In the JournalsPerspective

Community-based plan improves asthma symptoms in black teens

Black adolescents with poorly controlled asthma who participated in a family- and community-based treatment plan for 6 months experienced significantly improved lung function and medication adherence, and the plan also reduced hospitalizations and the frequency of symptoms, according to a study results published in Pediatrics.

“Pediatric asthma causes high rates of functional morbidity, such as school absences, frequent doctor visits and hospitalizations, and inner-city adolescents are at higher risk for asthma morbidity and mortality,” Sylvie Naar, PhD, distinguished endowed professor in the department of behavioral sciences and social medicine and director of the Center for Translational Research at Florida State University, and colleagues wrote. “African American youth have greater odds of an asthma diagnosis even compared with other minority groups, and the odds increase with each decrease in socioeconomic status.”

Naar and colleagues enrolled a group of black adolescents aged 12 to 16 years with moderate-to-severe persistent asthma who had at least one inpatient hospitalization or at least two ED visits in 12 months between January 2009 and June 2012. The 167 adolescents were randomly assigned to Multisystemic Therapy-Health Care (n = 84) or a control group (n = 83).

The researchers described Multisystemic Therapy-Health Care as “a 6-month home-and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions.”

Naar and colleagues conducted weekly family support counseling as an attention control condition for 6 months in the adolescents’ homes. They defined lung function (forced expiratory volume in 1 second [FEV1]) as the primary outcome.

The researchers used a linear mixed-effects models to determine that adolescents in the treatment group experienced significantly greater improvements in FEV1, as well as secondary outcomes of adherence to controller medication and asthma symptom frequency compared with controls. The adolescents in the Multisystemic Therapy-Health Care group also had greater reductions in hospitalizations (P = .04); however, the two cohorts did not experience a significant difference in reduction in ED visits.

“A comprehensive family- and community-based treatment significantly improved lung function (FEV1), medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma,” Naar told Infectious Diseases in Children. “Further evaluation in effectiveness and implementation trials is warranted.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Black adolescents with poorly controlled asthma who participated in a family- and community-based treatment plan for 6 months experienced significantly improved lung function and medication adherence, and the plan also reduced hospitalizations and the frequency of symptoms, according to a study results published in Pediatrics.

“Pediatric asthma causes high rates of functional morbidity, such as school absences, frequent doctor visits and hospitalizations, and inner-city adolescents are at higher risk for asthma morbidity and mortality,” Sylvie Naar, PhD, distinguished endowed professor in the department of behavioral sciences and social medicine and director of the Center for Translational Research at Florida State University, and colleagues wrote. “African American youth have greater odds of an asthma diagnosis even compared with other minority groups, and the odds increase with each decrease in socioeconomic status.”

Naar and colleagues enrolled a group of black adolescents aged 12 to 16 years with moderate-to-severe persistent asthma who had at least one inpatient hospitalization or at least two ED visits in 12 months between January 2009 and June 2012. The 167 adolescents were randomly assigned to Multisystemic Therapy-Health Care (n = 84) or a control group (n = 83).

The researchers described Multisystemic Therapy-Health Care as “a 6-month home-and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions.”

Naar and colleagues conducted weekly family support counseling as an attention control condition for 6 months in the adolescents’ homes. They defined lung function (forced expiratory volume in 1 second [FEV1]) as the primary outcome.

The researchers used a linear mixed-effects models to determine that adolescents in the treatment group experienced significantly greater improvements in FEV1, as well as secondary outcomes of adherence to controller medication and asthma symptom frequency compared with controls. The adolescents in the Multisystemic Therapy-Health Care group also had greater reductions in hospitalizations (P = .04); however, the two cohorts did not experience a significant difference in reduction in ED visits.

“A comprehensive family- and community-based treatment significantly improved lung function (FEV1), medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma,” Naar told Infectious Diseases in Children. “Further evaluation in effectiveness and implementation trials is warranted.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Gary Rachelefsky

    Gary Rachelefsky

    The article by Naar and colleagues describes a randomized “placebo-controlled trial” of a nonpharmacological “treatment” of black adolescents with severe asthma.

    The intervention is family specific and uses cognitive behavioral intervention.

    This reminds me of the early 1980s, when self-management of childhood asthma was in vogue.

    The authors tested the efficacy of multisystem therapy and compared this intervention with in-home family support, ie, the placebo.

    They describe a labor-intensive, 6-month intervention that, if adapted to the appropriate communities, would pay for itself. My only hope is that the program is easily transportable.

    • Gary Rachelefsky, MD, FAAP, FAAAI
    • Infectious Diseases in Children Editorial Board member
      Professor of allergy and immunology
      UCLA David Geffen School of Medicine

    Disclosures: Rachelefsky reports no relevant financial disclosures.