Trial of an Asthma Education Program in an Inner-City Pediatric Emergency Department

Abstract

The objective of this study was to determine the effect of an asthma education and management intervention, offered as part of an emergency department (ED) visit, on functional severity, use of asthma controller medication, and risk of needing crisis care. Designed as a randomized, controlled clinical trial, Medicaid-insured children aged 2 years to 18 years were seen in an inner-city hospital ED for acute asthma. In the intervention group, the adult accompanying the child received basic asthma education, a written asthma management plan (illustrated by zones colored green, yellow, and red), and prescriptions for both quick-relief and long-term control medication as part of the ED visit. The control group received routine care. Functional severity of asthma was assessed at baseline and at 1 month after the intervention. Medicaid claims data were used to determine frequency of asthma medication dispensing and dates of hospital-based events (ED visits and hospital admissions) during the 6 months after the intervention. Twenty-eight subjects were enrolled in each arm of the study. In the 6 months after enrollment, more asthma controller medication (predominantly inhaled corticosteroid medicine) was dispensed for the intervention group than for the control group (mean 2.1 vs. 0.63 dispensing events; p = 0.004). However, much undertreatment remained in both groups: 61% of subjects in the intervention group and 89% of subjects in the control group had ≤ 1 dispensing of asthma controller medication (p = 0.01). No statistically significant difference in asthma functional severity score was seen at 1 month after intervention. No significant difference in dispensing of quick-relief medication or in presence of hospital-based events was seen during the 6 months after the intervention. Among inner-city children who require ED care for asthma, a single session of ED-based educational and management intervention did improve use of long-acting asthma controller medication, but we were not able to demonstrate a large impact on functional severity of asthma or subsequent hospital-based events.