Asthma control and hospitalizations among inner-city children: results of a randomized trial

Abstract

Asthma prevalence is increasing among poor and minority children. We examined the effectiveness of a novel interactive device programmed for self-management of pediatric asthma in reducing asthma control problems and hospitalizations. A randomized controlled trial (66 children in the intervention group and 68 in the control group) was conducted at home and in an outpatient hospital clinic with 8-16-year-old inner-city children with physician-diagnosed asthma. During a 12-week period, children in the experimental group received an asthma self-management and education program, the Health Buddy (Health Hero Network), designed to enable them to monitor their symptoms and transmit this information to a case manager through a secure website. Control group participants used an asthma diary. After adjusting for baseline asthma control problems, asthma severity, and seasonality, children randomized to automated self-management had a significantly lower mean number of asthma control problems at 6 weeks (2.0, SD = 1.6) as compared to children assigned to the asthma diary (2.7, SD = 1.6) (p = 0.03). By 12 weeks, after adjusting for time and the other covariates, asthma control problems dropped markedly in both groups, and did not differ by intervention modality (p = .07). The intervention modality was not a significant predictor of hospitalization. Educational interventions that encourage children's active involvement in their own care and symptom monitoring would help children increase their control of asthma problems. Compared to the asthma diary, the automated self-management had a significant short-term impact on asthma control problems. Its initial effectiveness and more consistent use suggest that remote monitoring may be successfully used in short-term interventions and in settings where staffing for case management is weak.