Medication and Environmental Trigger Changes in Children Receiving Community Asthma Intervention: Results from a Randomized Controlled Trial
Year: 2021
Type: conference-abstract
Abstract: Rationale: The Asthma Action at Erie Trial (NCT02481986) is a comparative effectiveness trial comparing integrated asthma community health workers (CHW) to a certified asthma educator (AE-C) in low-income minority children in Chicago. This analysis explores the intervention's impact on asthma medication presence, adherence, technique and environment triggers. Methods: Participants were 5-16 years old with uncontrolled asthma. Participants were randomized to receive ten home CHW visits or two in-clinic AE-C sessions over one year. Asthma medications and technique were observed in home by research assistants. Adherence was measured using built-in dose counters and electronic monitors. Environmental triggers were captured by caregiver self-report, home observation, and objective measurement (salivary cotinine). Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes, including time, group, and time by group interaction controlled for repeated over-time observations, randomization factors (age, ethnicity, site), and season. Results: Participants (N=223) were mainly Hispanic (85%) and low-income. Mold/condensation was reported/detected in 99% of the households, roaches and/or rats/mice in 55%. No significant differences were seen between intervention groups for tobacco, mold, roaches, and rat/mice exposure at 12-and 24-months. At baseline, 82% of children had a reliever medicine, 72% had a spacer, and 44% had an inhaled corticosteroid (ICS). Of the children with uncontrolled asthma at baseline (n=201), 35% lacked an ICS prescription and 19% had an ICS prescribed but did not physically have the inhaler. Asthma medication technique improved in the CHW group at 6-months (p<0.001) which was sustained for 12-months after the intervention ended (p<0.001, see Figure ). Medication technique in the AE-C group worsened over time (p=0.013), resulting in a 13.4% (95% CI 7.8-18.9, p<0.01) difference between groups at 12-months. Those in the CHW group had more ICS available at 12-months, 56% in the CHW group comparing to 35% in the AE-C group (OR=2.39, 95% CI 0.99-5.79). This effect was not sustained at 24-months, after CHW intervention ended (OR=1.52, 95% CI 0.59-3.92). We also observed that ICS adherence improved in the CHW group at 12-months but did not change for the AE-C group, resulting in a 16.0% (95% CI 2.3-29.7, p=0.02) difference between groups, that was not sustained at 24months. Conclusions: Our CHW intervention demonstrated strong, sustainable improvements in medication technique, while clinic-based AE-C services did not. CHWs can improve ICS adherence, but further research is needed to sustain adherence long-term. Environmental triggers did not change, possibly because the intervention did not provide remediation equipment.
Institutions: University of Illinois Chicago, Endeavor Health
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4255693816