Improving Care for Urban Children with Asthma: Design and Methods of the School-Based Asthma Therapy (SBAT) Trial

Abstract

The School Based Asthma Therapy (SBAT) trial builds on a pilot study in which we found that school-based administration of preventive asthma medications for inner-city children reduced asthma symptoms. However, the beneficial effects of this program were seen only among children not exposed to environmental tobacco smoke (ETS). The current study is designed to establish whether this intervention can be enhanced by more stringent adherence to asthma guidelines through the addition of symptom-based medication dose adjustments, and whether smoke-exposed children benefit from the intervention when it is combined with an ETS reduction program. The intervention consists of both administration of preventive asthma medications in school (with dose adjustments according to NHLBI guidelines) and a home-based ETS reduction program utilizing motivational interviewing principles. This paper describes the methodology, conceptual framework, and lessons learned from the SBAT trial. Results of this study will help to determine whether this type of comprehensive school-based program can serve as a model to improve care for urban children and reduce disparities.

Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma

“…[5, 16, 17] Caregivers of children ages 3–10 years with asthma were interviewed to assess eligibility. Eligibility requirements for the study included the child having a physician diagnosis of asthma, poorly controlled symptoms at the time of screening based on NHLBI criteria, [18] ability to communicate in English, and not having other chronic conditions that could alter accurate reporting of asthma symptoms (including Cystic Fibrosis, heart disease, and Sickle Cell Disease).…”

“…[15] Unfortunately, this may be particularly true for high-risk urban children with asthma, who have suboptimal medication adherence, ongoing asthma symptoms, and a higher risk for obesity. [5, 10, 12, 16, 17] However, there is limited research on the barriers to activity that asthmatic children from disadvantaged homes may face.…”

Asthma and overweight/obese: double trouble for urban children

“…(17) Potential subjects were recruited from 67 elementary schools and preschools in the Rochester City School District, and were identified by review of school medical-alert forms filled out by parents at the start of each school year (response rate: 74%). As described in prior work(17), eligible participants had a physician diagnosis of asthma and parent report of symptoms indicating persistent asthma based on the National Heart Lung and Blood Institute guidelines. (5) Exclusion criteria included medical conditions that may interfere with the assessment of outcomes (i.e.…”

“…Further details of the intervention and results have been published elsewhere. (17, 18) While the data presented was collected as part of a large randomized control trial, this study is a cross-sectional analysis of initial symptom assessments which occurred prior to the initiation of any intervention procedures.…”

Translational Research and Pediatrics

“…88 For pediatric asthma, examples include phase 3 trials of asthma medications, clinical trials of office-based prompting to improve the delivery of preventive asthma care in controlled settings, and randomized trials of school-based delivery of preventive asthma medications to improve asthma care. [89][90][91][92][93] T3 translational research (effectiveness studies) involves translation from recommendations or guidelines into practice. The result is applied knowledge about interventions that work in real-world settings.…”