Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up Results of a home-based environmental intervention among urban children with asthma. Increasing parental knowledge of asthma decreases the hospitalization of the child: a pilot study. Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial Impact of education for physicians on patient outcomes. Impact of a quality improvement program on care and outcomes for children with asthma. Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children. Poor adherence to self-medication instructions in children with asthma and their parents. Controlled trial of a home and ambulatory program for asthmatic children. Practice-level effects of interventions to improve asthma care in primary care settings: the Pediatric Asthma Care Patient Outcomes Research Team. A randomized trial of A.C.T. (asthma care training) for kids. Home-based asthma self-management education for inner city children. Long-term effects of asthma education for physicians on patient satisfaction and use of health services. A randomised controlled trial of clinics in secondary schools for adolescents with asthma. Improving the Psychological Status of Children with Asthma: A Randomized Controlled Trial Proactive asthma care in childhood: general practice based randomised controlled trial Managing better: children, parents, and asthma. Home-based asthma education of young low-income children and their families. Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in medicaid. An asthma self-management program for children, including instruction in peak flow monitoring by school nurses. 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Education of parents of infants and very young children with asthma: a developmental evaluation of the Wee Wheezers program. An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children. Improving care for minority children with asthma: professional education in public health clinics.
Background : Until now , care provided by asthma nurses has been additional to care provided by paediatricians . A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician . Methods : Seventy four children referred because of insufficient control of persistent asthma were r and omly allocated to 1 year follow up by a paediatrician or asthma nurse . The main outcome measure was the percentage of symptom-free days . Additional outcome measures were airway hyperresponsiveness , lung function , daily dose of inhaled corticosteroids ( ICS ) , number of exacerbations , number of additional visits to the general practitioner , absence from school , functional health status , and disease specific quality of life . Results : There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days ( mean difference 2.5 % ; 95 % CI −8.8 to 13.8 ) , airway hyperresponsiveness ( log10 PD20 0.06 ; −0.19 to 0.32 ) , functional health status ( 10.1 ; −0.3 to 19.8 ) , disease specific quality of life of patients ( 0.08 ; −0.9 to 0.7 ) , and disease specific quality of life of caregivers ( 0.09 ; −0.2 to 0.3 ) , nor in any other outcome parameters . Most outcome parameters improved considerably over the 1 year study period . These improvements were achieved although the daily dose of ICS was reduced by a mean of 26 % compared with the dose received by children at referral . All parents were satisfied with the asthma care received . Conclusions : After initial assessment in a multidisciplinary clinic , childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician . During close follow up by paediatrician or asthma nurse , asthma control improved despite a reduction in ICS dose 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 The parents of asthmatic children treated in the pediatric respiratory service of Wolfson Hospital were r and omly divided into two groups . One group compromised 26 parents who voluntarily attended a teaching session .  After completion of the course , a question naire was completed by parents who had attended the course and parents who had not . The first group showed greater knowledge of all aspects of the disease and , after a year 's follow up , it was noted that there was a statistically significant lower hospitalization rate of their asthmatic child Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months OBJECTIVES This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1 ) the treatment practice s and communications and education behavior of physicians , 2 ) the health status and medical care utilization of their pediatric patients with asthma , and 3 ) the satisfaction with care of the subjects ' parents . METHODS A total of 74 general practice pediatricians were assigned to either a program or a control group in a r and omized controlled study . Data were collected from physicians at baseline , and 69 ( 93 % ) provided follow-up data 5 months after the program . Data were also collected from 637 of their patients at baseline , and in a 22-month window after the intervention , 472 ( 74 % ) of this number provided follow-up data . RESULTS After the seminar , physicians in the program group were more likely than were control group physicians to address patients ' fears about medicines , review written instructions , provide a sequence of educational messages , write down how to adjust the medicines at home when symptoms change , and report that they spent less time with their patients . Parents of the children treated by program physicians were significantly more likely than were  control group parents to report that the physician had been reassuring , described as a goal that the child be fully active , and gave information to relieve specific worries . After a visit with the physician , these parents were also more likely to report that they knew how to make management decisions at home . After the intervention compared to controls , patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler . After the intervention , children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms ; however , there were no differences in emergency department visits and hospitalizations . Among children who were placed on inhaled corticosteroids during this study , however , children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits , nonemergency physician office visits , emergency department visits , and hospitalizations . CONCLUSIONS The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration , had significant impact on the prescribing and communications behavior of physicians , led to more favorable patient responses to physicians ' actions , and led to reductions in health care utilization OBJECTIVE To test a quality improvement intervention , a learning collaborative based on the Institute for Healthcare Improvement 's Breakthrough Series methodology , specifically intended to improve care and outcomes for patients with childhood asthma . DESIGN R and omized trial in primary care practice s. SETTING Practice s in greater Boston , Mass , and greater Detroit , Mich. PARTICIPANTS Forty-three practice s , with 13 878 pediatric patients with asthma , r and omized to intervention and control groups . Intervention Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement . MAIN OUTCOME MEASURES Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma , and in the proportion of children whose parent received a written management plan for their child 's asthma , as determined by telephone interviews with parents of 631 children . RESULTS After adjusting for state , practice size , child age , sex , and within- practice clustering , no overall effect of the intervention was found . CONCLUSIONS This method ologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma . Potential deficiencies in program implementation , project duration , sample selection , and data sources preclude making the general inference that this type of improvement program is ineffective . Additional rigorous studies should be undertaken under more optimal setting s to assess the efficacy of this method for improving care An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated . Subjects aged 6 - 17 were recruited from four pediatric practice s and r and omly assigned to the computer intervention condition or to the usual-care comparison .  The main character in the game could match the subject on gender and ethnicity . Characteristics of the protagonist 's asthma were tailored to be like those of the subject . Subjects played the computer game as part of regular asthma visits . Time between pre- and post-test varied from 4 to 15.6 months ( mean , 7.6 months ) . Analysis of covariance , with pre-test scores , age , and asthma severity as covariates , found that the intervention was associated with fewer hospitalizations , better symptom scores , increased functional status , greater knowledge of asthma management , and better child self-management behavior for those in the intervention condition . Interactions with covariates were found and discussed in terms of variable efficacy of the intervention This study describes a self-treatment program for parents of children with asthma . The aim was to prevent asthma exacerbations by learning to recognise prodromal signs and acting upon them by increasing inhaled corticosteroids ( ICS ) . The study questions were : ( 1 ) can we teach parents and children to recognise prodromal signs ? ( 2 ) are instructions to increase inhalation medication followed ? ( 3 ) will frequency and severity of asthma attacks diminish subsequently ? Due to physicians ' changed attitude towards prescription of ICS , fewer children could be recruited who were " ICS-naive " than expected . Twenty-nine children of the age of 4 - 11 years with moderate asthma , participated in a one year prospect i ve r and omised study . Structured information was given to all patients on asthma , symptoms and medication . The experimental group received additional information on recognising prodromal signs and doubling ICS during one week . Only in 25 % of the patients who recognised prodromal signs the dose of ICS was doubled ( as prescribed ) , in 75 % inadequately or not at all . Recognition of prodromal signs was poor as well as compliance to increase as-needed medication . No significant decrease of asthma symptoms occurred in the experimental group . Clinical implication s are important for self-treatment instructions : an individually tailored and multi-component program should be offered by health care providers in order to help the patient to recognise early alarm symptoms , comply to self-treatment instructions and to make adaptations for continuous self-regulation Care of asthmatic children is often episodic and more therapeutic than preventive . A 2-year r and omized , 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 secondh and 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 OBJECTIVE To assess the practice -level effects of ( 1 ) a physician peer leader intervention and ( 2 ) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement . And , to compare findings with previously reported patient-level outcomes of trial enrollees . STUDY SETTING Data were included on children 5 - 17 years old with asthma in 40 primary care practice s , affiliated with managed health care plans enrolled in the Pediatric Asthma Care Patient Outcomes Research Team ( PORT ) r and omized trial . STUDY DESIGN Primary care practice s were r and omly assigned to one of two care improvement arms or to usual care . Automated cl aims data were analyzed for 12-month periods using a repeated cross-sectional design . The primary outcome was evidence of at least one controller medication dispensed among  patients  with persistent asthma . Secondary outcomes included controller dispensing among all identified asthmatics , evidence of chronic controller use , and the dispensing of oral steroids . Health service utilization outcomes included numbers of ambulatory visits and hospital-based events . PRINCIPAL FINDINGS The proportion of children with persistent asthma prescribed controllers increased in all study arms . No effect of the interventions on the proportion receiving controllers was detected ( peer leader intervention effect 0.01 , 95 percent confidence interval [ CI ] : -0.07 , 0.08 ; planned care intervention effect -0.03 , 95 percent CI : -0.09 , 0.02 ) . A statistical trend was seen toward an increased number of oral corticosteroid bursts dispensed in intervention practice s. Significant adjusted increases in ambulatory visits of 0.08 - 0.10 visits per child per year were seen in the first intervention year , but only a statistical trend in these outcomes persisted into the second year of follow-up . No differences in hospital-based events were detected . CONCLUSIONS This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions , using automated data . The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees . Analysis of automated data on nonenrollees adds information about practice -level impact of care improvement strategies . Benefits of practice -level interventions may accrue disproportionately to the subgroup of trial enrollees . The effect of such interventions may be less apparent at the level of practice s or health plans A r and omized control trial of a curriculum , A.C.T. ( Asthma Care Training ) for Kids , was conducted . Seventy-six children between the ages of 8 and 12 years , whose asthma required treatment with medications at least 25 % of the days per month , were r and omly assigned to control and experimental groups . The control group received 4 1/2 hours of lecture presentations on asthma and its management . The experimental groups ( consisting of four to seven children and their parents ) received five 1-hour sessions comprising " the treatment . " Children and their parents were interviewed before the sessions and 3 , 6 , and 12 months after the completion of the experimental treatment . Use of emergency rooms and hospitals was determined by review ing the records of these patients ( all members of the Los Angeles Kaiser Permanente health care system ) for the period of 1 year before and 1 year after the treatment . Results include ( 1 ) equivalent increases in knowledge and changes in beliefs in both groups , ( 2 ) significant changes in the self-reported compliance behaviors of the experimental group only , and ( 3 ) significant reductions in emergency room visits and days of hospitalization among those receiving the experimental treatment , compared with the control group . These changes represent an estimated savings of approximately $ 180 per child per year for those in the experimental group Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment . The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma . Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and r and omized into either a st and ard asthma education ( SAE ) or a symptom/nebulizer education intervention ( SNEI ) . Data included home visit records and parent 's self-report on question naires . Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration date s and the frequency of cleaning nebulizer device and equipment . However , significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group ( p = 0.05 ) . Of concern is that only 38 % of all parents reported having an asthma action plan in the home . A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma . Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices This r and omized clinical trial evaluated the long-term impact of an interactive seminar for physicians  based on principles of self-regulation on clinician behaviour , children 's use of health services for asthma , and parent 's views of physician performance . Seventy-four general practice paediatricians , and 637 of their asthma patients aged 1 - 12 yrs , were r and omized to treatment or control . Children and parents were blind to physicians ' participation . Data were collected at baseline and follow-up through self-administered surveys ( paediatricians ) , telephone interviews ( parents ) and medical records . The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines . Approximately 2 yrs postintervention , treatment group physicians were more likely than control physicians to : use protocol s for delivering asthma education ( odds ratio ( OR ) 4.9 , p=0.2 ) , write down for patients how to adjust medicines when symptoms change ( OR 5.7 , p=0.05 ) , and provide more guidelines for modifying therapy ( OR 3.8 , p=0.06 ) . Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours . Children seen by treatment group physicians had fewer hospitalizations ( p=0.03 ) and those with higher levels of emergency department ( ED ) use at baseline had fewer subsequent ED visits ( p=0.03 ) . No differences regarding the number of office visits were noted . There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits ( 26 versus 29 min ) or in the number of patients treated with anti-inflammatory medicine . It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care AIM To compare a nurse-led clinic in schools versus care in general practice for adolescents with asthma .  DESIGN OF STUDY R and omised controlled trial in four schools ; parallel observational study in two schools . SETTING Six comprehensive schools . METHOD In the r and omised trial , pupils were invited to attend asthma review  at a  nurse-led clinic  either in school , or in general practice . The parallel observational study compared pupils invited to practice care within and outside the r and omised trial . Primary outcome measures were attendance for asthma review , symptom control , and quality of life . Secondary outcomes were knowledge , attitudes , inhaler technique , use of steroids , school absence , peak flow rate , preference for future care , health service utilisation , and costs . RESULTS School clinic pupils were more likely to attend an asthma review than those r and omised to practice care ( 90.8 % versus 51.0 % overall [ P < 0.001 , not consistent across schools ] ) . No differences were observed in symptom control ( P = 0.42 ) or quality of life ( P = 0.63 ) . Pupils attending school clinics had greater knowledge of asthma ( difference = + 0.38 , 95 % CI = 0.19 to 0.56 ) , more positive attitudes ( difference = + 0.21 , 95 % CI = 0.05 to 0.36 ) , and better inhaler technique ( P < 0.001 , not consistent across all schools ) . No differences were observed in school absence or peak flow rate . A majority ( 63 % ) of those who had received care at school preferred this model in future . Median costs of providing care at school and at the practice were 32.10 Pounds and 19.80 Pounds , respectively . No differences were observed between the groups in the observational comparison on any outcome . CONCLUSIONS The schools asthma clinic increased uptake of asthma review s. There were improvements in various process measures , but not in clinical outcomes Children with asthma are at special risk for problems in psychological functioning , as are children with other chronic illnesses . We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma . Eighty-one children were r and omly assigned to an  intervention  or a control group ; 56 children completed data collection , 29 intervention and 27 control . Psychological status was assessed by the Child Behavior Checklist ( CBCL ) before and after the intervention , as were children 's knowledge of asthma , stress ( as measured by children 's life events ) , and functional status ( as indicated by such activities as school attendance , time playing with friends , and daily chore performance ) . Children in the intervention group had a significant improvement in the total Behavior Problems score ( p < .04 ) and Internalizing scale ( p < .01 ) on the CBCL and a significant increase in daily chores ( p < .04 ) compared with the control group . Before intervention , the two groups had statistically significant positive relationships between negative life events and behavior problem scores . After intervention , children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores , although participation in the intervention group negated that relationship . Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores ( p < .02 ) . We conclude that the intervention had a beneficial effect on psychological status and on children 's daily activities . The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment Abstract Objectives To assess the feasibility and effectiveness of a general practice based , proactive system of asthma care in children . Design R and omised controlled trial with cluster sampling by general practice . Setting General practice s in the northern region of the Australian Capital Territory . Participants 174 children with moderate to severe asthma who attended 24 general practitioners . Intervention System of structured asthma care ( the 3 + visit plan ) , with participating families reminded to attend the general practitioner . Main outcome measures Process measures : rates for asthma consultations with general practitioner , written asthma plans , completion of the 3 + visit plan ; clinical measures : rates for emergency department visits for asthma , days absent from school , symptom-free days , symptoms over the past year , activity limitation over the past year , and asthma drug use over the past year ; spirometric lung function measures before and after cold air challenge . Results Intervention group children had significantly more asthma related consultations ( odds ratio for three or more asthma related consultations 3.8 ( 95 % confidence interval 1.9 to 7.6 ; P = 0.0001 ) , written asthma plans ( 2.2 ( 1.2 to 4.1 ) ; P = 0.01 ) , and completed 3 + visit plans ( 24.2 ( 5.7 to 103.2 ) ; P = 0.0001 ) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6 % ( 1.7 to 3.5 ) ; P = 0.0001 ) less than control children . The number needed to treat ( benefit ) for one additional written asthma action plan was 5 ( 3 to 41 ) children . Intervention group children had lower emergency department attendance rates for asthma ( odds ratio 0.4 ( 0.2 to 1.04 ) ; P = 0.06 ) and less speech limiting wheeze ( 0.2 ( 0.1 to 0.4 ) ; P = 0.0001 ) than control children and were more likely to use a spacer ( 2.8 ( 1.6 to 4.7 ) ; P = 0.0001 ) . No differences occurred in number of days absent from school or symptom-free day scores . Conclusions Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial To evaluate a health education program to improve family management of asthma , 310 children with asthma and their 290 parents were r and omly assigned to a program or control group . Program families participated in health education design ed to resolve specific management problems and build self-confidence in the ability to manage asthma . Following education , program parents scored better on an asthma self-management index than parents in the control group ( + 1.57 versus -0.83 , P less than 0.0001 ) . Program parents also scored better on two subindices of the self-management index : attack management ( + 0.87 vs. + 0.42 , P less than 0.05 ) and preventive measures ( + 0.42 vs. -0.35 , P less than 0.05 ) . Also , program parents reported significantly more use of guidelines to determine appropriate levels of physical activity for children . Following education , program children reported more use of three management steps than control children : productive cough or postural drainage ( 59 % vs. 35 % , P less than 0.004 ) , breathing and relaxation exercises ( 80 % vs. 65 % , P less than 0.05 ) , and attempts to stay calm ( 12 % vs. 2 % , P less than 0.05 ) . Program children reported significantly less worry than control children about the limitations asthma imposes and about making mistakes at school OBJECTIVE To conduct a controlled trial of a home-based education program for low-income caregivers of young children with asthma . METHODS Participants were r and omized to treatment-eight weekly asthma education sessions adapted from the Wee Wheezers program ( n = 49)-or usual care ( n = 46 ) . Baseline and 3- and 12-month follow-up data were gathered from caregivers and from children 's medical records . RESULTS Treatment was associated with less bother from asthma symptoms , more symptom-free days , and better caregiver quality of life at follow-up for children 1 - 3 , but not those 4 - 6 , years of age . Treatment and control groups did not differ in caregiver asthma management behavior or children 's acute care utilization . CONCLUSIONS This home-based asthma education program was most effective with younger children ; perhaps their caregivers were more motivated to learn about asthma management . Targeting psychosocial factors associated with asthma morbidity might also enhance the efficacy of asthma education for these families OBJECTIVES To evaluate health care and financial outcomes in a population of Medicaid-insured asthmatic children after a comprehensive asthma intervention program .  DESIGN Controlled clinical trial . SETTING Pediatric allergy clinic in an urban , tertiary care children 's hospital . SUBJECTS Eighty children , 2 to 16 years old , with a history of frequent use of emergent health care services for asthma . Intervention . Children in the intervention group received asthma education and medical treatment in the setting of a tertiary care pediatric allergy clinic . An asthma outreach nurse maintained monthly contact with the families enrolled in the intervention group . OUTCOME MEASURES Emergency department ( ED ) visits , hospitalizations , and health care charges per patient in the year after enrollment . RESULTS Baseline demographics did not differ significantly between the 2 groups . In the year before the study , there were no significant differences between intervention and control children in ED visits ( mean , 3.5 per patient ) , hospitalizations ( mean,.6 per patient ) or health care charges ( $ 2969 per patient ) . During the study year , ED visits decreased to a mean of 1.7 per patient in the intervention group and 2.4 in controls , while hospitalizations decreased to a mean of.2 per patient in the intervention group and .5 in the controls . Average asthma health care charges decreased by $ 721/child/year in the intervention group and by $ 178/patient/year in the control group . CONCLUSIONS A comprehensive asthma intervention program for Medicaid-insured asthmatic children can significantly improve health outcomes while reducing health care costs.asthma education , health care outcomes , Medicaid , asthma outreach , utilization A r and omized trial of an instructional method was conducted in which school nurses taught children asthma self-management principles and skills , including peak flow monitoring , in 20-min , individual sessions over an 8-week period . Thirty-six children participated . An intervention group of 18 children received the teaching sessions .  A control group of 18 children received regular care by the nurses , but no teaching sessions .  The sample included 64 % boys , 69 % African-Americans , and 69 % Medicaid recipients . The average age of subjects was 10.2 years . The two groups were demographically similar , but despite r and om assignment , the control group had a significantly earlier age of onset of asthma and tended to have had more asthma attacks in the preceding year . These factors were statistically controlled in outcome analyses . Results of group comparisons showed no significant differences in the number of postintervention emergency room visits and days absent from school . However , nurses reported that children who practice d breathing exercises had less anxiety during exacerbations , and the nurses ' knowledge of the children 's baseline peak expiratory flow rates facilitated care of the children . Nurses expressed the opinion that the individual sessions with students might be useful in motivating them to participate effectively in later group sessions . The intervention was well accepted by students , parents , and nurses . We believe that this intervention is promising as a practical , low-cost approach to enhancing children 's asthma self-management skills and warrants further testing in a larger sample , with the intervention conducted over a longer period BACKGROUND Despite significant medical advances , many ethnic and racial minority children who live in inner cities continue to experience disproportionately high levels of asthma morbidity and mortality compared with white children . As a result , a growing number of psychosocial asthma management interventions are being developed to address their needs ; however , only a few of these interventions have incorporated cultural variables into their treatments and have had their efficacy evaluated . OBJECTIVE To examine the efficacy of the Multifamily Asthma Group Treatment ( MFAGT ) , design ed to enhance asthma management and reduce emergency department ( ED ) visits among African American and Hispanic families . METHODS Twenty-four African American and Hispanic families who have children with asthma were r and omly assigned to either the MFAGT or the St and ard Psychoeducational Asthma Intervention . Differences in the number of ED visits and the level of asthma management in both groups were compared 1 year before and 1 year after the intervention . In addition , these groups were contrasted to a control group that did not receive any psychoeducational intervention . RESULTS The MFAGT was significantly ( P = .04 ) more effective than the St and ard Psychoeducational Asthma Intervention and the control in decreasing ED visits and increasing parental asthma knowledge . CONCLUSIONS These preliminary results suggest that the MFAGT is efficacious in enhancing asthma management and in reducing ED visits in inner-city African American and Hispanic children from a lower socioeconomic background The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches . The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches . A total of 74 newly referred children with asthma were r and omly assigned to a 1‐yr follow-up by paediatricians or asthma nurse . Healthcare utilisation was recorded and associated costs calculated for both management approaches . There were no significant differences in healthcare utilisation except for the total time spent on patient contact ( 136(n=14 ) versus 187(n=41 ) min , for patients followed-up by paediatrician and an asthma nurse repectively ) . Costs within the healthcare sector were reduced by 7.2 % in favour of nurse-led care . The reduction in costs was solely attributable to a 17.5 % reduction in the costs of outpatient visits . Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor 's visits . Overall healthcare costs ( within and outside the healthcare sector ) were 4.1 % lower for nurse-led outpatient management compared to traditional medical care . Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians Abstract Objective : To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma . Design : Cluster r and omised controlled trial . Setting : Six high schools in rural Australia . Participants : 272 students with recent wheeze , recruited from a cohort of 1515 students from two school years ( mean age 12.5 and 15.5 years ) ; 251 ( 92.3 % ) completed the study . Intervention : A structured education programme for peers comprising three steps ( the “ Triple A Program ” ) . Main outcome measures : Quality of life , school absenteeism , asthma attacks , and lung function . Results : When adjusted for year and sex , mean total quality of life scores showed significant improvement in the intervention than control group . Clinical ly important improvement in quality of life ( > 0.5 units ) occurred in 25 % of students with asthma in the intervention group compared with 12 % in the control group ( P=0.01 ) . The number needed to treat was 8 ( 95 % confidence interval 4.5 to 35.7 ) . The effect of the intervention was greatest in students in year 10 and in females . Significant improvements occurred in the activities domain ( 41 % v 28 % ) and in the emotions domain ( 39 % v 19 % ) in males in the intervention group . School absenteeism significantly decreased in the intervention group only . Asthma attacks at school increased in the control group only . Conclusion : The triple A programme leads to a clinical ly relevant improvement in quality of life and related morbidity in students with asthma . Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in 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 BACKGROUND Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines . OBJECTIVE To evaluate the effectiveness of 2 asthma care improvement strategies in primary care . DESIGN Two-year r and omized controlled clinical trial . SETTING Forty-two primary care pediatric practice s affiliated with 4 managed care organizations . PARTICIPANTS Children aged 3 to 17 years with mild to moderate persistent asthma enrolled in primary care practice s affiliated with managed care organizations . INTERVENTIONS Peer leader education consisted of training 1 physician per practice in asthma guidelines and peer teaching methods . Planned care combined the peer leader program with nurse-mediated organizational change through planned visits with assessment s , care planning , and self-management support , in collaboration with physicians . Analyses compared each intervention with usual care . MAIN OUTCOME MEASURES Annualized asthma symptom days , asthma-specific functional health status ( Children 's Health Survey for Asthma ) , and frequency of brief oral steroid courses ( bursts ) . RESULTS Six hundred thirty-eight children completed baseline evaluations , representing 64 % of those screened and eligible . Mean + /- SD age was 9.4 + /- 3.5 years ; 60 % were boys . Three hundred fifty ( 55 % ) were taking controller medication .  Mean + /- SD annualized asthma symptom days was 107.4 + /- 122 days . Children in the peer leader arm had 6.5 fewer symptom days per year ( 95 % confidence interval [ CI ] , - 16.9 to 3.6 ) , a nonsignificant difference , but had a 36 % ( 95 % CI , 11 % to 54 % ) lower oral steroid burst rate per year compared with children receiving usual care . Children in the planned care arm had 13.3 ( 95 % CI , - 24.7 to -2.1 ) fewer symptom days annually ( -12 % from baseline ; P = .02 ) and a 39 % ( 95 % CI , 11 % to 58 % ) lower oral steroid burst rate per year relative to usual care . Both interventions showed small , statistically significant effects for 2 of 5 Children 's Health Survey for Asthma scales . Planned care subjects had greater controller adherence ( parent report ) compared with usual care subjects ( rate ratio , 1.05 [ 95 % CI , 1.00 to 1.09 ] ) . CONCLUSIONS Planned care ( nurse-mediated organizational change plus peer leader education ) is an effective model for improving asthma care in the primary care setting . Peer leader education on its own may also serve as a useful model for improving asthma care , although it is less comprehensive and the treatment effect less pronounced BACKGROUND Asthma is an important cause of morbidity , absence from school , and use of health services among children .  Computer-based educational programs can be design ed to enhance children 's self-management skills and to reduce adverse outcomes . OBJECTIVE To assess the effectiveness of an interactive device programmed for the management of pediatric asthma . DESIGN A r and omized controlled trial ( 66 participants were in the intervention group and 68 were in the control group ) . SETTING Interventions conducted at home and in an outpatient hospital clinic . PARTICIPANTS Inner-city children aged 8 to 16 years diagnosed as having asthma by a physician . INTERVENTION An asthma self-management and education program , the Health Buddy , design ed to enable children to assess and monitor their asthma symptoms and quality of life and to transmit this information to health care providers ( physicians , nurses , or other case managers ) through a secure Web site . Control group participants used an asthma diary . MAIN OUTCOME MEASURES Any limitation in activity was the primary outcome . Secondary outcomes included perceived asthma symptoms , absence from school , any peak flow reading in the yellow or red zone , and use of health services . RESULTS After adjusting for covariates , the odds of having any limitation in activity during the 90-day trial were significantly ( P = .03 ) lower for children r and omized to the Health Buddy . The intervention group also was significantly ( P = .01 ) less likely to report peak flow readings in the yellow or red zone or to make urgent calls to the hospital ( P = .05 ) . Self-care behaviors , which were important correlates of asthma outcomes , also improved far more for the intervention group . CONCLUSION Compared with the asthma diary , monitoring asthma symptoms and functional status with the Health Buddy increases self-management skills and improves asthma outcomes BACKGROUND Accurate symptom evaluation is a critical component of asthma management . Limited data are available about the accuracy of symptom evaluation by children with asthma and their parents , or the impact of various symptom-monitoring strategies on asthma morbidity outcomes . OBJECTIVE The purpose of this r and omized clinical trial was to evaluate the effect of three different intensities of symptom monitoring on asthma morbidity outcomes . METHODS One hundred sixty-eight children ( ages 6 to 19 ) of diverse racial , geographic , and socioeconomic background s were r and omized to 1 of 3 treatment groups ( subjective symptom evaluation , symptom-time peak expiratory flow rate ( PEFR ) monitoring , daily PEFR monitoring ) in this longitudinal , clinical trial . Outcome measures included a summary asthma severity score , forced expiratory volume in 1 second , symptom days , and health care utilization . RESULTS Children who used PEFR meters ( PFMs ) when symptomatic had a lower asthma severity score , fewer symptom days , and less health care utilization than children in the other two treatment groups . Minority and poor children had the greatest amount of improvement using PFMs when symptomatic . Results were much less striking in white families . Thirty percent of families in the PFM treatment groups discontinued use entirely by 1 year postexit , whereas the majority of families who continued use ( 94 % ) used them only when symptomatic to inform symptom interpretation and management decisions . CONCLUSIONS Not every child with asthma needs a PFM . Children and families facing extra challenges as a result of illness severity , sociodemographic , or health care system characteristics clearly benefited most from PFM use STUDY OBJECTIVES To determine whether an interactive physician seminar that has been shown to improve patient/parent satisfaction and to decrease emergency department visits for children with asthma was also effective for those children from low-income families . DESIGN Seventy-four pediatricians and 637 of their patients were r and omized to receive two  asthma seminars or no educational programs and were observed for 2 years . SETTING Physicians in the New York , NY , and Ann Arbor , MI , areas were enrolled , and , on average , 10 patients with asthma per provider were surveyed and observed for 2 years . PATIENTS OR PARTICIPANTS A total of 637 subjects were enrolled , and 369 subjects remained in the study after 2 years . Of these , 279 had complete medical and survey information . INTERVENTIONS Physicians were r and omized , and then a r and om sample of their patients was enrolled and surveyed regarding the physician 's communication style , the child 's asthma symptoms , medical needs , and asthma care . Low income was defined as annual income of < 20,000 dollars . MEASUREMENTS AND RESULTS The families of 36 children ( 13 % ) had an income of < 20,000 dollars , and they were treated by 23 physicians . Low-income children in the treatment group tended to have higher levels of use of controller medications , to receive a written asthma action plan , and to miss fewer days of school , although these differences were not statistically significant compared to low-income children in the control group . However , low-income treatment group children were significantly less likely to be admitted to an emergency department ( annual rate , 0.208 vs 1.441 , respectively ) or to a hospital ( annual rate , 0 vs 0.029 , respectively ) for asthma care compared to children in the control group . CONCLUSIONS The educational program for physicians improved asthma outcomes for their low-income patients . Provider interventions targeted to these high-risk patients may diminish hospital and emergency department asthma care BACKGROUND Asthma is common and is often poorly controlled in adolescent subjects . OBJECTIVE To determine the impact of an age-specific asthma program on asthma control , particularly on exacerbations of asthma requiring emergency department treatment , and on the quality of life of adolescents with asthma . METHODS The present r and omized , controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma . The interventional group attended an age-specific asthma program that included assessment , education and management by a team of asthma educators , respiratory therapists and respiratory physicians . In the control group , spirometry was performed , and the patients continued to receive usual care from their regular physicians . The outcomes were assessed by a question naire six months after entry into the study . RESULTS Ninety-three subjects entered the study and were r and omly assigned to the intervention or control group . Of these , only 62 patients were available for review after six months . Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control , reflected primarily by a 73 % reduction in the rate of emergency department attendance for asthma . Other indexes of disease control , including disease-specific quality of life , as assessed by question naires , were improved . There was , however , no discernible difference between the subjects in the two groups , with the exception of an improvement in favour of the intervention group in the symptom ( actual difference 0.7 , P=0.048 ) and emotional ( actual difference 0.8 , P=0.028 ) domains of the asthma quality of life question naire . The overall quality of life score favoured the intervention group by a clinical ly relevant difference of 0.6 , but this difference did not reach statistical significance ( P=0.06 ) . CONCLUSIONS Although all subjects demonstrated a significant improvement in asthma control and quality of life , the improvement attributable to this intervention was limited to two domains in disease-specific quality of life A small , controlled trial of joint treatment of childhood asthma by a doctor , a physiotherapist , a psychologist , and a social worker , working together in the family setting , demonstrated an improvement in ventilatory capacity . The limited scope of this trial does not permit more general conclusions as to the effect of such treatment on the severity and frequency of attacks , but the observation that some measurable physiological improvement occurred suggests that the place of multidisciplinary nonpharmaceutical management of childhood asthma should be investigated in more detail OBJECTIVE To evaluate an asthma education program for children with asthma that is delivered in their school by certified asthma educators from a local hospital-based asthma center . STUDY DESIGN R and omized controlled trial . SETTING Twenty-six elementary schools located in a suburb of Toronto . PARTICIPANTS A total of 256 children in grade s 2 to 5 with asthma and their parents were r and omized to control and experimental groups . INTERVENTION Children in the experimental group received the " Roaring Adventures of Puff " asthma education program over the course of six weekly 1-h sessions . Those in the control group continued receiving usual care . MEASUREMENTS AND RESULTS Data collection involved measuring asthma quality of life , self-efficacy for managing asthma , school absenteeism , days of interrupted activity , health services use , and parental loss of time from work . Quality of life and self-efficacy data were collected from the children at baseline and 2 months . Telephone parental interviews conducted over 1 year were used to collect data on the remaining variables . Unpaired t test , analysis of variance , and chi2 test were used to determine whether differences existed between the groups . The results are reported as the mean + /- SD . The experimental group demonstrated higher scores than the control group for self-efficacy ( 3.6 + /- 0.7 vs 3.8 + /- 0.9 , respectively ; p < 0.05 ) and quality of life ( 5.0 + /- 1.4 vs 5.5 + /- 1.4 , respectively ; p < 0.05 ) . At 1 year , the experimental group demonstrated fewer mean urgent health-care visits ( 2.5 + /- 2.5 vs 1.7 + /- 1.9 visits per year , respectively ; p < 0.01 ) , days of missed school ( 4.3 + /- 5.7 vs 3.0 + /- 4.4 days per year , respectively ; p > 0.05 ) , and days of interrupted activity ( 9.1 + /- 10.5 vs 6.2 + /- 7.3 days per year ; p < 0.01 ) related to asthma than the control group . There were no differences between the groups for parental work absenteeism or scheduled asthma visits . CONCLUSION Providing an asthma education program to children in their school can significantly improve quality of life and reduce the burden of childhood asthma Asthma is a very common chronic disease among preschool children in primary health care . Research has shown that planned and systematic patient education positively affects the management of asthma by parents . This study focuses on the question of whether an asthma patient education protocol that is used by general practitioners ( GPs ) has an effect on medical care consumption . The treatment group consisted of 28 GPs , representing 47 asthmatic infants . The control group contained 18 GPs , representing 38 patients . Data were collected from medical records ( with a written instrument ) for a 12-month period preceding and after the intervention period in which the education protocol was tested . Results indicated that sociodemographic variables and pretest data on asthma severity and medical care utilization were largely comparable for patients in both study groups . Furthermore , the treatment group showed a significantly greater decrease than the control group from pre- to post-test measurement in the number of contacts with the GP and the number of emergency visits to the physician 's office Our objective was to determine whether an  asthma education program in schools would have 1 ) a direct impact on student knowledge and attitudes to asthma and quality of life of the students with asthma , 2 ) an indirect impact on teacher knowledge and attitudes to asthma and on school policies about asthma , and 3 ) a sustainable program after the re sources to implement the research were withdrawn . Seventeen intervention and 15 control schools participated in a controlled trial . Baseline knowledge and attitudes were measured in year 8 students ( ages 13 - 14 years ) and their teachers together with quality of life in the students with asthma . A three-lesson package about asthma was delivered by teachers as part of the Personal Development/Health/Physical Education ( PD/H/PE ) curriculum . Follow-up question naires were administered to students and staff . Efforts to change school policies were documented . Five years after the intervention , PD/H/PE teachers were contacted to determine whether the program was still operating . Main outcome measures included asthma knowledge , attitudes , and quality of life . Question naires were returned by 4,161/4,475 of the year 8 students at baseline and by 3,443 at follow-up . In intervention schools , compared with control schools , students showed improved asthma knowledge ( P < 0.0001 ) , improvement in tolerance to asthma ( P = 0.02 ) , internal control ( P = 0.03 ) , and less tendency to believe in the role of chance in asthma control ( P = 0.04 ) . Students from intervention but not control schools showed significant improvements in overall quality of life ( P = 0.003 vs. P = 0.82 , respectively ) . Teachers from intervention schools showed significant increases in knowledge compared to control schools ( P < 0.0001 ) . Intervention schools were more likely to seek further health education about asthma ( P < 0.01 ) . Five years after the 35 schools involved in the development of the material s or the trial had been offered the Living With Asthma package , 25 ( 71 % ) were still teaching the program to most or all of their students . Fifty-nine of the 61 ( 97 % ) high schools in the Hunter Region now have the program . Management and distribution of the Living With Asthma program have been taken over by the Asthma Foundation of New South Wales . The package has been up date d and is being offered to all high schools throughout New South Wales as part of the National Asthma-Friendly Schools Project . In conclusion , a teacher-led asthma education program in secondary school had direct and indirect beneficial outcomes and was sustained at a high level for 5 years in most schools in the Hunter Region , despite minimal ongoing maintenance and support from health workers STUDY OBJECTIVES To examine the effectiveness of an interdisciplinary intervention for pediatric asthma . DESIGN R and omized , controlled study . SETTING Urban tertiary-referral pediatric hospital . PARTICIPANTS One hundred seventy-five patients with asthma lacking written treatment plans and presenting with asthma-related emergency department visits ( two or more ) and /or hospitalizations ( one or more ) in the past year were r and omized to a comparison group receiving medical care alone  ( n = 86 ) or to an interdisciplinary intervention group receiving medical care , asthma education , and problem-solving therapy  ( n = 89 ) INTERVENTION All participants received written asthma management plans , peak flow meters , and spacer devices . The intervention group also received asthma education , an asthma risk profile assessment , brief problem-solving therapy , and access to a 24-h nurse advice line . The primary outcome measure was change in asthma symptoms , and secondary outcomes included health-care utilization and asthma-related quality of life . RESULTS Both groups demonstrated significant reductions in asthma symptoms and improvements in quality of life without any between-group differences identified over the course of follow-up . In contrast , the intervention group demonstrated less frequent health-care utilization than the comparison group , with 28 % of the intervention group requiring emergency department or inpatient services for asthma compared to 41 % of the comparison group ( adjusted odds ratio , 1.92 ; 95 % confidence interval , 1.00 to 3.69 ) over the 12-month follow-up period . CONCLUSIONS This study examined the effectiveness of an interdisciplinary intervention for undertreated asthma . The intervention did not result in improvements in asthma symptoms , but accomplished modest reductions in the utilization of acute medical care This paper describes the results of an asthma self-management protocol delivered to parents of children aged 0 - 4 years . The protocol was delivered by general practitioners ( GPs ) , community nurses , asthma nurses , and doctors to child health centers . It consisted of 16 educational modules developed after an initial needs assessment of parents and a task analysis of primary care practitioners . The program was evaluated by means of an experimental design . Parents participating in the program had significantly more knowledge , a more favorable attitude toward asthma , and a higher self-efficacy score with respect to performing asthma self-management behaviors . Also , they reported performing self-management behaviors more frequently than parents in the control group . One-year follow-up results , which were collected for parents in the treatment group only , showed that the described changes were sustained . Further , the treatment group was found to have decreased its emergency and nonemergency use of the physician 's office and to have a reduction in ( reported ) asthma severity . Process evaluation indicated that most modules were provided by the GPs to nearly all parents . After parents had read the modules at home , almost all the information was discussed in the next contact . GPs seldom referred patients to the community nurses , although this was suggested in the protocol A clinic supervised by a nurse , using principles originally developed in general practice , was established in the paediatric department of a district general hospital . A r and omised controlled study was conducted comparing children admitted with asthma or attending out patients who were given a patient education programme and self management plan ( intervention group )  with a control group . The study comprised 91 patients aged 3 - 14 years admitted for asthma or attending a hospital outpatient department from November 1989 to November 1990 . Seventy seven patients completed the study and kept diaries for a median of 283 days . Patients in the intervention group had significantly less restriction of activity ( 95 % confidence interval ( CI ) -0.27 to -0.01 ) and fewer episodes of peak flow below 30 % of best ( 95 % CI 0.03 to 1.17 ) . Patients in the intervention group were more likely to make the correct response to an acute exacerbation of their asthma than the control group ( 71 % v 47 % , 95 % CI 9.51 to 39.1 ) . The intervention group had fewer school absences and fewer home visits by a general practitioner . There was an increase in the readmission rate for the intervention group . A subgroup of patients who self managed by doubling their use of inhaled steroids during an exacerbation performed better than those patients who only increased their bronchodilator or were managed on salbutamol or sodium cromoglycate alone . Improvements in patient follow up and the structure of the self management plans used , particularly changing the peak flow level at which inhaled steroids are doubled , may further improve the outcome of patients attending the asthma clinic The Self-Care Rehabilitation in Pediatric Asthma ( SCRPA ) project was design ed to ascertain ( 1 ) the level to which children with asthma are able to acquire the asthma knowledge and skills presented in a self-management training program conducted by the American Lung Association of Utah and ( 2 ) the effect of such training on the asthma experience . The preschool SCRPA Curriculum ( ages 2 - 5 ) consisted of six 1-hour classes scheduled twice a week for 3 weeks . The first and last classes were for one or both parents only , and the middle four sessions were for the child and parent(s ) . The school-age SCRPA curriculum ( ages 6 - 14 ) consisted of eight 90-minute classes for both child and parent(s )  scheduled twice a week for 4 weeks . Private physicians referred 21 preschool children and 38 school-age children into the program . The school-age children were r and omly assigned to a study or control group , and the preschool children served as their own controls . A comparison of asthma episodes during the 3 months before and after training showed a statistically significant decrease in the number of episodes but no change in severity in the preschool , school study , and school control groups . The decrease in episodes for the control groups suggest that the family record keeping required of all subjects may have a beneficial effect , a phenomenon worth further investigation . Also , the school-age group , in pre- and posttesting , demonstrated that the SCRPA curriculum increased knowledge and skills in the study group , changes not found in the control group The goal of this study was to determine the effectiveness of an asthma educational intervention in improving asthma knowledge , self-efficacy , and quality of life in rural families . Children 6 to 12 years of age ( 62 % male , 56 % white , and 22 % Medicaid ) with persistent asthma ( 61 % ) were recruited from rural elementary schools and r and omized into the  control st and ard asthma education ( CON ) group or an interactive educational intervention (  INT )  group geared toward rural families .  Parent/caregiver and child asthma knowledge , self-efficacy , and quality of life were assessed at baseline and at 10 months post enrollment . Despite high frequency of symptom reports , only 18 % children reported an emergency department visit in the prior 6 months . Significant improvement in asthma knowledge was noted for INT parents and young INT children at follow-up ( Parent : CON = 16.3 ; INT = 17.5 , p < 0.001 ; Young children : CON = 10.8 , INT = 12.45 , p < 0.001 ) . Child self-efficacy significantly increased in the INT group at follow-up ; however , there was no significant difference in parent self-efficacy or parent and child quality of life at follow-up . Asthma symptom reports were significantly lower for the INT group at follow-up . For young rural children , an interactive asthma education intervention was associated with increased asthma knowledge and self-efficacy , decreased symptom reports , but not increased quality of life BACKGROUND Improving asthma knowledge and self-management is a common focus of asthma educational programs , but most programs have had little influence on morbidity outcomes . We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care . OBJECTIVE To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk , school-aged children with asthma . METHODS We enrolled 119 children aged 5 to 12 years from low-income , urban areas in and around San Francisco , CA , and San Jose , CA . Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were r and omized to participate in the disease management intervention or to receive their usual care ( control group ) . Patients were evaluated for clinical and quality -of-life outcomes at weeks 8 , 32 , and 52 of the study . RESULTS Compared with controls , the intervention group had significant improvements in the physical domain ( P = .04 and P = .01 at 32 and 52 weeks , respectively ) and social activity domain ( P = .02 and P = .05 at 32 and 52 weeks , respectively ) of asthma quality of life on the Child Health Survey for Asthma and child ( P = .02 at 8 weeks ) and parent ( P = .04 and .004 at 32 and 52 weeks , respectively ) asthma self-management knowledge . There were no significant differences between groups on clinical outcome variables . CONCLUSIONS A multicomponent educational , behavioral , and medical intervention targeted at high-risk , inner-city children with asthma can improve asthma knowledge and quality of life To address the recent rise in asthma morbidity and mortality in Russia , an intervention study was conducted to improve asthma diagnosis , treatment and prevention . US recommendations for asthma management were adapted for use in educating Moscow families with children with asthma . Two hundred and fifty-two children with asthma aged 4 - 14 years receiving health care in eight Moscow public health clinics together with their parents were enrolled in the study to see whether US teaching manuals for asthma management would be acceptable and effective in Russia . Children at four of the clinics with recent asthma attacks were r and omly assigned to either the education or control group to test if patient education and guided asthma care would improve outcomes for patients . Modern medications were made available to both groups to see if training in the US guidelines was necessary to get physicians to use the medications . Children with recent asthma attacks at the other four clinics were defined as comparison group 1 to control for the possible effect of medication availability . All children at the eight clinics who had no asthma attacks composed comparison group 2 to see if the outcomes for these children would change over time . One-year follow-up results showed significant improvement in asthma self-management skills of children and parents , in terms of asthma treatment , only among those in the education group . Significant increases were observed in the subgroup of children in the education group using anti-inflammatory drugs for asthma control . Children in the education group had markedly increased peak flow rates and reduced daily peak flow variability as compared to control and comparison groups . There was a significantly greater reduction in doctor visits by the education group of children compared to control . Presumably , changes in parents ' and children 's behaviour in terms of asthma treatment and prevention skills , proper treatment of the disease and access to medications could be responsible for reducing asthma morbidity in children BACKGROUND We have previously reported a high prevalence of current asthma-related symptoms affecting predominantly Hispanic , socioeconomically disadvantaged schoolchildren in Southeast San Diego . OBJECTIVE We sought to assess the impact of a school-based education program on asthma outcomes . METHODS In cooperation with the San Diego Unified Schools , we developed and implemented a school-based asthma education program . Based on the National Heart , Lung , and Blood Institute consensus guidelines for asthma , the five-session bilingual , interactive curriculum was conducted in 20-minute segments . Asthma knowledge was tested before and after the education program , and asthma severity was prospect ively assessed at monthly intervals . Outcome parameters were compared in educated and control ( noneducated ) fourth grade students with asthma by using nonparametric techniques . RESULTS After asthma education , students demonstrated improvement with increases in mean scores for : asthma knowledge quiz from 9.9 ( SEM = 0.44 , n = 34 ) to 13.7 ( SEM = 0.30 ) ; peak flowmeter technique from 3.9 ( SEM = 0.33 , n = 32 ) to 6.4 ( SEM = 0.29 ) ; and inhaler technique from 2.3 ( SEM = 0.26 , n = 32 ) to 4.3 ( SEM = 0.26 ) . All changes were highly significant ( p < or = 0.00001 as determined by Wilcoxon matched-pairs signed-rank test ) . Mean score comparisons for asthmatic control students given paired examinations after a time interval matched with the educated students , did not reach statistical significance : quiz score of 11.3 ( SEM = 0.80 , n = 11 ) versus 10.9 ( SEM = 0.68 ) , peak flowmeter technique score of 2.6 ( SEM = 0.50 , n = 18 ) versus 3.1 ( SEM = 0.37 ) , and inhaler technique score of 2.5 ( SEM = 0.37 , n = 18 ) versus 2.2 ( SEM = 0.31 ) . Prospect i ve monthly data were collected on 27 educated and 15 control asthmatic subjects .  Severity of asthma was not significantly different between groups at entry to the study . Symptom question naires , vali date d for functional asthma severity , revealed a significant reduction in mean symptom scores at 180 days for the educated ( 2.87 , SEM = 0.447 ) versus the control ( 4.36 , SEM = 0.573 ) groups ( p = 0.0188 as determined by the Mann-Whitney U test ) . CONCLUSION Child-centered asthma education can be successfully conducted in the school setting , result ing in increased asthma knowledge , improved skills for peak flowmeter and inhaler use , and a reduction in the severity of asthma symptoms We asked whether the addition of PEF recordings to a symptom-based self-management plan improved outcome in school children with asthma . In an open-r and omized , parallel-group , controlled trial , we studied children aged 7 - 14 years with moderate asthma . After a 4-week run-in , 90 children were r and omized to receive either PEF plus symptom-based management or symptom-based management alone for 12 weeks . Thresholds for action based on PEF were 70 % of best ( for increasing inhaled steroids ) and 50 % of best ( for commencing prednisolone ) . Children were asked to perform twice-daily spirometry at home ( using an electronic recording spirometer that revealed only PEF to the study group alone ) and to record a symptom diary . The mean daily symptom score was the main outcome . There were no differences between groups in mean symptom score or in spirometric lung function , PEF , quality of life score , or reported use of health services over 12 weeks . During acute episodes , children responded to changes in symptoms by increasing their inhaled steroids at a mean value of PEF of greater than 70 % of best so that overall PEF did not contribute to this important self-management decision . Knowledge of PEF did not enhance self-management even during acute exacerbations OBJECTIVES This report presents both age-adjusted and unadjusted statistics from the 2004 National Health Interview Survey ( NHIS ) on selected health measures for children under 18 years of age , classified by sex , age , race , Hispanic origin , family structure , parent 's education , family income , poverty status , health insurance coverage , place of residence , region , and current health status . The topics covered are asthma , allergies , learning disability and Attention Deficit Hyperactivity Disorder ( ADHD ) , prescription medication use , respondent-assessed health status , school-loss days , usual place of health care , time since last contact with a health care professional , selected measures of health care access and utilization , and dental care . SOURCE OF DATA The NHIS is a multistage probability sample survey conducted annually by interviewers of the U. S. Census Bureau for the Centers for Disease Control and Prevention 's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States . Data are collected for all family members during face-to-face interviews with adults present at the time of interview . Additional information about children is collected for one r and omly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child 's health . SELECTED HIGHLIGHTS In 2004 , most U.S. children under 18 years of age had excellent or very good health ( 82 % ) . However , 9 % of children had no health insurance coverage , and 5 % of children had no usual place of health care . Twelve percent of children had ever been diagnosed with asthma . An estimated 8 % of children 3 - 17 years of age had a learning disability , and an estimated 7 % of children had ADHD OBJECTIVE To assess the effect of a structured program of pharmaceutical care on changes in disease control , functional status , and health services utilization for pediatric and adolescent patients with moderate-to-severe asthma . DESIGN R and omized , controlled trial . SETTING Community and clinic pharmacies ( 14 intervention and 18 usual care pharmacies ) in western Washington State . PATIENTS Three hundred thirty children , aged 6 to 17 years , with asthma . INTERVENTION Structured training for the intervention group pharmacists to provide individualized asthma management services during patient-pharmacist encounters for up to 1 year following the patient 's enrollment into the study . MAIN OUTCOME MEASURES The primary outcome measure was change in pulmonary function as measured by peak expiratory flow rate and spirometry . Secondary outcome measures included changes in functional status and use of asthma-related health care services . RESULTS The intervention had no significant effect on the health or health services use outcomes of study subjects . When compared with the usual care group , there was no evidence that patients from the intervention group experienced improvements in pulmonary function , functional status , quality of life , asthma management , or satisfaction with care . In addition , there were no differences between groups in use of anti-inflammatory medications , total or asthma-related medical care utilization , or total or asthma-related school days lost . CONCLUSION This pharmaceutical care intervention had no significant effect on the health or health services use outcomes of pediatric patients with asthma . The intervention may not have been powerful enough to significantly affect pharmacists ' behaviors and asthma patients ' outcomes in community pharmacy setting s , and there is evidence that the pharmacists ' compliance with the study protocol was low due , in part , to patient- and practice -related obstacles OBJECTIVE To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program . METHODS Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were r and omly assigned to control and intervention groups . Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program . Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking .  Pediatric Asthma Care Knowledge Survey , Pediatric Asthma Caregiver 's Quality of Life Question naire , asthma symptom history , spirometry , and health services utilization data were collected at the initial visit and at 3 and 12 months . RESULTS Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers , decreased asthma symptom days ( 81 vs 51 per year ) , and decreased number of emergency department visits ( 1.93 vs 0.62 per year ) among the intervention group participants . The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids ( 434 vs 754 micro g [ beclomethasone equivalents ] ) at visit 3 . Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits ( r = 0.37 ) and less frequent use of quick-relief medicines ( r = 0.30 ) . CONCLUSIONS Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma The increased prevalence , morbidity , mortality , and health costs associated with asthma among children suggest the need for accessible asthma education . This study examined the effect of telepharmacy counseling , using interactive compressed video , on metered-dose inhaler ( MDI ) technique and patient satisfaction among adolescents with asthma in rural Arkansas . The telepharmacy counseling provided accessible education regarding MDI technique for adolescents in this study . Twenty percent of the adolescents who participated had never been shown the appropriate use of an MDI . The study used an experimental design with r and om assignment of participants to a  telepharmacy counseling group ( n = 15 ) or a control group ( n = 21 ) . Both groups participated in pre-test , post-test , and 2- to 4-week follow-up assessment s for MDI technique and patients satisfaction ( follow-up assessment only ) via interactive compressed video . Results indicated that from pre-test to follow-up the telepharmacy counseling group showed more improvement in MDI technique than participants in the control group ( p < 0.001 ) . There was no significant difference between the telepharmacy counseling group and control group in satisfaction with the instructional sessions ( p = 0.132 ) . Both groups had high levels of satisfaction with the telepharmacy sessions . The study findings demonstrated that patient education provided by pharmacists via interactive compressed video was superior to education provided via written instructions on an inhaler package insert . Interactive compressed video is an effective medium for teaching and improving MDI technique in this rural , adolescent , predominantly African-American population OBJECTIVES This report presents both age-adjusted and unadjusted statistics from the 2002 National Health Interview Survey on selected health measures for children under 18 years of age , classified by sex , age , race , Hispanic origin , family structure , parent 's education , family income , poverty status , health insurance coverage , place of residence , region , and current health status . The topics covered are asthma , allergies , learning disability , Attention Deficit Hyperactivity Disorder ( ADHD ) , use of prescription medication , respondent-assessed health status , school-loss days , usual place of health care , time since last contact with a health care professional , unmet dental needs , time since last dental contact , and selected measures of health care access . SOURCE OF DATA The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention 's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States . Data are collected during face-to-face interviews with adults present at the time of interview . Information about children is collected for one r and omly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child 's health . SELECTED HIGHLIGHTS In 2002 , most U.S. children under 18 years of age had excellent or very good health ( 84 % ) . However , 10 % of children had no health insurance coverage , and 5 % of children had no usual place of health care . Twelve percent of children had ever been diagnosed with asthma . An estimated 8 % of children 3 - 17 years of age had a learning disability , and an estimated 7 % of children had ADHD OBJECTIVE To highlight the unique challenges of evaluative research on practice behavior change in the " real world " setting s of contemporary managed-care organizations , using the experience of the Pediatric Asthma Care PORT ( Patient Outcomes Research Team ) . STUDY SETTING The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago , Seattle , and Boston . At its core is a r and omized trial of two care improvement strategies compared with usual care : ( 1 ) a targeted physician education program using practice based Peer Leaders ( PL ) as change agents , ( 2 ) adding to the PL intervention a " Planned Asthma Care Intervention " incorporating joint " asthma check-tips " by nurse-physician teams . During the trial , each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway . DATA COLLECTION Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT r and omized trial . These experiences were review ed for common themes and " lessons " that might be useful to investigators planning interventional research in similar care-delivery setting s. CONCLUSIONS R and omized trials in " real world " setting s represent the most robust design available to test care improvement strategies . In complex , rapidly changing managed-care organizations , blinding is not feasible , corporate initiatives may complicate implementation , and the assumption that a " usual care " arm will be static is highly likely to be mistaken . Investigators must be prepared to use innovative strategies to maintain the integrity of the study design , including : continuous improvement within the intervention arms , comanagement by research ers and health plan managers of condition-related quality improvement initiatives , procedures for avoiding respondent burden in health plan enrollees , and anticipation and minimization of risks from experimental arm contamination and major organizational change . With attention to these delivery system issues , as well as the usual design features of r and omized trials , we believe managed-care organizations can serve as important laboratories to test care improvement strategies BACKGROUND Previous studies have shown that asthma education and case management may reduce asthma emergency care , hospitalizations , and expenditures . OBJECTIVE We sought to study the effect of an asthma outreach program ( AOP ) , a team-based , case-management intervention , on emergency ward ( EW ) and hospital use . METHODS Fifty-seven patients aged 1 to 15 years with the diagnosis of asthma based on the usual clinical practice criteria who were continuously enrolled in a staff-model health maintenance organization for a period of at least 2 consecutive years were r and omized into 2 intervention groups . The control group received a single intensive asthma education intervention , and the AOP group received the same initial education but then was followed-up by an asthma case management nurse throughout the intervention period . RESULTS EW visits , hospitalizations , and total outside-of-health-plan expenditures ( consisting of EW and hospital expenses , as well as miscellaneous costs , such as ambulance , durable medical equipment , tertiary referrals , and home care ) were assessed from cl aims filed for a year before and after enrollment . Control group patients experienced significant reductions in EW visits ( 39 % ) , hospitalizations ( 43 % ) , and outside-of-health-plan costs ( 28 % ) , possibly as a result of the baseline educational intervention received by all enrolled patients , in conjunction with regression to the mean . AOP group patients experienced significant reductions in EW visits , ( 73 % , P = .0002 ) , hospitalizations ( 84 % , P = .0012 ) , and outside-of-health-plan use ( 82 % , P < .0001 ) . When compared with the control group , AOP group patients demonstrated additional significant reductions in EW visits ( 57 % , P < .05 ) , hospitalizations ( 75 % , P < .05 ) , and outside-of-health-plan use ( 71 % , P < .001 ) . Estimates of direct savings to the health plan ranged from $ 7.69 to $ 11.67 for every dollar spent on the AOP nurse 's salary , depending on assumptions . CONCLUSIONS Asthma patients in a staff-model health maintenance organization decreased their re source use between 57 % to 75 % by participation in an AOP as compared with a r and omized control group receiving only an educational intervention . Substantial savings were achieved compared with the cost of the AOP nurse A research project , which looks at the value of health education in the prevention of childhood asthma  , is described . The project was a controlled trial by a health visitor focused within the community . This exploratory research looked at three groups of children over a 2-year period , and compared the effect of : ( a ) individual health education , and ( b ) group health education . During the first year , two groups were active , one receiving individual health education , the other collecting data of the same type . During the second year , a third group was involved in health education sessions . The findings have been similar in both cases , in that both groups have demonstrated a good improvement in knowledge of asthma and its treatment . Through the active involvement of using a peakflow meter and diary records in the health education programme , both groups receiving health education have shown a significant improvement in the morbidity indicators related to night symptoms and restricted activities . The qualitative analysis of the research also highlighted the value parents of asthmatic children place on counselling BACKGROUND A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact . The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies : a peer leader-based physician behavior change intervention ( PLE ) and a practice -based re design called the planned asthma care intervention ( PACI ) . OBJECTIVE To estimate the cost-effectiveness of the interventions . METHODS This was a 3-arm , cluster r and omized trial conducted in 42 primary care practice s. A total of 638 children ( age range , 3 - 17 years ) with mild to moderate persistent asthma were followed up for 2 years . Practice s were r and omized to PLE ( n = 226 ) , PACI ( n = 213 ) , or usual care ( n = 199 ) . The primary outcome was symptom-free days ( SFDs ) . Costs included asthma-related health care utilization and intervention costs . RESULTS Annual costs per patient were as follows : PACI , USD 1292 ; PLE , USD 504 ; and usual care , USD 385 . The difference in annual SFDs was 6.5 days ( 95 % confidence interval [ CI ] , -3.6 to 16.9 days ) for PLE vs usual care and 13.3 days ( 95 % CI , 2.1 - 24.7 days ) for PACI vs usual care . Compared with usual care , the incremental cost-effectiveness ratio was USD 18 per SFD gained for PLE ( 95 % CI , USD 5.21-dominated ) and USD 68 per SFD gained for PACI ( 95 % CI , USD 37.36 - 361.16 ) . CONCLUSIONS Results of this study show that it is possible to increase SFDs in children and move organizations toward guideline recommendations on asthma control in setting s where most children are receiving controller medications at baseline . However , the improvements were realized with an increase in the costs associated with asthma care A sample of 310 low income urban children with asthma from 290 families was r and omized into a control group and an experimental group that received health education to improve asthma management at home . No significant decreases in subsequent health care use were observed when the experimental group was compared to the control group without regard to previous hospitalization . When the comparison was restricted to children who had been hospitalized during the preceding year , however , the experimental group was found to have decreased its use of the emergency room significantly more than the control group ( p less than 0.05 ) and to have experienced a significantly greater reduction in the mean number of hospitalizations ( p less than 0.05 ) during the year of follow-up . The program reduced health care costs for children with one or more hospitalizations , saving $ 11.22 for every $ 1.00 spent to deliver health education A r and omised controlled trial , involving 112 adolescents with asthma , and a 2-year follow-up was conducted to assess the impact of an intervention programme aim ed at enhancing adherence to asthma medication . This programme had a duration of 1 year and consisted of an experimental group which received usual care from a paediatrician , but additionally attended individual and group sessions with an asthma nurse , and a control group which received usual care only . The programme aim ed at enhancing adherence by stimulating a positive attitude , increasing feelings of social support , and enhancing self-efficacy . At baseline , and after 12-month ( T1 ) and 24-month ( T2 ) follow-up , the participants filled in question naires which were based on the concepts of the ASE-model . Adherence was assessed by self-report ( range : 1 - 10 ) at the same points in time . After 12 months , 97 adolescents ( 87 % ) were available for follow-up , decreasing to 86 adolescents ( 77 % ) after 24 months . No statistically significant differences were found between the control and the experimental group , except for one . At T2 , self-reported adherence appeared to be statistically significantly higher in the experimental group . In conclusion , there seems to have been no substantial effect of the intervention programme OBJECTIVE --To determine whether an intervention programme based on existing school and community re sources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma . DESIGN --Parallel group controlled intervention study . SETTING --102 primary schools in Nottingham : 49 were r and omised to receive the intervention and 53 to be control schools . SUBJECTS -- All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only . INTERVENTIONS --Children with asthma were referred to their general practitioner for assessment of symptoms and treatment . Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools . MAIN OUTCOME MEASURES --Changes in school absence and missed games and swimming lessons because of wheezing , and schools ' policy towards management of asthma in school . RESULTS --Of 17,432 children screened , 451 met the entry criteria --228 in intervention schools and 223 in control schools . 152 ( 67 % ) children in intervention schools visited their general practitioner , of whom 39 ( 26 % ) were given a new diagnosis of asthma and 58 ( 38 % ) had treatment for asthma increased or changed . Over the next academic year mean ( SE ) parent reported school absence due to wheezing fell significantly , but to a similar extent , in both intervention and control schools ( 0.82 ( 0.11 ) and 1.09 ( 0.21 ) weeks respectively ) . There was little change in school recorded absence or participation in games lessons and swimming lessons in either group . At the end of the study intervention schools were more likely to have improved aspects of management of asthma in school . CONCLUSION --The intervention result ed in a majority of children being assessed by their general practitioner and improved teachers ' underst and ing and management of asthma , but it did not result in any appreciable reduction in morbidity BACKGROUND Guidelines recommend preventive medications for all children with persistent asthma , yet young urban children often receive inadequate therapy . This may occur in part because primary care providers are unaware of the severity of their patients ' symptoms . OBJECTIVE To determine whether systematic school-based asthma screening , coupled with primary care provider notification of asthma severity , will prompt providers to take preventive medication action ( prescribe a new preventive medication or change a current dose ) . DESIGN Children aged 3 to 7 years with mild persistent to severe persistent asthma were identified at the start of the 2002 - 2003 school year in Rochester . Children were assigned r and omly to a provider notification group ( child 's primary care provider notified of asthma severity ) or a control group ( provider not notified of severity ) . Primary care providers of children in the provider notification group were sent a facsimile indicating the child 's symptoms and recommending medication action based on national criteria . Interviewers blinded to the child 's group assignment called parents 3 to 6 months later to determine if preventive actions were taken . RESULTS Of 164 eligible children with mild persistent or more severe asthma , 151 ( 92.1 % ) were enrolled . Children in the provider notification group were not more likely to receive a preventive medication action than were children in the control group ( 21.9 % vs 26.0 % ; P = .57 ) . Additional preventive measures , including encouraging compliance with medications ( 33.3 % vs 31.3 % ; P = .85 ) , recommending environmental modifications ( 39.3 % vs 42.4 % ; P = .86 ) , and referrals for specialty care ( 6.6 % vs 6.0 % ; P > .99 ) , also did not differ between the provider notification and control groups . At the end of the study , 52.4 % of children in both groups with no medication changes were still experiencing persistent symptoms . CONCLUSIONS School-based asthma screening identified many symptomatic children in need of medication modification . Provider notification , however , did not improve preventive care . Findings suggest that more powerful interventions are needed to make systematic asthma screening effective A r and omized control trial of the Wee Wheezers asthma education program was conducted with 76 children < 7 years of age , 31 % of whom were on a medication regimen consistent with mild , 51 % with moderate , and 18 % with moderately severe/severe asthma . Treatment children showed improved morbidity at 3-month follow-up relative to the changes in the controls : increased symptom-free days in the preceding 2 weeks ( mean change of + 2.2 vs. -2.6 in the controls ; p = .004 ) and month ( + 2.0 vs. -3.8 ; p < .02 ) , fewer nights of parental sleep interruption in a typical week ( + 0.7 vs. + 1.8 ; p < or = .05 ) , and a trend toward fewer asthma sick days ( -0.2 vs + 0.7 ; p = ns ) . These improvements were accompanied by significantly better parental asthma management compared with controls ( more consistent use of preventive medications , p < or = .01 ; early symptom intervention , [ corrected ] p < or = .05 ) and trends toward more restrictions on smoking in the home ( p < .07 ) and decreased parental confusion about asthma treatment ( p < .11 ) . This study provides evidence that a multisession program of asthma education for parents can improve parental asthma management and clinical outcomes in very young children and provides information on the validity and sensitivity of various asthma outcome measures in this age group The adherence and disease-control outcomes associated with the use of an Internet-based store- and -forward video home telehealth system to manage asthma in children were studied . Pediatric patients with persistent asthma were provided with home computers and Internet access and monitored biweekly over the Internet .  All patients were seen in the pediatric clinic at 0 , 2 , 6 , 12 , and 24 weeks . Half of the patients received  asthma education in person and half via an interactive Web site .  Adherence measures were assessed by therapeutic and diagnostic monitoring . Therapeutic monitoring included digital videos of patients using their controller medication inhaler . Diagnostic monitoring included an asthma symptom diary and a video of peak flow meter use . Videos were su bmi tted electronically twice a week by using in-home telemonitoring with store- and -forward technology . Feedback was provided electronically to each patient . Disease control was assessed by examining quality of life , utilization of services , rescue-therapy use , symptom control , satisfaction with home telemonitoring , and retention of asthma knowledge . Patients were r and omly assigned to an asthma education group ( Internet versus office ) , and the data were analyzed by comparing results for study days 0 - 90 and 91 - 180 . Ten children participated . A total of 321 videos of inhaler use and 309 videos of peak flow meter use were su bmi tted . Inhaler technique scores improved significantly in the second study period . Su bmi ssion of diagnostic monitoring videos and asthma diary entries decreased significantly . Peak flow values as a percentage of personal best values increased significantly . Overall , there was no change in quality of life reported by patients . However , the caregivers in the virtual-education group reported an increase in the patients ' quality -of-life survey scores . Emergency department visits and hospital admissions for asthma were avoided . Rescue therapy was infrequent . A high rate of satisfaction with home telemonitoring was reported . Internet-based , store- and -forward video assessment of children 's use of asthma medications and monitoring tools in their homes appeared effective and well accepted OBJECTIVE Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children . Although effective preventive therapy is available , many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care . To see if access , continuity , and quality of care could be improved in pediatric clinics serving low-income children in New York City , we trained staff in New York City Bureau of Child Health clinics to provide continuing , preventive care for asthma . METHODS We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics . Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma , and included screening to identify new cases and health education to improve family management . The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change . We hypothesized that after the intervention , clinics that received the intervention would , compared with control clinics , have increased numbers of children with asthma  receiving continuing care  in the clinics and increased staff use of new pharmacologic and educational treatment methods . RESULTS In both the first and second follow-up years , the intervention clinics had greater positive changes than control clinics on measures of access , continuity , and quality of care . For second year follow-up data these include : for access , greater rate of new asthma patients ( 40/1000 vs 16/1000 ; P < .01 ) ; for continuity , greater percentage of asthma patients returning for treatment 2 years in a row ( 42 % vs 12 % ; P < .001 ) and greater annual frequency of scheduled visits for asthma per patient ( 1.85 vs .88 ; P < .001 ) ; and for quality , greater percentage of patients receiving inhaled beta agonists ( 52 % vs 15 % ; P < .001 ) and inhaled antiinflammatory drugs ( 25 % vs 2 % ; P < .001 ) , and greater percentages of parents who reported receiving patient education on 12 topics from Bureau of Child Health physicians ( 71 % vs 58 % ; P < .01 ) and nurses ( 61 % vs 44 % ; P < .05 ) . CONCLUSION We conclude that the intervention substantially increased the Bureau of Child Health staff 's ability to identify children with asthma , involve them in continuing care , and provide them with state-of-the-art care for asthma
OBJECTIVE To evaluate the evidence that quality improvement ( QI ) strategies can improve the processes and outcomes of outpatient pediatric asthma care .