According to the article, national guidelines recommend that children with mild to severe persistent asthma take daily maintenance medications (including inhaled corticosteroids), but undertreatment with these medications and poor adherence is common, especially for young urban children.
Jill S. Halterman, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, N.Y., and colleagues evaluated the impact of school-based provision of inhaled corticosteroids on asthma severity among urban children.
The researchers identified children aged three to seven years with mild to severe persistent asthma at the start of the 2000-2001 and 2001-2002 school years in Rochester, N.Y. Of the 242 eligible children, 184 enrolled in the study, and data for 180 children was available.
For the school-based care group (n=89), one dose of inhaled corticosteroid from an inhaler was given by the school nurse each day the child was in school. For days the child was home, the parents were provided with a second, identical inhaler for daily doses. Primary care practitioners and parents of children in the usual care group (n=91) were informed of the child's asthma severity and parents were advised to contact their clinician for asthma care.
Children in the school-based care group missed fewer days of school compared to children in the usual care group (average number of days missed, 6.8 vs. 8.8), and had more symptom-free days during the early winter months (average number of days in a two week period, 9.2 vs. 7.3).
In later analysis, the researchers found that their findings were caused by differences among children who were not exposed to secondhand smoke. Among children not exposed to secondhand smoke, those in the school-based care group (47 children) had more symptom-free days compared to children in the usual-care group (54 children) (11.5 vs. 10.5 days), had fewer days needing rescue medications (1.6 vs. 2.3 days) and were less likely to have had three or more emergency visits for asthma.
"This study demonstrates two new and potentially important findings about the management of urban children with asthma: the utility of a system change involving school-based provision of inhaled corticosteroids and the ineffectiveness of this program among those children with secondhand smoke in their homes," the authors write.
The authors conclude: "Most children included in this study were poor and from minority populations, and represent the group with the greatest need for assistance with this common chronic illness. If these findings are replicated in other settings, this school-based system of preventive care could become standard for the management of childhood asthma in underserved communities."
(Arch Pediatr Adolesc Med. 2004;158:460-467. Available post-embargo at archpediatrics.com) Editor's Note: This study was supported by a grant from the Halcyon Hill Foundation, Webster, N.Y.; and by the Robert Wood Johnson Foundation's Generalist Physician Faculty Scholars Program.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
To contact Jill S. Halterman, M.D., M.P.H., call Travis Anderson at 585/273-1757.
Journal
Archives of Pediatrics and Adolescent Medicine