1. Develop a simple school-based intervention using school-based supervised asthma therapy
to increase adherence to asthma medication.
2. Implement a school-based internet monitoring system within both the school-based
supervised asthma therapy and parent supervised asthma therapy groups to record asthma
symptoms, peak flow meter readings, school absences, and usage of rescue medications at
3. Randomly assign 250 children from inner-city school systems to either school-based
supervised asthma therapy or parental supervised asthma therapy.
4. Compare children assigned to school-based supervised asthma therapy with children
assigned to parent supervised asthma therapy, in regards to time-averaged proportion
having at least one exacerbation per month, rescue medication use, peak flow meter
readings, asthma symptoms, school absences, and asthma self-management knowledge.
Pediatric asthma is a well-documented public health issue in the United States. The impact
of pediatric asthma can be measured by both health care costs and morbidity. Whereas many
factors contribute to the high health care costs of asthma, much of the morbidity can be
directly attributed to lack of adherence to medical treatments. The consequence of
non-adherence for most individuals with ashtma is exacerbations. Greater numbers of
exacerbations lead to increased school absenteeism, greater activity limitations, decreased
quality of life for both parent and child, increased urgent health care use and costs, and
increased parental days missed at work. Therefore, adherence to treatment is essential for
proper asthma management and ultimate reductions in morbidity.
Asthma morbidity, as measured by the number of exacerbations, is largely preventable with
patient education and optimal treatment. However, it has been demonstrated that patient
education alone is insufficient to decrease asthma morbidity. Optimal treatment is essential
to control asthma morbidity. Inhaled corticosteroids offer considerable protection against
asthma exacerbations. However, only a minority of asthma patients take their inhaled
steroids as recommended by the National Asthma Education and Prevention Program (NAEPP)
guidelines. Therefore, the Pediatric Asthma Guidelines recommend development and testing of
programs (including school-based programs) to increase adherence with therapy.
Because morbidity is higher in inner-city, low-income, minority children, this study will
collaborate with several inner-city, low-income, minority school districts to examine the
effects of school-based supervised asthma therapy.
This study is a longitudinal two-group trial of the effectiveness of a school-based
supervised asthma therapy program. Two hundred and fifty children will be randomly assigned
to one of two groups: school-based supervised asthma therapy or parental supervised asthma
therapy. The children will be followed for 16 months.
- Persistent asthma requiring daily controller medication
- Enrolled at a participating elementary school