December 7, 2009

Educational home visits can improve asthma in children

A few home visits by a health care specialist to educate children with asthma about basic strategies for earlier symptom recognition and improving medication use can lead to fewer flare-ups and less-frequent trips to the emergency room, according to research from the Johns Hopkins Children’s Center published in the December issue of Pediatrics.

An estimated 6.5 million children in the United States have asthma, which is the leading pediatric chronic illness in this country and disproportionately affects minorities.

“We compared several strategies to improve asthma control among children and, much to our delight, we found that taking a few simple steps can go a long way toward doing so,” said senior investigator Kristin Riekert, a pediatric psychologist at Johns Hopkins and co-director of the Johns Hopkins Adherence Research Center.

Researchers say the key is providing regular asthma education that includes in-the-home demonstration and training on the proper use of inhalers by an asthma specialist and a discussion with the family about regular access to a pediatrician, and ensuring they have access to one; an asthma action plan specifically tailored to each child, with a list of must-take daily controller medication to keep inflammation at bay; and a checklist of what to do when symptoms start and when to seek emergency care.

Researchers compared the effectiveness of three different strategies in 250 African-American children with asthma who ended up in an emergency room with an asthma attack. One group received a booklet with basic asthma information, the standard and usual care. The other two had educational home visits by asthma educators, with one group receiving education only and the other education plus feedback on how well the patient was following his or her medication instructions, which researchers determined by a monitoring device on the child’s inhaler to record each use, as well as coaching on how to improve adherence.

Follow-ups at six, 12 and 18 months showed that:

Children in the two groups that received home visits and whose medication use was monitored had 15 percent fewer trips to the emergency room compared to children who got the standard care. They also had a 52 percent faster rate of refill of inhaled corticosteroids, a daily controller medication that helps keep inflammation at bay.

Children who got educational home visits reported, on average, fewer symptoms per month compared to children who received the informational booklet.

Children who got the informational pamphlet—the standard of care—had 12 percent more emergency room visits and 17 percent higher use of oral corticosteroids, a marker of an asthma flare-up, when compared to children from the other two groups.

There was no added value in providing medication monitoring and feedback beyond providing at-home educational visits alone.

There was no significant difference in the number of hospitalizations among the three groups.

The National Heart, Lung and Blood Institute funded the research.

Lead author Michiko Otsuki was a Johns Hopkins Behavioral Medicine fellow at the time of the study and is currently at the University of South Florida, St. Petersburg. Other Johns Hopkins investigators in the study were Michelle Eakin, Arlene Butz, Cynthia Rand, Jean Ogrborn and Andrew Bilderback. University of Maryland co-investigators were Van Doren Hsu and Ilene Zuckerman.