Under-perception of asthma symptoms in children is a major risk factor for emergency department visits, hospitalizations, and near-fatal/fatal asthma attacks. Puerto Rican and Black children have greater asthma morbidity and mortality rates than all other racial/ethnic groups. Interventions targeting asthma symptom perception and medication adherence may help close this asthma health disparities gap. There are no RCT studies to date designed to improve asthma symptom perception in ethnic minority children. This R01 study builds upon this new investigator PI's prior grants. We demonstrated that children who did not receive peak expiratory flow (PEF) feedback under-perceived asthma symptoms 42% of the time vs. 15% for the PEF feedback group and had lower controller medication adherence (27.5% vs. 48.8%). The proposed randomized controlled trial consists of two arms: PEF feedback (N = 130) versus control feedback (N = 130). Latino and Black adolescents with asthma ages 10-17 years old and their caregivers will be recruited from clinics in the Bronx, NY. The primary aims are to examine the efficacy of PEF prediction with feedback versus control feedback on 1) under-perception of asthma symptoms 2) controller medication adherence and 3) asthma control and emergency health care use.
These aims will be examined across a 1- year follow-up. An exploratory aim examines the hypothesized pathway that the PEF intervention reduces under-perception of symptoms, shifts illness representations toward the professional model and increases adolescents' and parents' asthma management self-efficacy, resulting in greater medication adherence and improved asthma control. The baseline visit for all families consists of standardized asthma education followed by 3 weeks of PEF prediction without feedback using a programmable, electronic spirometer. Participants then will be randomized to intervention group and their spirometer reprogrammed, showing either the actual PEF and daily asthma management messages (PEF feedback group) or a brief, positive message (control feedback group). For the next 6 weeks, all adolescents will predict their PEF, which will be locked in before blowing into the device. Families will return at mid-intervention and post-intervention to receive verbal individualized feedback on symptom perception and problem-solving skills training (PEF feedback group) or supportive counseling (control feedback group). All adolescents will play Quest for the Code to reinforce the baseline asthma education. At the post-intervention visit, the spirometer will be reprogrammed for all adolescents to provide no feedback for the next 4 weeks. These symptom perception data will be downloaded at 1-month post-intervention. Controller medication adherence will be monitored by electronic devices. Post-intervention sessions will take place at 3, 6, 9, and 12 months to collect adherence data and conduct spirometry. Physicians will be blinded to group assignment and rate asthma control using national guidelines. A 12-month retrospective medical record abstraction will compare emergency health care use for asthma between groups.
An intervention to improve asthma symptom perception has great potential to reduce the immense ethnic disparities that exist in asthma outcomes. Prediction of peak expiratory flow followed by feedback can be applied on a large-scale level due to the accessibility of peak flow meters, brevity of the intervention, and immediate learning effects. Guessing peak expiratory flow can be appealing for adolescents, and it does not require any cultural adaptation due to the common language of peak expiratory flow.
