Improving Asthma Control in the Rural Setting: The BREATHE (Better Respiratory Education and Asthma Treatment in Hinton and Edson) Study

Abstract

Background: Overuse of β-agonists is a risk factor for poor control of asthma. Pharmacists can identify high-risk patients through refill information and can then initiate disease-management programs for these patients. Methods: The Better Respiratory Education and Asthma Treatment in Hinton and Edson (BREATHE) study was a randomized, controlled trial in high-risk asthma patients. The intervention included an educational program (with focus on development of a written action plan), assessment of asthma therapy, and referral to a respiratory therapist and primary care physician. The primary objective was to determine the effect of this program (initiated by community pharmacists) on asthma control, as measured by the Asthma Control Questionnaire. Secondary objectives included determining the effect of the program on numbers of emergency department visits and hospital admissions, use of inhaled corticosteroids, courses of oral steroids, and lung function. Endpoints were measured at baseline, 2 months, and 6 months. Results: A total of 70 patients were randomized (34 to usual care, 36 to the intervention). At 6 months, there was no significant difference in asthma control between the usual care and inter-vention groups (change in ACQ score 0.33 and 0.43 respectively, p = 0.66). There were no significant differences in the secondary endpoints. Generally, pharmacist compliance with the intervention was poor. Conclusions: Although no differences were found in asthma control, this model, which uses a multidisciplinary, community-based approach, offers a unique management strategy for rural asthma patients. Can Pharm J 2006;139(4):44–50.