Randomized Controlled Trial to Improve Care for Urban Children With Asthma

OBJECTIVE: To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. DESIGN: Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. SETTING: Rochester, New York. PARTICIPANTS: Children aged 3 to 10 years with persistent asthma. INTERVENTIONS: Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. MAIN OUTCOME MEASURE: Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. RESULTS: We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference = 0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P < .01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk = 0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n = 285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference = 0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52). CONCLUSIONS: The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.