Results of a home-based environmental intervention among urban children with asthma. Trial of a "credit card" asthma self-management plan in a high-risk group of patients with asthma. Reducing asthma health disparities in poor Puerto Rican children: the effectiveness of a culturally tailored family intervention. Feather bedding and childhood asthma associated with house dust mite sensitisation: a randomised controlled trial A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Short-term impact of a randomized multifaceted intervention for wheezing infants in low-income families. Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. Outcome of a randomized multifaceted intervention with low-income families of wheezing infants. Outcomes of a Web-based patient education program for asthmatic children and adolescents. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial. Randomized Clinical Trial of a School-Based Academic and Counseling Program for Older School-Age Students Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation. The school-based preventive asthma care trial: results of a pilot study. Home intervention in the treatment of asthma among inner-city children. Beliefs and Barriers to Follow-up After an Emergency Department Asthma Visit: A Randomized Trial The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Reduction in resource utilization by an asthma outreach program. A double-blind, placebo controlled trial of solidified benzyl benzoate applied in dwellings of asthmatic patients sensitive to mites: clinical efficacy and effect on mite allergens. Effectiveness of Evidence-Based Asthma Interventions Influence on asthma morbidity of asthma education programs based on self-management plans following treatment optimization. Mechanical ventilation and high-efficiency vacuum cleaning: A combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. Chronic disease management: what will it take to improve care for chronic illness? Effects of a school-based intervention for urban adolescents with asthma. A controlled trial. Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial. Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: a randomized controlled trial. The Breathe-Easy Home: the impact of asthma-friendly home construction on clinical outcomes and trigger exposure.
BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity BACKGROUND The " credit card " asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma , which are based on the self- assessment of peak expiratory flow rate recordings and symptoms . OBJECTIVE The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients . METHODS In this " before- and -after " trial , patients discharged from the emergency department of Wellington Hospital , after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced . Question naires were used to compare markers of asthma morbidity , requirement for emergency medical care , and medication use during the 6-month period before and after intervention with the credit card plan . RESULTS Of the 30 patients with asthma who attended the first outpatient clinic , 26 ( 17 women and 9 men ) completed the program . In these 26 participants , there was a reduction in both morbidity and requirement for acute medical services : specifically , the proportion waking with asthma more than once a week decreased from 65 % to 23 % ( p = 0.005 ) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58 % to 15 % ( p = 0.004 ) . The patients attending the clinics commented favorably on the plan , in particular on its usefulness as an educational tool for monitoring and treating their asthma . CONCLUSIONS Although the interpretation of this study is limited by the lack of a r and omized control group , the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma BACKGROUND Isl and and mainl and Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States . OBJECTIVE We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA ( an acronym of the Spanish for " Take Control , Empower Yourself and Achieve Management of Asthma " ) in reducing asthma morbidity in poor Puerto Rican children with asthma . METHODS Low-income children with persistent asthma were selected from a national health plan insurance cl aims data base by using a computerized algorithm . After baseline , families were r and omly assigned to either the intervention or a control group . RESULTS No significant differences between control and intervention group were found for the primary outcome of symptom-free days . However , children in the CALMA intervention group had 6.5 % more symptom-free nights , were 3 times more likely to have their asthma under control , and were less likely to visit the emergency department and be hospitalized as compared to the control group . Caregivers receiving CALMA were significantly less likely to feel helpless , frustrated , or upset because of their child 's asthma and more likely to feel confident to manage their child 's asthma . CONCLUSION A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity Introduction Observational studies report inverse associations between the use of feather upper bedding ( pillow and /or quilt ) and asthma symptoms but there is no r and omised controlled trial ( RCT ) evidence assessing the role of feather upper bedding as a secondary prevention measure . Objective To determine whether , among children not using feather upper bedding , a new feather pillow and feather quilt reduces asthma severity among house dust mite ( HDM ) sensitised children with asthma over a 1-year period compared with st and ard dust mite avoidance advice , and giving children a new mite-occlusive mattress cover . Design RCT . Setting The Calvary Hospital in the Australian Capital Territory and the Children 's Hospital at Westmead , Sydney , New South Wales . Patients 197 children with HDM sensitisation and moderate to severe asthma . Intervention New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover ( feather ) versus st and ard care and a mite-occlusive mattress cover ( st and ard ) . Main outcome measures The proportion of children reporting four or more episodes of wheeze in the past year ; an episode of speech-limiting wheeze ; or one or more episodes of sleep disturbance caused by wheezing ; and spirometry with challenge testing . Statistical analysis included multiple logistic and linear regression . Results No differences between groups were found for primary end points – frequent wheeze ( OR 1.51 , 95 % CI 0.83 to 2.76 , p=0.17 ) , speech-limiting wheeze ( OR 0.70 , 95 % CI 0.32 to 1.48 , p=0.35 ) , sleep disturbed because of wheezing ( OR 1.17 , 95 % CI 0.64 to 2.13 , p=0.61 ) or for any secondary end points . Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine . Conclusion No differences in respiratory symptoms or lung function were observed 1 year after children with moderate – severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding ( pillow and quilt ) or st and ard bedding care OBJECTIVE To test an air cleaner and health coach intervention to reduce secondh and smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter ( PM ) , air nicotine , and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker . DESIGN R and omized controlled trial , with r and omization embedded in study data base . SETTING S The Johns Hopkins Hospital Children 's Center and homes of children . PARTICIPANTS Children with asthma , residing with a smoker , r and omly assigned to interventions consisting of air cleaners only ( n = 41 ) , air cleaners plus a health coach ( n = 41 ) , or delayed air cleaner ( control ) ( n = 44 ) . MAIN OUTCOME MEASURES Changes in PM , air nicotine , and urine cotinine concentrations and symptom-free days during the 6-month study . RESULTS The overall follow-up rate was high ( 91.3 % ) . Changes in mean fine and coarse PM ( PM(2.5 ) and PM(2.5 - 10 ) ) concentrations ( baseline to 6 months ) were significantly lower in both air cleaner groups compared with the control group ( mean differences for PM(2.5 ) concentrations : control , 3.5 μg/m(3 ) ; air cleaner only , -19.9 μg/m(3 ) ; and air cleaner plus health coach , -16.1 μg/m(3 ) ; P = .003 ; and PM(2.5 - 10 ) concentrations : control , 2.4 μg/m(3 ) ; air cleaner only , -8.7 μg/m(3 ) ; and air cleaner plus health coach , -10.6 μg/m(3 ) ; P = .02 ) . No differences were noted in air nicotine or urine cotinine concentrations . The health coach provided no additional reduction in PM concentrations . Symptom-free days were significantly increased [ corrected ] in both air cleaner groups compared with the control group ( P = .03 ) . CONCLUSION Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days , it is not enough to prevent exposure to secondh and smoke OBJECTIVE To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables . METHOD Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were r and omly assigned to environmental support intervention ( ES ) ( n = 90 ) or control ( n = 91 ) groups . Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management . Assessment s at baseline and 12 months included allergens in house dust , infant urinary cotinine levels , caregivers ' symptom reports , quality of life , illness management , and quality of caregiving . Medical records were coded for hospitalizations , emergency department visits , and corticosteroid bursts . RESULTS Within the ES group , cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog d and er levels . Among infants with detectable urinary cotinine , levels were significantly reduced in the ES group . Caregiver psychological re sources modified the impact , and low-re source ES caregivers were the most strongly affected . Asthma knowledge and provider collaboration improved significantly in the ES group . Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects . Number of corticosteroid bursts for infants was significantly higher for the ES group . CONCLUSIONS The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management . However , even with an intensive home-based intervention , we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group , illustrating the difficulty of changing the course of early asthma development among low-income infants OBJECTIVE : The goal was to test the effects of high-efficiency , particulate-arresting ( HEPA ) air cleaners on unscheduled asthma visits and symptoms among children with asthma exposed to secondh and smoke . METHODS : We enrolled 225 eligible children who were 6 to 12 years of age , had physician-diagnosed asthma , and were exposed to ≥5 cigarettes per day . We conducted a double-blind , r and omized trial . Children were assigned r and omly to receive 2 active or inactive HEPA air cleaners . RESULTS : Of 225 enrolled children , 110 ( 49 % ) were assigned to the intervention group and 115 ( 51 % ) to the control group ; 215 ( 95 % ) completed the trial . During the trial , there were 42 fewer unscheduled asthma visits among children in the intervention group ( 18.5 % [ 95 % confidence interval : 1.25%–82.75 % ] ; P = .043 ) , compared with those in the control group , after adjustment for baseline differences . There was a significant difference in the reductions of levels of particles of > 0.3 μm according to group assignment ; there was a 25 % reduction in particle levels in the intervention group , compared with a 5 % reduction in the control group ( P = .026 ) . There were no significant differences in parent-reported asthma symptoms , exhaled nitric-oxide levels , air nicotine levels , or cotinine levels according to group assignment . CONCLUSIONS : These results hold promise for using HEPA air cleaners as part of a multifaceted strategy to reduce asthma morbidity , but further research is necessary before they can be recommended routinely for the medical management of asthma BACKGROUND The effectiveness of avoidance of house-dust-mite allergen ( Dermatophagoides pteronyssinus 1 [ Der p1 ] ) in the management of  asthma  is uncertain . METHODS We conducted a double-blind , r and omized , placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma . The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through 12 .  Der p1  was measured in mattress dust in a 10 percent r and om sub sample of homes at entry and at 6 and 12 months . RESULTS The prevalence of sensitivity to dust-mite allergen was 65.4 percent in the group supplied with allergen-impermeable bed covers ( active-intervention group ) and 65.1 percent in the control group supplied with non-impermeable bed covers . The concentration of Der p1 in mattress dust was significantly lower in the active-intervention group at 6 months ( geometric mean , 0.58 microg per gram vs. 1.71 microg per gram in the control group ; P=0.01 ) but not at 12 months ( 1.05 microg per gram vs. 1.64 microg per gram ; P=0.74 ) . The mean morning peak expiratory flow rate improved significantly in both groups ( from 410.7 to 419.1 liters per minute in the active-intervention group , P<0.001 for the change ; and from 417.8 to 427.4 liters per minute in the control group , P<0.001 for the change ) . After adjustment for base-line differences ( by analysis of covariance ) , there was no significant difference between the groups in the peak expiratory flow rate at six months ( difference in means , active-intervention group vs. control group , -1.6 liters per minute [ 95 percent confidence interval , -5.9 to 2.7 ] among all patients [ P=0.46 ] and -1.5 liters per minute [ 95 percent confidence interval , -6.9 to 3.9 ] among mite-sensitive patients [ P=0.59 ] ) . There was no significant difference between the groups in the proportion in whom complete cessation of inhaled corticosteroid therapy was achieved ( 17.4 percent in the active-intervention group and 17.1 percent in the control group ) or in the mean reduction in steroid dose , either among all patients or among mite-sensitive patients . CONCLUSIONS Allergen-impermeable covers , as a single intervention for the avoidance of exposure to dust-mite allergen , seem clinical ly ineffective in adults with asthma STUDY OBJECTIVE To determine the effect of a symptom-based and a peak flow-based action plan in preventing acute exacerbations in subjects with poorly controlled asthma . DESIGN A r and omized controlled trial in which subjects who had required urgent treatment for their asthma were allocated to receive no action plan , a symptom-based plan , or a peak flow-based action plan . SETTING A university hospital asthma clinic . POPULATION One hundred fifty subjects were recruited after attending an emergency department or a clinic for urgent treatment of asthma . INTERVENTIONS All subjects received evaluation and education for asthma before being r and omly allocated to receive no action plan , a symptom-based action plan , or a peak flowmeter and a peak flow-based action plan . MEASUREMENTS Subjects were assessed by question naire at 3 and 6 months after enrollment with questions relating to their asthma control and their need for urgent treatment or hospital admission for asthma . RESULTS At 6 months after enrollment , although all three intervention groups experienced improvement in their asthma control , there was a striking reduction in emergency department visits for asthma only in the peak flow-based action plan group ( p=0.006 ) . No significant difference in emergency visits was apparent between the symptom-based action plan and no action plan groups . CONCLUSIONS We conclude that a peak flow-based action plan is effective , at least in the short term , in protecting patients with asthma against severe exacerbations of their disease OBJECTIVE To evaluate the outcome of a secondary intervention conducted with infants at risk for asthma . DESIGN Families of wheezing infants were r and omized to a 1-year intervention or control group ; outcome evaluation occurred from April 1 , 2000 , through September 30 , 2003 , when children reached 4 years of age . SETTING Home intervention and clinic evaluation . PARTICIPANTS A total of 149 children from low-income urban families with multiple wheezing episodes before the age of 2 years . INTERVENTION Nurse home visitors provided a multifaceted intervention ( environmental allergen and tobacco smoke reduction as well as illness management ) that lasted 12 months , with the goal of decreasing asthma onset and /or severity when children reached 4 years of age . MAIN OUTCOME MEASURES Asthma status ( parent-reported symptoms , impulse oscillometry , and documented asthma diagnosis ) , caregiver quality of life , medication use , and emergency department visits . RESULTS A total of 46.0 % of children from the intervention group and 54.9 % from the control group met criteria for asthma at the age of 4 years ( P = .33 ) . Caregiver quality of life was better for the intervention group ( P = .01 ) . Children in the intervention group were less likely to have reactive airways ( prebronchodilator-postbronchodilator decrease in impulse oscillometry resistance at 10 Hz of > or = 15 % ; P = .07 ) . Outcome was modified by baseline illness severity ; among children with low severity , odds of developing asthma by the age of 4 years were 3 times lower for intervention children than controls ( P = .04 ) , and symptom severity was lower for intervention children ( P = .03 ) . CONCLUSIONS Multifaceted intervention did not decrease asthma among children with early wheezing illness as a whole , but only for children with low illness severity in infancy . Despite having an impact on only less severely ill children , results demonstrate the possibility of ameliorating illness burden for some inner-city families with children at high risk for poor asthma outcomes BACKGROUND Asthma is the most common chronic disease among children in Germany . Approaches to reduce the burden of asthma include patient education to improve self-management skills . STUDY OBJECTIVES We determined whether a continuous Internet-based education program ( IEP ) as an add-on to a st and ardized patient management program ( SPMP ) improves health outcomes of asthma patients at a favorable benefit-cost ratio . PATIENTS AND METHODS A total of 438 asthmatic patients aged 8 to 16 years in 36 study centers were enrolled during a 6-month period . We performed a prospect i ve cost-benefit analysis alongside a nonr and omized trial . At baseline and at 6 months and 12 months , health service utilization data were collected . INTERVENTIONS Study participants were assigned to a control group and two intervention groups . Patients in both intervention groups participated in an SPMP . Additionally , patients in one intervention group received the IEP . RESULTS Utilization of various health-care services decreased significantly in both intervention groups . From a payer perspective , the benefit-cost ratio of the traditional education program was 0.55 . Adding the IEP improved the ratio ( 0.79 ) . For patients with moderate or severe asthma , the benefit-cost ratios were 1.07 and 1.42 ( with IEP ) , respectively . CONCLUSIONS The IEP offers the potential to decrease the burden of disease and to realize incremental morbidity cost savings . Subgroup analysis demonstrated that within 1 year , the savings exceed the intervention costs in patients with moderate or severe asthma Objective To assess whether non-polluting , more effective home heating ( heat pump , wood pellet burner , flued gas ) has a positive effect on the health of children with asthma . Design R and omised controlled trial . Setting Households in five communities in New Zeal and . Participants 409 children aged 6 - 12 years with doctor diagnosed asthma . Interventions Installation of a non-polluting , more effective home heater before winter . The control group received a replacement heater at the end of the trial . Main outcome measures The primary outcome was change in lung function ( peak expiratory flow rate and forced expiratory volume in one second , FEV1 ) . Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs . At the end of winter 2005 ( baseline ) and winter 2006 ( follow-up ) parents reported their child ’s general health , use of health services , overall respiratory health , and housing conditions . Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child ’s bedroom were recorded hourly . Results Improvements in lung function were not significant ( difference in mean FEV1 130.7 ml , 95 % confidence interval −20.3 to 281.7 ) . Compared with children in the control group , however , children in the intervention group had 1.80 fewer days off school ( 95 % confidence interval 0.11 to 3.13 ) , 0.40 fewer visits to a doctor for asthma ( 0.11 to 0.62 ) , and 0.25 fewer visits to a pharmacist for asthma ( 0.09 to 0.32 ) . Children in the intervention group also had fewer reports of poor health ( adjusted odds ratio 0.48 , 95 % confidence interval 0.31 to 0.74 ) , less sleep disturbed by wheezing ( 0.55 , 0.35 to 0.85 ) , less dry cough at night ( 0.52 , 0.32 to 0.83 ) , and reduced scores for lower respiratory tract symptoms ( 0.77 , 0.73 to 0.81 ) than children in the control group . The intervention was associated with a mean temperature rise in the living room of 1.10 ° C ( 95 % confidence interval 0.54 ° C to 1.64 ° C ) and in the child ’s bedroom of 0.57 ° C ( 0.05 ° C to 1.08 ° C ) . Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households ( geometric mean 8.5 μg/m3 v 15.7 μg/m3 , P<0.001 ) . A similar effect was found in the children ’s bedrooms ( 7.3 μg/m3 v 10.9 μg/m3 , P<0.001 ) . Conclusion Installing non-polluting , more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma , days off school , healthcare utilisation , and visits to a pharmacist . Trial registration Clinical Trials NCT00489762 OBJECTIVE To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma . DESIGN R and omized trial , with children stratified by smoke exposure in the home and r and omized 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 Background : Up to 17 % of children in the United States have been diagnosed with asthma ; children ages 9 - 14 years experience higher morbidity and mortality compared with other age groups . An academic and counseling program for older elementary students with asthma was developed in collaboration with school personnel , healthcare professionals , and community members : Staying Healthy-Asthma Responsible and Prepared ( SHARP ) . The life span development perspective and the Acceptance of Asthma Model were used to guide development and implementation . Objectives : This study aim ed to establish the preliminary efficacy of SHARP to improve cognitive , behavioral , psychosocial , and quality -of-life outcomes . Methods : A two-group , longitudinal , prospect i ve , cluster r and omized clinical trial design was used . The sample of fourth- to sixth- grade students ( N = 66 ) with asthma aged 9 - 12 years ( M = 10.5 , SD = 0.9 ) was 52 % male , was racially diverse ( 30 % Black , 36 % White , and 18 % biracial ) , and had a wide range of incomes . Three schools ( n = 38 students ) were r and omized to receive SHARP , and two schools ( n = 28 students ) were assigned to usual care .  Self-report instruments were used . Results : Compared with the usual care group , statistically significant improvements in the SHARP group were found in student knowledge of asthma , reasoning about asthma , use of risk reduction behaviors , and participation in life activities ( p < .01 , effect sizes > 0.7 ) . Improvements in use of episode management behaviors and acceptance of asthma outcomes were clinical ly significant with medium effect sizes of 0.3 - 0.5 . Discussion : The SHARP Student and Community Components demonstrated preliminary efficacy for improving asthma knowledge , reasoning about asthma , use of episode management and risk reduction behaviors , acceptance of asthma in taking control and vigilance , and participation in life activities Asthma education decreases the number of emergency visits in specific subgroups of patients with asthma . However , it remains unknown whether this improvement is related only to the use of an action plan alone or to other components of the educational intervention . A total of 126 patients consulting urgently for an acute asthma exacerbation were recruited ; 98 completed the study . The first 45 patients were assigned to Group C ( control ; usual treatment ) . Thereafter , patients were r and omized to either Group LE ( limited education ; teaching of the inhaler technique plus self- action plan given by the on call physician ) or Group SE ( same as group LE plus a structured educational program emphasizing self-capacity to manage asthma exacerbations ) . At baseline , there was no difference between groups in asthma morbidity , medication needs , or pulmonary function . After 12 mo , only Group SE showed a significant improvement in knowledge , willingness to adjust medications , quality of life scores , and peak expiratory flows . In the last 6 mo , the number of unscheduled medical visits for asthma was significantly lower in Group SE in comparison with groups C and LE ( p = 0.03 ) . The number ( % ) of patients with unscheduled medical visits also decreased significantly in Group SE compared with Groups C and LE ( p = 0.02 ) . We conclude that a structured educational intervention emphasizing self-management improves patient outcomes significantly more than a limited intervention or conventional treatment OBJECTIVE To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology ( SB-PACT ) program , which includes directly observed therapy of preventive asthma medications in school facilitated by Web-based technology for systematic symptom screening , electronic report generation , and medication authorization from providers . STUDY DESIGN We conducted a pilot r and omized trial of SB-PACT versus usual care with 100 children ( aged 3 - 10 years ) from 19 inner-city schools in Rochester , New York . Outcomes were assessed longitudinally by blinded interviewers . Analyses included bivariate statistics and linear regression models , adjusting for baseline symptoms . RESULTS There were data for 99 subjects for analysis . We screened all children using the Web-based system  , and 44 of 49 treatment group children received directly observed therapy as authorized by their providers . Treatment group children received preventive medications 98 % of the time they were in school . Over the school year , children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group ( 11.33 vs 10.40 , P = .13 ) . Treatment children also experienced fewer nights with symptoms ( 1.68 vs 2.20 , P = .02 ) , days requiring rescue medications ( 1.66 vs 2.44 , P = .01 ) , and days absent from school due to asthma ( 0.37 vs 0.85 , P = .03 ) compared with usual care . Further , treatment children had a greater decrease in exhaled nitric oxide ( -9.62 vs -0.39 , P = .03 ) , suggesting reduction in airway inflammation . CONCLUSION The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study . Future work will focus on further integration of preventive care delivery across community and primary care systems BACKGROUND In Atlanta , as in other major urban areas of the United States , asthma is a leading cause of school absenteeism , emergency department use , and hospitalization . Recent guidelines for asthma management recommend reducing exposure to relevant allergens , but neither the feasibility nor the efficacy of this form of treatment has been established for children living in poverty . OBJECTIVE We sought to investigate allergen avoidance as a treatment for asthma among inner-city children . METHODS One hundred four children with asthma living in the city of Atlanta were enrolled into a controlled trial of avoidance without being skin tested . The children were r and omized to an active avoidance group , a placebo avoidance group , and a second control group for which no house visits occurred until the end of the first year . Avoidance included bed and pillow covers , hot washing of bedding , and cockroach bait .  Eighty-five children completed the study , and the outcome was measured as unscheduled clinic visits , emergency department visits , and hospitalization for asthma , as well as changes in mite and cockroach allergen levels . RESULTS There was a significant decrease in acute visits for asthma among children whose homes were visited ( P < .001 ) . However , there was no significant difference between the active and placebo homes either in the effect on asthma visits or in allergen concentrations . When the children with mite allergy were considered separately , there was a significant correlation between decreased mite allergen and change in acute visits ( P < .01 ) . The avoidance measures  for cockroach allergen appeared to be ineffective , and the changes observed did not correlate with changes in visits . CONCLUSIONS Applying allergen avoidance as a treatment for asthma among children living in poverty is difficult because of multiple sensitivities and problems applying the protocol s in this environment . The current results demonstrate that home visiting positively influences the management of asthma among families living in poverty . Furthermore , the results for children with mite allergy strongly suggest that decreasing relevant allergen exposure should be an objective of treatment in this population BACKGROUND : Studies in urban emergency departments ( EDs ) have found poor quality of chronic asthma care and identified beliefs and barriers associated with low rates of follow-up with a primary care provider ( PCP ) . OBJECTIVES : To develop an ED-based intervention including asthma symptom screening , a video addressing beliefs and a mailed reminder ; and measure the effect on PCP follow-up and asthma-related outcomes . METHODS : This r and omized , controlled trial enrolled children aged 1 to 18 years who were discharged after asthma treatment in an urban pediatric ED . Control subjects received instructions to follow-up with a PCP within 3 to 5 days . In addition , intervention subjects ( 1 ) received a letter to take to their PCP if they screened positive for persistent asthma symptoms , ( 2 ) viewed a video featuring families and providers discussing the importance of asthma control , and ( 3 ) received a mailed reminder to follow-up with a PCP . All subjects were contacted by telephone 1 , 3 , and 6 months after the ED visit , and follow-up was confirmed by PCP record review . Asthma-related quality of life ( AQoL ) , symptoms , and beliefs about asthma care were assessed by using vali date d surveys . RESULTS : A total of 433 subjects were r and omly assigned , and baseline measures were similar between study groups . After the intervention and before ED discharge , intervention subjects were more likely to endorse beliefs about the benefits of follow-up than controls . However , rates of PCP follow-up during the month after the ED visit ( 44.5 % ) were similar to control subjects ( 43.8 % ) as were AQoL , medication use , and ED visits . CONCLUSIONS : An ED-based intervention influenced beliefs but did not increase PCP follow-up or asthma-related outcomes OBJECTIVES We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers . METHODS We conducted a r and omized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4 - 12 years who had asthma .  Community health workers provided in-home environmental assessment s , education , support for behavior change , and re sources . Participants were assigned to either a high-intensity group receiving 7 visits and a full set of re sources or a low-intensity group receiving a single visit and limited re sources . RESULTS The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality -of-life score ( P=.005 ) and asthma-related urgent health services use ( P=.026 ) . Asthma symptom days declined more in the high-intensity group , although the across-group difference did not reach statistical significance ( P=.138 ) . Participant actions to reduce triggers generally increased in the high-intensity group . The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were 189 - 721 dollars . CONCLUSIONS Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality -of-life score . Improvement was greater with a higher-intensity intervention OBJECTIVE To test whether community health workers are able to reach low-income parents of African American children hospitalized for asthma and to reduce rehospitalization among them . DESIGN A r and omized controlled evaluation of usual care vs 2-year asthma coach intervention . SETTING An urban children 's hospital and the surrounding community . PARTICIPANTS A population -based sample of 306 children hospitalized for asthma met the inclusion criteria of being 2 to 8 years of age , of African American ethnicity , and having Medicaid coverage . Of these , 200 were contacted and 191 recruited with commitment to evaluation activities but , in order to assess reach , no commitment to participating in intervention . INTERVENTIONS Coaches reinforced basic asthma education and encouraged key management behaviors through home visits and phone calls tailored to parent 's readiness to adopt management practice s and emphasizing a nondirective supportive style ( cooperative and accepting of feelings and choices ) . OUTCOME MEASURES The reach of intervention to parents , contacts with coaches , and rehospitalization over 2 years based on hospital records . RESULTS Within 3 months of r and omization to the asthma coach group , 89.6 % of parents had at least 1 substantive contact with the coach , with an average of 21.1 contacts per parent over the 24-month intervention . The proportion of children rehospitalized was 35 of 96 ( 36.5 % ) in the asthma coach group and 55 of 93 ( 59.1 % ) in the usual care group ( P < .01 ) , controlling for parental education and child age , sex , and hospitalization in the year prior to the index hospitalization . In surveys , parents indicated the importance of the nondirective approach to support . CONCLUSIONS An asthma coach can reach low-income parents of African American children hospitalized for asthma and reduce rehospitalization among the children OBJECTIVE To study the effect of an asthma outreach program on emergency ward and hospital utilization . DESIGN Before and after trial . SETTING Ambulatory patients in a staff-model health maintenance organization with a 70 % black inner-city population . PATIENTS Fifty-three patients aged 1 to 17 years with the diagnosis of asthma based on usual clinical practice criteria . INTERVENTION Asthma emergency ward visits and hospitalizations were monitored over a 6-month to 2-year period after enrollment in the program . Patients were scheduled for one-on-one orientation visits with the asthma outreach nurse and instructed in asthma management , medications , triggers , and use of inhalers and peak flowmeters . An individualized step-care treatment program was outlined for each patient by the nurse , primary care pediatrician , and , when appropriate , an allergist . The outreach nurse maintained personal or telephone contact with the families on a regular basis to assure underst and ing of and compliance with the treatment plan . OUTCOME MEASURES Outcome was assessed by measuring annualized emergency ward and hospital admissions for each patient for an equal period before and after entry into the program . RESULTS Emergency ward admissions were reduced 79 % ( from a rate of 72 visits per year to 15 visits per year , P < .0001 ) and hospital admissions were reduced 86 % ( from 35 per year to five per year , P < .001 ) . These reductions were achieved by a single outreach nurse working an average of 8 hours per week at an annualized cost of $ 11,115 ; this saved approximately $ 87,000 in costs . CONCLUSIONS Patients enrolled in a pediatric asthma outreach program experienced a significant reduction in utilization of emergency ward and hospital admissions , result ing in reduced cost of care BACKGROUND The aim of this double-blind , r and omized study was to investigate the effectiveness of an acaricidal cleaning product in modifying both clinical symptoms and mite allergen levels over a period of at least 1 year . METHODS Twenty-six asthmatic patients with proven Dermatophagoides pteronyssinus ( Dp ) asthma were selected ; three were withdrawn from the trial . The patients ' homes were divided into two groups ; 11 homes were treated with solidified benzyl benzoate and tenside agents ( A ) , and 12 were treated with a placebo ( P ) . Two applications were performed at the beginning of the trial and at least 6 months later . Patients were examined 1 month before the trial , at the beginning of the trial , and every 3 months over a period of 1 year . Indoor mite exposure was evaluated by three methods : semiquantitative guanine determinations , quantitative guanine determinations , and the measurement of Der p I + Der f 1 ( antigen P , of Dp + antigen F1 of D. farinae ) levels . RESULTS The symptom scores established at the beginning of the trial and 12 months later showed a statistically significant improvement only in the A group ( p < 0.01 ) . The visual analog scale also showed a statistically significant difference both in the A ( p < 0.05 ) and P groups ( p < 0.01 ) . No statistical differences were found between medication scores in the A or P groups . A statistically significant increase was also observed for forced expiratory volume in 1 second and maximal expiratory flow rate 25/75 in the two groups ( p < 0.05 for P group ; p < 0.01 for A group ) . The mean decreases in Der p I + Der f 1 in patient mattresses between the beginning of the trial and after 12 months were 20 % for the acaricide group and 17 % for the placebo group , respectively ( NS ) . For house dust sample s with origins other than the patients ' mattresses we found significant decreases in Der p I+Der f 1 in the A group ( p < 0.01 for carpets and p < 0.05 for upholstery elements ) This study assessed the effectiveness of translating evidence -based asthma interventions into community health centers . BACKGROUND AND OBJECTIVES : Research ers often struggle with the gap between efficacy and effectiveness in clinical research . To bridge this gap , the Community Healthcare for Asthma Management and Prevention of Symptoms ( CHAMPS ) study adapted an efficacious , r and omized controlled trial that result ed in evidence -based asthma interventions in community health centers . METHODS : Children ( aged 5–12 years ; N = 590 ) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk , low-income communities located in Arizona , Michigan , and Puerto Rico . The asthma intervention was tailored to the participant ’s allergen sensitivity and exposure , and it comprised 4 visits over the course of 1 year . Study visits were documented and monitored prospect ively via electronic data capture . Asthma symptoms and health care utilization were evaluated at baseline , and at 6 and 12 months . RESULTS : A total of 314 intervention children and 276 control children were enrolled in the study .  Allergen sensitivity testing ( 96 % ) and home environmental assessment s ( 89 % ) were performed on the majority of intervention children . Overall study activity completion ( eg , intervention visits , clinical assessment s ) was 70 % . Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings ( control , change of −2.28 ; intervention , change of −3.27 ; difference , −0.99 ; P < .001 ) , and this result was consistent with changes found in the rigorous evidence -based interventions . CONCLUSIONS : Evidence -based interventions can be successfully adapted into primary care setting s that serve impoverished , high-risk population s , reducing the morbidity of asthma in these high-need population The objective of this study was to evaluate the effectiveness of an asthma education program on morbidity , knowledge , and compliance with inhaled corticosteroid treatment using a prospect i ve , r and omized , controlled , one-year-before/one-year-after protocol . After rigorous optimization of asthma therapy under the care of respirologists , patients were assigned to one of three groups : Group C ( control group : no formal education ) , Group P ( education and action plan based on peak-flow monitoring ) , and Group S ( education with action plan based on monitoring of asthma symptoms ) . A total of 188 subjects with moderate to severe asthma were enrolled and 149 completed the study .  Asthma morbidity decreased significantly in all groups ( p = 0.001 ) . Mean values one-year-before/one-year-after in Groups C , P , and S were : unscheduled medical visits , 2.4/0.8 , 2.3/0.7 , and 1.9/ 0.7 ; hospitalizations , 0.21/0.04 , 0.24/0.04 , and 0.40/0.09 ; oral steroid treatments ; 1.3/0.5 , 1.2/0.7 , and 1.3/0.9 ; absenteeism from work/school , 9.6/5.2 , 8.8/2.2 , and 6.3/2.9 . Between-group differences did not reach statistical significance ( p > 0.05 ) . Asthma knowledge increased in both educated groups compared with the control group ( p < 0.001 ) as did short-term compliance with inhaled corticosteroids . These results confirm that treatment optimization coupled with sustained high quality care in motivated patients can lead to a significant decrease in asthma morbidity . In such clinical setting s , structured asthma education significantly improved short-term compliance with treatment and knowledge about asthma , although it could not add extra benefit with regard to morbidity . Nevertheless , this study does not refute the potential benefit of educational interventions aim ed at improving asthma-related morbidity over a longer time period or in patients with less optimal care or with high-risk factors BACKGROUND The relationship between exposure to house dust mite ( HDM ) allergens and prevalence of sensitization to these allergens in patients with asthma has been confirmed in many studies . Mite population growth is regulated by humidity . Reducing humidity and removing allergen by efficient vacuuming should control mite allergen and reduce symptoms . OBJECTIVE We sought to investigate the effect of mechanical ventilation and high-efficiency vacuuming on HDM numbers and Der p 1 concentrations in the homes of mite-sensitive asthmatic subjects and to evaluate the effect of any reductions on symptoms . METHODS The homes of 40 HDM-sensitive asthmatic subjects were r and omized to receive ( 1 ) mechanical ventilation and a high-efficiency vacuum cleaner ( HEVC ) ; ( 2 ) mechanical ventilation alone ; ( 3 ) an HEVC alone ; and ( 4 ) no intervention . Homes and patients were monitored for 12 months . Change in absolute humidity , mite numbers , Der p 1 concentrations , lung function , bronchial hyperresponsiveness , and symptom scores were analyzed . RESULTS Homes with mechanical ventilation achieved significantly lower humidity levels than those without ( P < .001 ) , with an associated reduction of mite numbers ( P < .05 ) and Der p 1 concentrations ( P < .001 ¿ in nanograms per gram , P = .006 ¿ in milligrams per square meter ) in bedroom carpets and some other mite sources in the ventilated areas of the homes . The addition of a vacuum cleaner enhanced this effect . There was a trend for an improvement in histamine PC(20 ) ( P = .085 ) in the patients whose homes were ventilated . CONCLUSION The use of a mechanical ventilation system in suitable homes result ed in some reduction in numbers of HDM and Der p 1 concentrations . The addition of an HEVC slightly enhanced the effect but not sufficiently to see an improvement in symptoms OBJECTIVE To evaluate a family-focused asthma intervention design ed for inner-city children 5 to 11 years old with moderate to severe asthma . STUDY DESIGN R and omized , multisite , controlled trial to minimize symptom days ( wheeze , loss of sleep , reduction in play activity ) measured by a 2-week recall assessed at 2-month intervals over a 2-year follow-up period . The intervention was tailored to each family 's individual asthma risk profile assessed at baseline . RESULTS Averaged over the first 12 months , participants in the intervention group ( n = 515 ) reported 3.51 symptom days in the 2 weeks before each follow-up interview compared with 4.06 symptom days for the control group ( n = 518 ) , a difference of 0.55 ( 95 % CI , 0.18 to 0.92 , P = .004 ) . The reduction among children with severe asthma was approximately 3 times greater ( 1.54 d/2 wk ) . More children in the control group ( 18.9 % ) were hospitalized during the intervention compared with children in the intervention group ( 14 . 8 % ) , a decrease of 4.19 % ( CI , -8.75 to 0.36 , P = .071 ) . These improvements were maintained in the intervention group during the second year of follow-up , during which they did not have access to the asthma counselor . CONCLUSIONS We demonstrated that an individually tailored , multifaceted intervention carried out by Masters-level social workers trained in asthma management can reduce asthma symptoms among children in the inner city M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice . Usual care is not doing the job ; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy , have poor disease con- trol , and are unhappy with their care ( 1 ) . Results of r and omized trials also show that effective disease management programs can achieve substantially better outcomes than usual care , the control intervention . These trials , along with the ideas and efforts for improvement discussed in this issue , show that we can improve care and outcomes . As the articles suggest , these improvements will not come easily . If we are to improve care for most patients with chronic illness , the evidence strongly suggests that we reshape our ambulatory care systems for this purpose . Pri- mary care practice was largely design ed to provide ready access and care to patients with acute , varied problems , with an emphasis on triage and patient flow ; short appointments ; diagnosis and treatment of symptoms and signs ; reliance on laborato- ry investigations and prescriptions ; brief , didactic patient education ; and patient- initiated follow-up . Patients and families struggling with chronic illness have differ- ent needs , and these needs are unlikely to be met by an acute care organization and culture . They require planned , regular interactions with their caregivers , with a focus on function and prevention of exacerbations and complications . This interac- tion includes systematic assessment s , attention to treatment guidelines , and behav- iorally sophisticated support for the patient 's role as self-manager . These interactions must be linked through time by clinical ly relevant information systems and continu- ing follow-up initiated by the medical practice . Comprehensive System RATIONALE Asthma prevalence and morbidity are especially elevated in adolescents , yet few interventions target this population . OBJECTIVES To test the efficacy of Asthma Self-Management for Adolescents ( ASMA ) , a school-based intervention for adolescents and medical providers . METHODS Three hundred forty-five primarily Latino/a ( 46 % ) and African American ( 31 % ) high school students ( mean age = 15.1 yr ; 70 % female ) reporting an asthma diagnosis , symptoms of moderate to severe persistent asthma , and asthma medication use in the last 12 months were r and omized to ASMA  , an 8-week school-based intervention , or a wait-list control group . They were followed for 12 months . MEASUREMENTS AND MAIN RESULTS Students completed bimonthly assessment s. Baseline , 6-month , and 12-month assessment s were comprehensive ; the others assessed interim health outcomes and urgent health care use . Primary outcomes were asthma self-management , symptom frequency , and quality of life ( QOL ) ; secondary outcomes were asthma medical management , school absences , days with activity limitations , and urgent health care use . Relative to control subjects , ASMA students reported significantly : more confidence to manage their asthma ; taking more steps to prevent symptoms ; greater use of controller medication and written treatment plans ; fewer night awakenings , days with activity limitation , and school absences due to asthma ; improved QOL ; and fewer acute care visits , emergency department visits , and hospitalizations . In contrast , steps to manage asthma episodes , daytime symptom frequency , and school-reported absences did not differentiate the two groups . Most results were sustained over the 12 months . CONCLUSIONS ASMA is efficacious in improving asthma self-management and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents IMPORTANCE A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care . OBJECTIVE To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers ( PAIR-UP ) intervention , administered in primary care offices , improves the delivery of preventive care and reduces morbidity for urban children with asthma . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized trial in which 12 urban primary care practice s were matched based on size and type and r and omly allocated to the PAIR-UP intervention or usual care ( UC ) . We enrolled 638 children aged 2 to 12 years with persistent or poorly controlled asthma in the waiting room prior to a visit with a clinician for any reason from October 2009 to January 2013 . Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit and called them 2 and 6 months later to assess symptoms . INTERVENTIONS Children enrolled at PAIR-UP practice s received prompts for the caregiver and clinician at the time of the visit that outlined the child 's asthma severity or control as well as specific guideline -based recommendations to enhance preventive care . These practice s also received educational re sources and periodic feedback on their asthma care performance . The UC practice s received copies of the asthma guidelines . MAIN OUTCOMES AND MEASURES The primary outcome was symptom-free days ( SFDs ) per 2 weeks at the 2-month follow-up . RESULTS We enrolled 638 children ( participation rate of 80 % ; 36 % were black , 36 % were Hispanic , and 68 % had Medicaid insurance ) . Groups were similar in demographic characteristics and asthma severity at baseline . At the index visit , more children in the PAIR-UP group received a preventive medication action  ( new medication , increased dose , recommendation to restart preventive medication ) than in the UC group ( 58 % vs 33 % ; odds ratio [ OR ] = 2.8 ; 95 % CI , 1.9 to 3.9 ) . More children in the PAIR-UP group than in the UC group received an asthma action plan ( 61 % vs 23 % ; OR = 8.3 ; 95 % CI , 3.7 to 18.7 ) , discussion s regarding asthma ( 93 % vs 78 % ; OR = 4.5 ; 95 % CI , 2.8 to 7.2 ) , and secondh and smoke counseling ( 80 % vs 63 % ; OR = 2.6 ; 95 % CI , 1.2 to 5.5 ) . At the 2-month follow-up , children in the PAIR-UP group had more SFDs per 2 weeks than those in the UC group ( mean difference , 0.78 days ; 95 % CI , 0.29 to 1.27 ) . At 6 months , the improvement in SFDs was no longer statistically significant ( mean difference , 0.56 ; 95 % CI , -0.14 to 1.25 ) . CONCLUSIONS AND RELEVANCE The PAIR-UP intervention improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma at 2 months , but the improvement in SFDs was no longer significant at 6 months . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01105754 BACKGROUND Improving inhaled corticosteroid ( ICS ) adherence should improve asthma outcomes . OBJECTIVE In a r and omized controlled trial we tested whether an individualized problem-solving ( PS ) intervention improves ICS adherence and asthma outcomes . METHODS Adults with moderate or severe asthma from clinics serving urban neighborhoods were r and omized to PS ( ie , defining specific barriers to adherence , proposing/weighing solutions , trying the best , assessing , and revising ) or st and ard asthma education ( AE ) for 3 months and then observed for 3 months . Adherence was monitored electronically . Outcomes included the following : asthma control , FEV(1 ) , asthma-related quality of life , emergency department ( ED ) visits , and hospitalizations . In an intention-to-treat- analysis longitudinal models using r and om effects and regression were used . RESULTS Three hundred thirty-three adults were r and omized : 49 ± 14 years of age , 72 % female , 68 % African American , 7 % Latino , mean FEV(1 ) of 66 % ± 19 % , and 103 ( 31 % ) with hospitalizations and 172 ( 52 % ) with ED visits for asthma in the prior year . There was no difference between groups in overall change in any outcome ( P > .20 ) . Mean adherence ( 61 % ± 27 % ) decreased significantly ( P = .0004 ) over time by 14 % and 10 % in the AE and PS groups , respectively . Asthma control improved overall by 15 % ( P = .002 ) . In both groups FEV(1 ) and quality of life improved by 6 % ( P = .01 ) and 18 % ( P < .0001 ) , respectively . However , the improvement in FEV(1 ) only occurred during monitoring but not subsequently after r and omization . Rates of ED visits and hospitalizations did not significantly decrease over the study period . CONCLUSION PS was not better than AE in improving adherence or asthma outcomes . However , monitoring ICS use with provision of medications and attention , which was imposed on both groups , was associated with improvement in FEV(1 ) and asthma control OBJECTIVES We examined the asthma-control benefit of moving into an asthma-friendly Breathe-Easy home ( BEH ) . METHODS We used a quasi-experimental design to compare the asthma outcomes of 2 groups of low-income children and adolescents with asthma : 34 participants who moved into a BEH , and a local matched cohort of 68 participants who had received a previous asthma-control intervention .  Both groups received in-home asthma education . BEHs were constructed with moisture-reduction features , enhanced ventilation systems , and material s that minimized dust and off-gassing . RESULTS BEH residents ' asthma-symptom-free days increased from a mean of 8.6 per 2 weeks in their old home to 12.4 after 1 year in the BEH . The proportion of BEH residents with an urgent asthma-related clinical visit in the previous 3 months decreased from 62 % to 21 % . BEH caretakers ' quality of life increased significantly . The BEH group improved more than did the comparison group , but most differences in improvements were not significant . Exposures to mold , rodents , and moisture were reduced significantly in BEHs . CONCLUSIONS Children and adolescents with asthma who moved into an asthma-friendly home experienced large decreases in asthma morbidity and trigger exposure
Abstract Background : Despite growing access to effective therapies , asthma control still needs improvement .
Many non-drug factors , such as allergens , air pollutants and stress also affect asthma control and patient quality of life , but an overview of the effectiveness of non-drug interventions on asthma control was lacking .
Objectives : To identify non-drug interventions likely to improve asthma control .