Background-An inverse association between domestic exposure to endotoxin and atopy in childhood has been observed. The relevance of this aspect of the "hygiene hypothesis" to U.S. innercity communities that have disproportionately high asthma prevalence has not been determined.

Rationale: Asthma prevalence and morbidity are especially elevated in adolescents, yet few interventions target this population. Objectives: To test the efficacy of Asthma Self-Management for Adolescents (ASMA), a school-based intervention for adolescents and medical providers. Methods: Three hundred forty-five primarily Latino/a (46%) and African American (31%) high school students (mean age 5 15.1 yr; 70% female) reporting an asthma diagnosis, symptoms of moderate to severe persistent asthma, and asthma medication use in the last 12 months were randomized to ASMA, an 8-week school-based intervention, or a wait-list control group. They were followed for 12 months. Measurements and Main Results: Students completed bimonthly assessments. Baseline, 6-month, and 12-month assessments were comprehensive; the others assessed interim health outcomes and urgent health care use. Primary outcomes were asthma selfmanagement, symptom frequency, and quality of life (QOL); secondary outcomes were asthma medical management, school absences, days with activity limitations, and urgent health care use. Relative to control subjects, ASMA students reported significantly: more confidence to manage their asthma; taking more steps to prevent symptoms; greater use of controller medication and written treatment plans; fewer night awakenings, days with activity limitation, and school absences due to asthma; improved QOL; and fewer acute care visits, emergency department visits, and hospitalizations. In contrast, steps to manage asthma episodes, daytime symptom frequency, and school-reported absences did not differentiate the two groups. Most results were sustained over the 12 months. Conclusions: ASMA is efficacious in improving asthma selfmanagement and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.

No abstract

Objective-To describe and test the feasibility of Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA-Undx), an eight-week school-based intervention for urban adolescents comprised of three group and five individual coaching sessions, and academic detailing for their primary care providers (PCPs).Methods-Thirty high school students (mean age 15.9; 92% female; 72% Latino/a) who reported symptoms of persistent asthma, but no diagnosis were randomized to ASMA-Undx or a notreatment control group. Interviews were conducted pre-and post-intervention.Results-All intervention students participated in the three group sessions; 64% received all five individual coaching sessions. Academic detailing telephone calls made by a pediatric pulmonologist reached 83% of the students' PCPs. Relative to controls, a significantly greater proportion of ASMA-Undx students were diagnosed (79% versus 6%, respectively), and prescribed asthma medication (57% versus 6%, respectively). Barriers to diagnosis and treatment included students' and parents' lack of knowledge about asthma.Conclusion-ASMA-Undx is a feasible and promising intervention to assist urban adolescents with undiagnosed asthma obtain a diagnosis and treatment.Practice Implications-ASMA-Undx has the potential to reach many adolescents because it is school-based. It can serve as a model for interventions targeting other pediatric illnesses.

Few studies have addressed use of written treatment plans (WTPs) for asthma by specialist physicians. The purpose of this study is to characterize the attitudes, beliefs, and self-reported practice behaviors regarding asthma WTP use among specialist physicians. Structured interviews were conducted with pulmonologists and allergists who provide direct patient asthma care in two New York City medical centers. The interview covered five areas: (1) demographic information; (2) experiences with WTPs; (3) reported clinical practice behaviors; (4) factors influencing use of WTPs; and (5) physician-patient communication. Forty-five physicians were eligible to participate in the study. Sixty-eight percent of physicians treated adult patients while 32% were pediatric specialists. Forty-four physicians completed interviews, (response rate of 98%). Eighty-six percent indicated they use WTPs with at least some of their patients (71% of their patients had received a plan from them). Most reported handwriting plans on a blank piece of paper (66%). Most plans were symptom-based (47%) or combined symptoms with peak flow measurement (50%). Most plans supported patient autonomy. More than 80% of physicians believe the use of a WTP improves patient outcomes. The results suggest that asthma specialists in this survey utilize WTPs more frequently than reported in other studies. Physicians encourage patient autonomy and believe asthma self-management by patients improves their outcomes. Controlled studies of the efficacy of asthma management plans are needed to assess the impact of WTPs as used in clinical practice.

No abstract

No abstract

Although specific tests screen children in preschool programs for vision, hearing, and dental conditions, there are no published validated instruments to detect preschool-age children with asthma, one of the most common pediatric chronic conditions affecting children in economically disadvantaged communities of color. As part of an asthma education intervention, a 15-item Brief Respiratory Questionnaire (BRQ) was developed to detect children with probable asthma in Head Start and subsidized preschool settings in communities with high asthma prevalence and associated morbidity. Preschool personnel administered the BRQ to consenting parents of 419 enrolled children. Trained interviewers administered validation interviews (VALs) to parents of 149 case-positive children and 51 case-negative children. Three physicians independently assessed deidentified summaries of the VALs that captured responses about signs and symptoms of asthma, diagnosis and treatment, and use of medical services. The physicians' assessments of the summarized VALs were the validated standard to which the BRQ classifications were compared. A simple algorithm of 4 items was identified that can be administered and scored by nonmedical preschool personnel in less than 5 minutes. The chance-corrected agreement between these 4 items of the BRQ and the VAL was good: kappa, .73 (95% confidence interval, 0.62-0.84); specificity, 96%; sensitivity, 73%; and positive predictive value, 97%. The BRQ appears to be a valid instrument for detecting children with probable asthma in Head Start and other subsidized preschool settings in communities with high prevalence of asthma.