Pediatric asthma is a substantial cause of morbidity in children. Much of this morbidity is preventable as it can be directly attributable to lack of adherence to medical regimens. The consequence of non-adherence for most patients is exacerbations. Inhaled corticosteroids offer considerable protection against asthma exacerbations. However, very few children take their medications as recommended by the National Asthma Education and Prevention Program Guidelines. Therefore, adherence to medication is essential for ultimate reductions in morbidity. Asthma morbidity is higher in inner-city, low-income, minority children and adherence may be even more problematic in this group. To reach inner-city, low-income, minority children, the school provides a logical access point. Many types of school-based self-management and educational interventions have been developed and tested. While these programs have shown improvements in knowledge and self-management behaviors, they have had only a minimal impact on asthma morbidity. Therefore, we propose to develop a school based supervised asthma therapy intervention to increase adherence to medication in low-income, minority children with asthma from an inner-city pediatric asthma clinic. We will use a randomized clinical trial of 250 children from an inner-city clinic to test the impact of school based supervised asthma therapy on asthma exacerbations. Our long-term collaborative relationships and current work within our city school systems provide a strong foundation for this proposal. ? ?
