Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure

Abstract

Rationale Evaluate the impact of school-based provision of inhaled corticosteroids (ICS) on asthma severity among urban children with persistent asthma. Methods Children 3-7 yrs with mild persistent to severe persistent asthma were identified at the start of the 2000-2001 and 2001-2002 school years in Rochester, NY. Children were assigned randomly to a school-based care group (daily ICS provided at school) or a usual care group (ICS not given). Results 184/242 eligible children were enrolled from 54 urban schools. Data for 180 children were available. Parents of children in the school-based care group (S) had a greater improvement in QofL compared to parents of children in the usual care group (U) ( S=.63, U=.24, p<.05). Children in the school-based care group missed less school due to asthma (mean total days missed: S=6.8, U=8.8, p<.05) and experienced more symptom-free days during the early winter months compared to usual care children (mean days per 2 week period: S=9.2, U=7.3, p=.02). Post hoc analysis revealed that all significant findings were produced by differences among children who were not exposed to secondhand smoke. Further, among children not exposed to smoke, S had more symptom-free days overall (S=11.5, U=10.5, p<.05), fewer days needing rescue medications (S=1.6, U=2.3, p=.03), and were less likely to have had ≥3 acute visits for asthma (S=13%, U=32%, p=.03) compared to children in the usual care group. Conclusions School-based provision of ICS improved symptoms, quality of life, and absenteeism among urban children with persistent asthma. This effect was seen only among children not exposed to secondhand smoke.