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AAAAI: School supervision aids asthma therapy in
students
Terry Murray
Salbutamol use, absenteeism
both improved
By Terry Murray
SAN ANTONIO, TEX. – Directly observed therapy(DOT)by non-medical personnel has been
successful in the treatment of tuberculosis. Now, clinicians are finding
it can also work for pediatric asthma, especially in inner cities.
Seeing the
success of some DOT programs administered by school nurses, Chicago
researchers have now shown improved outcomes for asthmatic schoolchildren
when non-medical school staff gives the treatment.
In a pilot
study in Chicago, students who got their morning dose of an inhaled steroid
at school showed a greater reduction in daily salbutamol
use and school absences than those whose asthma therapy was delivered at
home.
"Home
adherence is likely lowest on hectic school mornings," said Dr. Lisa
Sullivan, an allergy fellow
at Rush University Medical Centre.
The pilot
study included 31 children, ages six to 15 years, with an established
diagnosis of asthma and already being managed on daily fluticasone, the steroid of choice offered by the
asthma clinic at Chicago's
Cook County Hospital.
In the
study, conducted during the 2003/04 school year, 15 children(who
attended 14 different schools)received the morning dose of steroid at
school, any time between 8 a.m. and noon. Any adult could supervise, and
they included a school principal, office staff, teachers' aides and in
one case, a security guard.
The adults
directly observed children age seven and up who could administer the drug
themselves; they administered the drugs to six-year-olds.
The
control group of 16 children were left to take
all asthma medications at home, and both groups received basic asthma
education at each of six study visits.
They were
also allowed to continue all other medications, as well as salbutamol for their acute asthma symptoms. The
primary endpoint of the study was the number of salbutamol
treatments per day.
Through
the fourth and fifth visits, both groups of children improved
"dramatically," decreasing daily salbutamol
use by up to 50%, Dr.
Sullivan said, which she
attributed to the education provided during the study. But by the end of
the school year, the kids who had been getting their morning steroid dose
at school showed a significantly greater decrease of about 73% from
baseline. They had gone from an average 1.5 salbutamol
treatments per day to 0.4, Dr.
Sullivan said.
As far as
school absenteeism, both groups also dramatically improved through the
fourth visit, when the control group "peters out," although
with a 70% reduction in monthly absences from baseline.
"But
the intervention group improved that much more," she added, and by
the sixth visit, their reduction in absences was significantly greater
than that of the control group—from 2.8 days absent per month at the
start to 0.5 days.
Dr. Sullivan called the results
"promising."
"Schools
are uniquely situated to have the largest impact on inner-city
asthma," she said. "They would offer one 'square' treatment a
day," similar to the "square meals" provided in school
breakfast and lunch programs.
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