Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Abstract

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p < 0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity.

Conceptual Framework of the Controlling Asthma in American Cities Project

“…Given the age of the target population, all sites conducted interventions in the schools, three of which appear in this supplement. The paper from Oakland by Shrimali et al 25 describes changes in asthma medication use following a program offered in middle schools. Two case studies from the St. Louis site describe innovative approaches to increasing the number of asthma action plans submitted to school nurses 26 and to integrating asthma education into the routine school curriculum.…”

“…The paper from Oakland by Shrimali et al 25 describes changes in asthma medication use following a program offered in middle schools. Two case studies from the St. Louis site describe innovative approaches to increasing the number of asthma action plans submitted to school nurses 26 and to integrating asthma education into the routine school curriculum. 27 All sites brought asthma self-management training and indoor-trigger reduction directly into the home, thus directly providing two of the necessary services listed in the program theory ( Figure 1).…”

“…Two case studies from the St. Louis site describe innovative approaches to increasing the number of asthma action plans submitted to school nurses 26 and to integrating asthma education into the routine school curriculum. 27 All sites brought asthma self-management training and indoor-trigger reduction directly into the home, thus directly providing two of the necessary services listed in the program theory ( Figure 1). The cross-site paper by Brown et al 28 contrasts different approaches to designing these home-based interventions as well as strategies for recruiting participants for, staffing, and sustaining them.…”

“…27 All sites brought asthma self-management training and indoor-trigger reduction directly into the home, thus directly providing two of the necessary services listed in the program theory ( Figure 1). The cross-site paper by Brown et al 28 contrasts different approaches to designing these home-based interventions as well as strategies for recruiting participants for, staffing, and sustaining them.…”

“…The Richmond site took their quality improvement intervention directly to pediatric practices, using problem-based leaning within an academic detailing model. 29 Richmond_s experience, as described Ragazzi et al, emphasizes the importance of flexibility and adaptability in reaching out to providers and designing practice-based interventions.…”