Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs. Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence. A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools. This study aims to evaluate: (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;(2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained;and 3) the program's implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation. Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma. This project will provide critical information regarding the program's value, feasibility, and sustainability within communities with large asthma burden. In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations. With this information, policy makers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health.

Public Health Relevance

. The proposed project will evaluate the effectiveness and cost-effectiveness of a comprehensive school-based asthma program including supervision of daily asthma medicine. The information gained will help communities determine if such a program could be implemented in their schools to help children with asthma achieve better asthma control.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HL110858-02
Application #
8716806
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Freemer, Michelle M
Project Start
2013-08-10
Project End
2017-04-30
Budget Start
2014-05-01
Budget End
2015-04-30
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Arizona
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
City
Tucson
State
AZ
Country
United States
Zip Code
85721
Goodwin, James L; Gerald, Lynn B; Johnson, Jennifer L H et al. (2018) Use of a disposable valved-holding chamber (spacer) in a school-based asthma trial. J Allergy Clin Immunol Pract 6:307-309