PURPOSE OF THE STUDY.
To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology (SB-PACT) program, which included directly observing therapy of preventive asthma medications in school facilitated by Web-based technology for systemic symptom screening, electronic report generation, and medication authorization from providers.
The study included 100 children (aged 3–10 years) with physician-diagnosed asthma with persistent symptoms based on National Heart, Lung, and Blood Institute guidelines from 19 inner-city schools in Rochester, New York.
The investigators conducted a pilot, randomized trial of SB-PACT versus usual care. Outcomes were assessed longitudinally by blinded interviewers. Analyses included bivariate statistics and linear regression models, adjusting for baseline symptoms.
There were data for 99 subjects for analysis. The investigators screened all children by using a Web-based system, and 44 of 49 treatment group children received directly observed therapy as authorized by their providers. Treatment group children received preventive medications 98% of the time they were in school. Over the school year, children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group (11.3 vs 10.40, P = .13). Treatment children also experienced fewer nights with symptoms (1.68 vs 2.20, P = .02), days requiring rescue medications (1.66 vs 2.44, P = .01), and days absent from school due to asthma (0.37 vs 0.85, P = .3) compared with usual care. Further, treatment children had a greater decrease in exhaled nitric oxide (−9.62 vs −0.39, P = 0.03) suggesting reduction in airway inflammation.
The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study. Future work will focus on further integration of preventive care delivery across community and primary care systems.
I applaud these investigators not only on their previous work with their school-based asthma therapy trial from 2006 to 2009 (Arch Pediatr Adolesc Med 2011;165:262–268) that directly observed administration of preventive asthma medications in the school setting, but this current SB-PACT study, which used a Web-based program to overcome key barriers to sustainability identified in their original study. This pilot study of school-based asthma care was effective in reducing morbidity for children at high risk with asthma. The Web-based screening mechanism worked efficiently for most participants and primary care physicians involved in terms of communication and systematic medication delivery. Children receiving this intervention experienced fewer asthma symptoms, less absenteeism from school, and had reduced airway inflammation. It will be very interesting to see how future studies with larger sample sizes can help to effectively reduce the overall morbidity among high-risk school aged children with asthma. Keeping our asthmatic children healthy and in school where they can learn effectively should be the primary goal here!
- Copyright © 2013 by the American Academy of Pediatrics