). Fewer days were spent in hospital by the study subjects admitted compared with control subjects (3.67 vs 11.2 days, P = .02). After 1 year, more study than control families (72.1% vs 33.1%, P = .006) reported that their asthmatic child took responsibility for the asthma management. The intervention failed to reduce exposure to secondhand smoke or to household pets. There were no significant differences in medical visits, theophylline levels, or records of asthma symptoms. One year after discontinuing the intervention, a marked "washout" effect was observed. Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.