A randomized clinical trial to reduce asthma morbidity among inner-city children: Results of the National Cooperative Inner-City Asthma Study

Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Richard Evans,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Peter J Gergen,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Herman Mitchell,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Meyer Kattan,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Carolyn Kercsmar,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,Ellen Crain,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,John Anderson,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Peyton Eggleston,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,Floyd J Malveaux,H.James Wedner

doi:10.1016/s0022-3476(99)70130-7

Abstract

Objective: To evaluate a family-focused asthma intervention designed for inner-city children 5 to 11 years old with moderate to severe asthma. Study design: Randomized, multisite, controlled trial to minimize symptom days (wheeze, loss of sleep, reduction in play activity) measured by a 2-week recall assessed at 2-month intervals over a 2-year follow-up period. The intervention was tailored to each family’s individual asthma risk profile assessed at baseline. Results: Averaged over the first 12 months, participants in the intervention group (n = 515) reported 3.51 symptom days in the 2 weeks before each follow-up interview compared with 4.06 symptom days for the control group (n = 518), a difference of 0.55 (95% CI, 0.18 to 0.92, P = .004). The reduction among children with severe asthma was approximately 3 times greater (1.54 d/2 wk). More children in the control group (18.9%) were hospitalized during the intervention compared with children in the intervention group (14.8%), a decrease of 4.19% (CI, –8.75 to 0.36, P = .071). These improvements were maintained in the intervention group during the second year of follow-up, during which they did not have access to the asthma counselor. Conclusions: We demonstrated that an individually tailored, multifaceted intervention carried out by Masters-level social workers trained in asthma management can reduce asthma symptoms among children in the inner city. (J Pediatr 1999;135:332-8)

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