Asthma and lower airway disease
Asthma in Head Start children: Effects of the Breathmobile program and family communication on asthma outcomes

https://doi.org/10.1016/j.jaci.2011.10.013Get rights and content

Background

Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors.

Objective

This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care.

Methods

Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care.

Results

Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures.

Conclusions

Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity.

Section snippets

Study design

The Johns Hopkins Medical Institution and University of Maryland School of Medicine Institutional Review Boards approved the study. Written informed consent was obtained from the child’s primary caregiver. Overall, 336 children with persistent asthma were consented, and 322 were randomized into one of 4 groups. HS sites were the units of randomization for the Breathmobile intervention, whereas families were the units of randomization for the FACI. Because the Breathmobile was present only at

Sample characteristics

Of the 336 families who consented to participate, 322 (96%) completed the baseline questionnaire, and 321 were randomized (Fig 1); 1 participant was excluded because of lack of an asthma diagnosis at baseline. Intervention completion rates are shown in Table I. More than 375 appointment slots were made available specifically to study participants who attended an HS site randomized to the Breathmobile, and staff also offered appointments at nearby locations. Of all the eligible participants, 73

Discussion

This study evaluated the effects of providing Breathmobile services only, FACI only, or combined Breathmobile plus FACI on asthma outcomes relative to standard care in low-income minority preschool children. Both interventions tested in this study were designed to remove common barriers to asthma care. The Breathmobile was intended to overcome structural barriers, such as transportation, access to care, and health insurance status. The FACI was designed to empower families to communicate with

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    Disclosure of potential conflict of interest: C. S. Rand has consultant arrangements with TEVA and is an advisor for the Merck Foundation. A. Butz receives research support from the National Institute of Nursing Research, National Institutes of Health. The rest of the authors declare that they have no relevant conflicts of interest.

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    Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.