Family, Preschool Asthma Education Improve Low-Income Kids' Asthma Control

By Lisa Rapaport

October 07, 2020

(Reuters Health) - Children with asthma enrolled in Head Start preschool programs have better outcomes when they receive home-based asthma education for families in addition to asthma support in school, a new trial suggests.

The clinical trial included 398 children with asthma attending Head Start preschool programs in Baltimore, Maryland, and their family caregivers. Participants were randomized 1:1 to receive Head Start asthma education alone or in combination with home-based family education.

Researchers assessed asthma control using the Test for Respiratory and Asthma Control in Kids (TRACK) score, which ranges from 0 to 100 with higher scores indicating better outcomes. A TRACK score of less than 80 indicates uncontrolled asthma, and changes in TRACK scores of at least 10 points indicate clinically meaningful changes in kids' respiratory symptoms.

Fewer children in the home and school asthma education program had uncontrolled asthma based on TRACK scores at 3 months (beta = -0.81) compared with children who received support only in the Head Start program. There was no significant difference between the groups at 6, 9, or 12 months.

"The results show that a multilevel intervention at both the school and home was more effective than just a school program to improve asthma control, reduce oral steroids, and hospitalizations," said lead study author Michelle Eakin, an associate professor of pulmonary and critical care medicine at Johns Hopkins University in Baltimore.

"It is important for evidence-based asthma interventions to be broadly implemented in community settings in order to reduce known health disparities," Eakin said by email.

The majority of participants were Black (95.2%) and had a family income of less than $40,000 a year (89.7%).

Among the 199 families who were randomized to receive asthma education both at school and at home, 144 (72.4%) participated in at least one home intervention session, and a total of 69 (34.7%) finished all four home visits.

Education programs were designed to train school staff and family caregivers to recognize asthma symptoms, reduce exposures to triggers such as smoking and allergens, and understand when and how to provide rescue medication for asthma attacks and other treatments as needed.

"A multilevel education program teaches both families and school personnel about asthma to ensure that all of the caregivers in a child's daily life know how to manage asthma," Eakin said. "Also, the home education program was tailored to the specific child's treatment plan and triggers that are observed in the home, to help the families make specific changes to their homes to improve their child's asthma."

The main limitation of the study is that measures of asthma control that figure in the TRACK score like hospital visits or usage of oral corticosteroids were self-reported by families, not verified by medical records, the study team notes in JAMA Pediatrics.

It's also possible that results from a predominantly Black study population might not be generalizable to other racial or ethnic groups, said Dr. Avni Joshi, a specialist in allergy and immunology at the Mayo Clinic Children's Center in Rochester, Minnesota, who wasn't involved in the study.

Still, the results underscore the importance of ensuring that all adults who spend time with young children with asthma understand how to avoid triggers and respond to attacks, Dr. Joshi said by email.

"Education of caregivers is critical to improving care in asthmatic children," Dr. Joshi said. "Using multiple settings, including clinic environment, school environment and home environment improves the chances of greater understanding, which in turn improves provider-caregiver buy-in (to) the asthma treatment process which in turn improves outcomes."

SOURCE: JAMA Pediatrics, online October 5, 2020.