A Pilot Study to Enhance Preventive Asthma Care among Urban Adolescents with Asthma

Abstract

Background Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high-risk for non-adherence 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. Design/Methods Subjects/Setting Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. Design Single group pre-post pilot study during the 2009–10 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 3 counseling sessions (1 in-home and 2 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 .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.

Every parent tells a story: why non-adherence may persist in children receiving guideline-based comprehensive asthma care

“…Whether motivation enhancing techniques such as motivational interviewing may change long-term adherence in such patients remains to be established. Short-term benefits of this approach have been established in inner-city asthmatic adolescents [37]. In families struggling with many and complex daily life issues, a child's asthma may be a minor problem not getting priority.…”

Asthma medication adherence among urban teens: a qualitative analysis of barriers, facilitators and experiences with school-based care

“…Many barriers were related to home life and time management [10]. Similar research, including a foundational study conducted by van Es, involving [12][13][14][15][16] year olds with asthma [11], has reinforced the necessity of understanding teens' daily lives in order to make the use of ICS a part of an essential routine [6,11,12]. As the evidence suggests that teen perspectives, preferences and behaviors may vary widely [7], to effectively target interventions for this developmentally diverse population, it is imperative to understand their needs fully.…”

“…symptom free days, quality of life, activity limitations and rescue inhaler use) of the larger pilot study, follow-up phone calls were completed by our research associates at two and four months, and year-end visits occurred in the teens' homes. These data collection efforts were completely separate from the MI counseling sessions [13].…”

“…MI phone calls offered continued support for medication adherence and an exploration of benefits and/or barriers to independent adherence, individualized for each teen. The MI protocol was developed with an expert in the field who provided fidelity supervision throughout the pilot [13].…”

“…Quantitative findings demonstrated decreased daily asthma symptoms and functional impairment related to asthma and increased motivation to take medication among participants [13]. To build upon those quantitative data, an additional qualitative descriptive study was conducted.…”